CORONA UPDATE 12

COVID SO WHAT ?

Compiled by Dr. Narendra Malhotra

It is now clear that Corona virus is here to stay with us for a long-long time and recent seropositiveness studies in Delhi and Pune have shown antibodies in almost 29% of surveyed population – this shows that most of us have caught the infection and a ‘HERD’ immunity seems to be developing.
The statics of corona as on 24th August in India is-

World Covid Meter 24rd August (Courtesy Prof. K.K. Agarwal)
Acute manageable immuno-thrombo- inflammatory viral disease with post virus phase 213 Countries

Cases:1M:April2,2MApril15,3M:April27,4MMay8;5M20May,6M30th May,7M7th June,8Mby15June,9

M22nd June,10M29th June.11M4th July,16M,17M29July,18MistAugust,21.8M16August

Ground Zero: Wuhan in live animal market or cafeteria for animal pathogens: 10th January; Total cases are based on RT PCR, 67% sensitivity

Coronavirus Cases: 23,368,637
Deaths: 808,380
Recovered: 15,898,052
ACTIVE CASES 6,662,206
Currently Infected Patients 6,600,472 (99%) in Mild Condition 61,734 (1%) Serious or Critical

CLOSED CASES 16,706,432
Cases which had an outcome: 15,898,052 (95%) Recovered / Discharged 808,380 (5%) Deaths

Country, # Other

Total Cases

New Total New Cases Deaths Deaths

World 23,577,649 +206,509

1 USA 5,874,146 +32,718

Brazil 3,605,783 +23,085

3 India 3,105,185 +61,749

812,181 +4,235

180,604 +430

114,772 +495

57,692 +846

Doubling Time

India Brazil difference over 20000 per day, or one lac in 3-4 days

Total difference 5 lac

In one month may cross Brazil

23rd August: New cases 61749, New deaths 846, Total cases 3105185, Total deaths 61749 22nd August: New cases 70068; new deaths 981; Total cases 3043436; Total Deaths 56846 21st August: New Cases 69039; new deaths 953, Total cases 2973368, total deaths 55928 20th August: Cases 68507, 981 deaths, 2904329 total cases, 54975 total deaths

19th August: Cases 69196, 980 deaths, 2835822 total cases, 53994 total deaths 18th August: cases 65022, 1089 deaths, 2766626 total cases, 65022 total deaths 17th August: 54288 cases, 880 deaths, 2701604 total cases, 51925 total deaths 16th August: 58108 cases, 961 deaths, 2647316 total cases, 51045 deaths

15t August: 63986 new cases, 950 deaths, 2589208 total cases, 50084 deaths

India predictions

1. Death Rate is deaths today vs number of cases today

2. Corrected Death Rate is deaths today vs number of cases 14 days back

3. For one symptomatic test positive case there are 10-30 asymptomatic cases and 20 untested cases

4. Estimated Number of deaths = Reported deaths x 2

5. Number of deaths today should be 15% of the serious patients present 14 days back

6. Undocumented cases for each documented case [Iceland: 1: 2; German: 1: 5; New York City
grocery store shoppers: 1: 10; California 1.5%]

7. Amongst active 2.37% are serious, 1.82% need oxygen, and 0.41% need ventilator support.

Facts

1. India: In states with average population density of 1185 /sk km the average number of cases were 2048. On the contrary in states with population density of 909/ sk km the number of cases were 56. (When Chandigarh and Pondicherry were taken out from this group) the Average Density of other states were 217 and the average number of cases were 35 [HCFI]

2. COVID Sutras: COVID-19 Pandemic is due to SARS 2 Beta Corona Viruses (different from SARS 1 where spread was only in serious cases); with over eleven virus sequences floating; has affected up to 22.8% of Delhi population, Causes Mild or Atypical Illness in 82%, Moderate to Severe Illness in 15%, Critical Illness in 3% and Death in 2.3% cases (15% of admitted serious cases, 71% with comorbidity< Male > Females); affects all ages but Predominantly Males (56%, 87% aged 30-79, 10% Aged < 20, 3% aged > 80); with Variable Incubation Period days (2-14; mean 5.2 days); Mean Time to Symptoms 5 days; Mean Time to Pneumonia 9 days, Mean Time to Death 14 days, Mean Time to CT changes 4 Days, Reproductive Number R0 1.5 to 3 (Flu 1.2 and SARS 2), Epidemic Doubling Time 7.5 days; Origin Possibly from Bats (Mammal); Spreads via Human to Human Transmission via Large and Small Droplets and Surface to Human Transmission via Viruses on Surfaces for up to three days. Enters through MM of eyes, nose or mouth and the spike protein gets attached to the ACE2 receptors. ACE2 receptors make a great target because they are found in organs throughout our bodies ( heart muscle, CNS, kidneys, blood vessels, liver) Once the virus enters, it turns the cell into a factory, making millions and millions of copies of itself — which can then be breathed or coughed out to infect others.

3. Prevalence: New York: 13.9%; New York City at 21.2%, S Korea 5.7%, world 5%; Ohio prison: 73% of inmates; New York: 21% mortality April 22 in JAMA.

4. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.

5. Thrombosis: University of Pennsylvania clots are seen in patients even on blood thinners.
Netherlands study, 31%

6. Other human beta-coronaviruses has immunity lasting only for one year with no IMMUNITY
PASSPORT.

7. In absence of interventions, prolonged or intermittent social distancing (till 2022-24)

8. Low levels of cross immunity from the other beta-coronaviruses against SARS-CoV-2 could make
SARS-CoV-2 appear to die out, only to resurge after a few years. Surveillance till 2024.

9. During peak (trace and treat) and after the peak (trace and treat the close contacts

10.Increased spread: close environment, crowded place with close physical contacts with no

ventilation
11. Strategies: From community mitigation to individual containment; broader good over individual

autonomy; perfect cannot be the enemy of the good; pandemics are fought on the grounds and not

the hospitals., Treat the patient and not the test report, Consider every surface and every

asymptomatic person as virus carrier

12. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.

13. Italy mortality reduced when they were short of ventilators.

14. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary
tract infections.

15. Great Imitator (protean manifestation)

16. IgM can be false positive in pregnancy, immunological diseases); Pooled tests (< 5, 20 Kerala, 64
Singapore RTPCR) when seroprevalence is < 2%

17. Early treatment, day 3-5, to reduce the viral load and prevent cytokine storm using hydroxy
chloroquine with azithromycin or ivermectin with doxycycline with IV remdesivir and IV single dose

Tocilizumab interleukin (IL-6 receptor inhibitor) if very high DDimer and IL 6; convalescent plasma therapy ( given early; donor 14 days symptoms free, between day 28-40, single donation can help 4 patients), Lopinavir-ritonavir and Favipiravir ivf very low CD 4 counts).

18. Hypoxia: Low flow oxygen < 6l/mt, titrated to high flow oxygen using non breathing mask, Venti mask, HFNC and helmet CPAP, NAV in supine or prone position.

19. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.

Formulas

1. Deaths in symptomatic cases: Less than one percent (best of the care)

Therefore, Deaths X 100= expected number of symptomatic cases

2. Cases after seven days: Cases today x 2 (based on doubling time 7 days, will change as per doubling time of the country)

3. Cases expected in the community

. a) Get number of deaths occurring in a five-day period

. b) Estimate the number of infections required to generate these deaths based on the country
or area case fatality rate

. c) Compare that to the number of new cases actually detected in the five-day period.

. d) This can then give us an estimate of the total number of cases, confirmed and unconfirmed

4. Lock down effect = Reduction in cases after average incubation period (5 days)

5. Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to
death of that country)

6. Requirements of ventilators on day 9: 1-3% of number of new cases detected

7. Requirement of future oxygen on day seven: 10 of total cases detected today

8. Number of people which can be managed at home care: 90% of number of cases today

9. Requirements of ventilators: 1-3% of Number of cases admitted 7-9 days back

10. Requirement of oxygen beds today: 10% of total cases admitted seven days back

11. Case fatality rate: Number of total deaths as on date / number of total RTPCR positive cases as on
today

12. Infection fatality rate: Number of total deaths as on date / number of total calculated cases as on
today

13. Number of reported deaths = Number of confirmed deaths x 2

14. Number of unreported or untested cases = Number of reported cases x (10-30 depending on the
country, New York 10, Delhi 23.8, Pakistan 30)

15. Number of asymptomatic cases ( for 6 symptomatic cases 200 asymptomatic cases)

16. Oxygen requirement on that day in the hospital at 6am: Number of cases detected to have hypoxia on six minutes’ walk test

So friends time has come to say SO WHAT ? to Corona and covid illness and the “देखी जायेगी” attitude needs to be encouraged to get life back to normal. Of course this does not say to not take precaution.

Strict precautions of sanitization, hand wash, social distancing and mask in public need to be followed. As of date (now) these simple methods one only way to keep corona away and say “देखी जायेगी” & Covid SO WHAT ?

Please take care of the following: Fig – 1, 2, 3, 4, 5, 6, 7, 8, 9.

[Fig-1] [Fig-2]

[Fig-3] [Fig-4]

[Fig-6]

[Fig-5]

[Fig-7]

[Fig 8]

[Fig 9]

[Fig 1-9: Rainbow Advices]

Let’s all follow the simple ways and change of life style to the “NEW NORMAL” and when corona or covid comes we can say SO WHAT ?
Stay safe and stay in the green zone (Fig 10, 11).

[Fig-10]

[Fig-11]

Adjust to the NEW NORMAL and protect yourself by taking precautions.

Further reading guidelines of WHO, CDC, FDA, ICMR, IMA & FOGSI Brought to you for public awareness by Rotary Club Agra Taj City.