World Covid Meter 24th April 2021
Dr K K Aggarwal
World Covid Meter 24th April 2021
Acute manageable immunogenic thrombogenic inflammatory contagious novel viral disease pandemic
Novel Covid 19 viral vaccines
B 1.1.7 UK, B.1.351 South Africa, P1 Brazil
CMAAO: In susceptible high-risk (pro inflammatory and / or pro-coagulative) individuals reactogenic vaccines can trigger transient thrombo- inflammation lasting first few (up to four) days”.
Covid Vaccine: Fifed non-replicative, non-repetitive dose, spike gene mRNA / spike gene DNA to mRNA/whole killed virus, reactogenic vaccine
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
Coronavirus Cases:
146,220,311
Deaths:
3,098,883
Recovered:
124,013,702
ACTIVE CASES
19,107,726
Currently Infected Patients 18,997,842 (99.4%) in Mild Condition
109,884 (0.6%)
Serious or Critical
CLOSED CASES
127,112,585
Cases which had an outcome: 124,013,702 (98%) Recovered / Discharged
3,098,883 (2%)
Deaths
|
# |
Country, |
Total |
New |
Total |
New |
Total |
Active |
Serious, |
Tot Cases/ |
Deaths/ |
Total |
Tests/ |
Population |
|
World |
146,220,311 |
+895,604 |
3,098,883 |
+14,196 |
124,323,939 |
18,797,489 |
109,884 |
18,759 |
397.6 |
||||
|
1 |
32,735,704 |
+66,515 |
585,075 |
+790 |
25,296,047 |
6,854,582 |
9,832 |
98,431 |
1,759 |
437,068,081 |
1,314,196 |
||
|
2 |
16,602,456 |
+345,147 |
189,549 |
+2,621 |
13,862,119 |
2,550,788 |
8,944 |
11,936 |
136 |
274,445,653 |
197,304 |
||
|
3 |
14,238,110 |
+65,971 |
386,623 |
+2,866 |
12,711,103 |
1,140,384 |
8,318 |
66,601 |
1,808 |
28,600,000 |
133,781 |
||
|
4 |
5,440,946 |
+32,340 |
102,496 |
+332 |
4,276,282 |
1,062,168 |
5,962 |
83,207 |
1,567 |
73,826,703 |
1,129,011 |
||
|
5 |
4,744,961 |
+8,840 |
107,501 |
+398 |
4,371,214 |
266,246 |
2,300 |
32,503 |
736 |
127,100,000 |
870,636 |
||
|
6 |
4,550,820 |
+49,438 |
37,672 |
+343 |
3,970,111 |
543,037 |
3,475 |
53,493 |
443 |
45,342,795 |
532,989 |
||
|
7 |
4,401,109 |
+2,678 |
127,385 |
+40 |
4,177,375 |
96,349 |
261 |
64,556 |
1,869 |
147,468,783 |
2,163,097 |
||
|
8 |
3,935,703 |
+14,761 |
118,699 |
+342 |
3,351,461 |
465,543 |
2,979 |
65,172 |
1,966 |
56,565,755 |
936,679 |
||
|
9 |
3,468,617 |
+11,731 |
77,591 |
+95 |
3,163,849 |
227,177 |
2,297 |
74,164 |
1,659 |
44,374,223 |
948,786 |
||
|
10 |
3,261,764 |
+23,710 |
81,936 |
+243 |
India
23rd April: New Cases 386623, New deaths 2866, Total cases 14238110, Total Deaths 386623, Active Cases 114-384
22nd April: New cases 332503, New Deaths 2256, Total cases 16257309, Total Deaths 186928, Active Cases 2428775
21st April: New cases 315802, New Deaths 2102, Total cases 15924806, Total Deaths 184672, Active Cases 2290728
20th April: New cases 294290, New Deaths 2020, Total cases 15609004, Total Deaths 182570, Active Cases 2156571
19th April: New Cases 260778, New Deaths 1495, Total Cases 14782461, Total Deaths 177168, Active Cases 1800199
18th April: New cases 260778, New Deaths 1495, Total Cases 14782461, Total Deaths 177168, Active Cases 1800199
17th April: New cases 233493, New Deaths 1495, Total Cases 14782461, Total Deaths 177495, Active Cases 1800199
16th April: New Cases 233943, New deaths 1338, Total Cases 14521683, Total Deaths 175673, Active Cases 1679121
15th April: New cases 216850, New deaths 1183, Total Cases 14287740, Total Deaths 174335, Active Cases 1569427
14th April: New cases 199569, New deaths 1037, Total Cases 14070890, Total Deaths 173152, Active cases 141592
13th April: New Cases 185248, New Deaths 1026, Total Cases 13871321, Total Deaths 172115, Active Cases 1366518
12th April: New Cases 171089, New Deaths 880, Total Cases 13686073, Total Deaths 171089, Active Cases 1264544
11th April: New cases 169899, New Deaths 904, Total Cases 13525364, Total Deaths 170209, Active Cases 1201456
10th April: New cases 152682, New Deaths 838, Total Cases 13355465, Total Deaths 169305, Active Cases 1107827
9th April: New Cases 144829, New Deaths 773, Total Cases 13202783, Total Deaths 168487, Active Cases 1046376
8th April: New cases 131893, New Deaths 802, Total cases 13057954, Total Deaths 167694, Active Cases 979519
7th April: New Cases 126316, New Deaths 684, Total cases 12926061, Total Deaths 166892, Active Cases 910264
6th April: New Cases 115269, New Deaths 631, Total Cases 12799746, Total Deaths 166208, Active Cases 843,779
5th April: New Cases 96557, New Deaths 445, Total Cases 12684477, Total Deaths 165577, Active Cases 788855
4th April: New Cases 103793, New Deaths 477, Total Cases 12587920, Total Deaths 165132, Active Cases 742830
3rd April: New Cases 92998, New Deaths 514, Total Cases 12484127, Total Deaths 164655, Active Cases 177638
2nd April: New cases 89019, New Deaths 713, Total Cases 12391129 Total Deaths 164141, Active Cases 659928
1st April: New Cases 81459, New Deaths 468, Total Cases 12302110, Total Deaths 163428, Active cases 615798
31st March: New Cases 72182, New Deaths 458, Total Cases 12220669, Total Deaths 162960, Active Cases 585215
30th March: New Cases 53158, New Deaths 355, Total Deaths 12148487, Total Deaths 162502, Active Cases 553933
29th March: New Cases 56119, New Deaths 266, Total Cases
12095329, Total Deaths 162147, Active Cases 542353
28th March: New Cases 68206, New Deaths 295, Total Cases
12039210, Total Deaths 161881, Active Cases 523602
27th March: New cases 62631, New deaths 311, Total Cases 11971004, Total Deaths 161586, Active Cases 487840
26th March: New cases 62291, New Deaths 292, Total Cases 11908373, Total Deaths 161275, Active Cases 454249
25th March: New Cases 59069, New Deaths 257, Total Cases 11846082, Total Deaths 160983, Active Cases 422596
24th March: New Cases 53419, New Deaths 249, Total Cases 11787013, Total Deaths 160726, Active Cases 396696
23rd March: New Cases 47264, New Deaths 277, Total Cases 11733594, Total Deaths 160477, Active Cases 370101
22nd March: New cases 40611, New Deaths 197. Total Cases 11686330, Total Deaths 160200, Active Cases 347071
21st March: New Cases 47774, New Deaths 213, Total Cases 11645719, Total Deaths 160003, Active Cases 336392
20th March: New Cases 43815, New deaths 196, Total Cases 11598710, Total Deaths 159790, Active cases 310801
19th March: New cases 40950, New Deaths 189, Total Cases 11554895, Total Deaths 159954, Active Cases 290154
18th March: New Cases 39643, New Deaths 155, Total Cases 11513945, Total Deaths 159405, Active Cases 273062
17th March: New Cases 35838, New deaths 171, Total Cases 11474302, Total Deaths 159250, Active Cases 1128238
16th March: New cases 28869, New Deaths 187, Total Cases 11438464, Total Deaths 159079, Active cases 236008
15th March: New Cases 24366, New Deaths 130, Total Cases 11409524, Total Deaths 158892, Active Cases 225139
14th March: New Cases 26514, New Deaths 120, Total Cases 11385158, Total Deaths 158762, Active Cases 220951
13th March: New Cases 25153, New Deaths 159, Total Cases 11358644, Total Deaths 158642, Active Cases 212147
12th March: New Cases 27512, New Deaths 157, Total Cases 11333491 Total Deaths 158483, Active Cases 203661
11th March: New Cases 21668, New Deaths 113, Total cases 11305979, Total Deaths 158326, Active Cases 200401
10th March: New Cases 22841, New Deaths 134, Total Cases 11284311, Total Deaths 158213, Active Cases 190295
9th March: New Cases 16846, New Deaths 113, Total cases 11260470, Total Deaths 158079, Active Cases 185767
8th March: New Cases 15353, New Deaths 76, Total Cases 11244624, Total Deaths 157996, Active Cases 189172
7th March: New Cases 18691, New Deaths 99, Total Cases 11229271, Total Deaths 157890, Active Cases 190501
6th March: New Cases 18716, New Deaths 98, Total Cases 11210580, Total Deaths 157791, Active Cases 186253
5th March: New Cases 18292, New Deaths 109, Total Cases 11191864, Total Deaths 157693, Active Cases 181997
4th March: New Cases 16824, New Deaths 113, Total Cases 11173572, Total Deaths 157584, Active Cases 177967
3rd March: New Cases 17425, New Deaths 86, Total Cases 11156748, Total Deaths 157471, Active Cases 175044
2nd March: New Cases 15704, New Deaths 110, Total Cases 11139323, Total Deaths 157385, Active Cases 171776
1st March: New Cases 10930, New Deaths 62, Total Cases 11122986, Total Deaths 157257, Active Cases 169565
Cases:1M: April 2, 2 M April 15, 3 M: April 27, 4 M May 8; 5 M 20 May, 6 M 30th May, 7 M 7th June, 8M by 15 June, 9 M 22nd June, 10 M 29th June. 11 M 4th July, 16 M , 17 M 29 July, 18 M 1st August, 21 .8 M 16 August, 25 M 30th August, 28 M 10 September 2020,
Ground Zero: Wuhan in live animal market or cafeteria for animal pathogens: 10th January; Total cases are based on RT PCR, 67% sensitivity
B.1.1.7 lineage (a.k.a. 20I/501Y.V1 Variant of Concern (VOC) 202012/01): 23 mutations: This variant has a mutation in the receptor binding domain (RBD) of the spike protein at position 501, where the amino acid asparagine (N) has been replaced with tyrosine (Y). The shorthand for this mutation is N501Y. This variant also has several other mutations, including: 69/70 deletion: occurred spontaneously many times and likely leads to a conformational change in the spike protein; P681H: near the S1/S2 furin cleavage site, a site with high variability in coronaviruses. This mutation has also emerged spontaneously multiple times; variant is associated with increased transmissibility (i.e., more efficient and rapid transmission); In January 2021, scientists from UK reported evidence[1] that suggests the B.1.1.7 variant may be associated with an increased risk of death compared with other variants; Early reports found no evidence to suggest that the variant has any impact on the severity of disease or vaccine efficacy.
B.1.351 lineage (a.k.a. 20H/501Y.V2): This variant has multiple mutations in the spike protein, including K417N, E484K, N501Y. Unlike the B.1.1.7 lineage detected in the UK, this variant does not contain the deletion at 69/70. This variant was first identified in Nelson Mandela Bay, South Africa, in samples dating back to the beginning of October 2020, and cases have since been detected outside of South Africa, including the United States. There is some evidence to indicate that one of the spike protein mutations, E484K, may affect neutralization by some polyclonal and monoclonal antibodies.
P.1 lineage (a.k.a. 20J/501Y.V3): 17 Mutations, The P.1 variant is a branch off the B.1.1.28 lineage that was first reported by the National Institute of Infectious Diseases (NIID) in Japan in four travelers from Brazil, sampled during routine screening at Haneda airport outside Tokyo. The P.1 lineage contains three mutations in the spike protein receptor binding domain: K417T, E484K, and N501Y. There is evidence to suggest that some of the mutations in the P.1 variant may affect its transmissibility and antigenic profile, which may affect the ability of antibodies generated through a previous natural infection or through vaccination to recognize and neutralize the virus.
Some of the potential consequences of emerging variants are the following:
- Ability to spread more quickly in people: D614G, confers increased ability to spread more quickly than the wild-type SARS-CoV-2. In the laboratory, 614G variants propagate more quickly in human respiratory epithelial cells, outcompeting 614D viruses. There also is epidemiologic evidence that the 614G variant spreads more quickly than viruses without the mutation.
- Ability to cause either milder or more severe disease in people: B.1.1.7 variant may be associated with an increased risk of death compared to other variants.
- Ability to evade detection by specific viral diagnostic tests: B.1.1.7 has S gene target failure
- Decreased susceptibility to therapeutic agents such as monoclonal antibodies. B.1.1.28
- Ability to evade natural or vaccine-induced immunity: B.1.1.28
Ability to evade vaccine-induced immunity: Once a large population is vaccinated, there will be immune pressure that could favor and accelerate emergence of such variants by selecting for “escape mutants.” There is no evidence that this is occurring, and most experts believe escape mutants are unlikely to emerge because of the nature of the virus.
· “Wild-type” refers to the strain of virus – or background strain – that contains no major mutations.
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
DENSITY: 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]
COVID Sutra: 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.
One most important
1. Masking is THE prevention
2. RTPCR cT is THE test for diagnosis
3. Zinc is THE Vitamin
4. Day 5 is THE day in Covid phase for mortality prevention
5. Day 90 is THE day after which the word COVID ends
6. Home Isolation is THE modality of Treatment
7. 12 years is THE age when the mortality starts
8. CRP is THE lab test for seriousness
9. Loss of Smell is THE symptoms equal to RTPCR test
10. 15 minutes is THE time get the infection
Numbers to remember
1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770945: RDW at admission 14.5%
Other Sutras
1. 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.
2. Viral particles seen in tears, stool, kidneys, liver, pancreas, heart, semen, peritoneal fluid, CSF.
3. Thrombosis: University of Pennsylvania clots are seen in patients even on blood thinners. Netherlands study, 31%
4. Other human beta-coronaviruses has immunity lasting only for one year with no IMMUNITY PASSPORT
5. In absence of interventions, prolonged or intermittent social distancing (till 2022-24)
6. 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.
7. During peak (trace and treat) and after the peak (trace and treat the close contacts)
8. Increased spread: close environment, crowded place with close physical contacts with no ventilation
9. 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
10. HCW: Direct patient exposure time < 30 minutes; 7 days work and 7 days holidays.
11. Italy mortality reduced when they were short of ventilators.
12. Hospital at HOME: CHF, mild pneumonia, exacerbations of asthma and COPD, cellulitis, and urinary tract infections.
13. Great Imitator (protean manifestation)
14. IgM can be false positive in pregnancy, immunological diseases); Pooled tests (< 5, 20 Kerala, 64 Singapore RTPCR) when seroprevalence is < 2%
15. 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).
16. 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.
17. Early intubation with prone ventilation only if progressive. Hypoxia (walking dead) have capillary problem and not alveoli.
Formulas and Predictions
Deaths
1. The goal is to save lives. Monitoring deaths is important, especially when testing is limited.
2. Daily deaths are the best indicator of the progression of the pandemic, although there is generally a 17- to 21-day lag between infection and deaths.
3. Deaths in symptomatic cases: Less than one percent (best of the care).
4. Therefore, Deaths X 100= expected number of symptomatic cases
5. Some may count "probable" or "presumptive" COVID-19 deaths when cases are not confirmed with a positive test but are based on symptoms and medical history. New York added 3,700 presumptive deaths in one day in April when testing was more limited.
6. Case fatality rate: Number of total deaths as on date / number of total RTPCR positive cases as on today
7. Infection fatality rate: Number of total deaths as on date / number of total calculated cases as on today
8. Number of reported deaths = Number of confirmed deaths x 2
Prediction Metrics
1. The University of Washington's Institute for Health Metrics and Evaluation (IHME):
Is based on what is known about a disease and how people's actions may affect that.
The latest forecasts say the U.S. will reach nearly 317,000 deaths by Dec. 1, at the current rate of mask-wearing, which currently is slightly below 50% nationally and increasing mask wearing in public to 95% could save more than 67,000 lives. Forecasts are not static but change depending on public behavior. When people learn that new cases are rising, they start wearing masks and using social distancing again; and when they realize new cases are declining, they tend to drop their guard. IHME uses real-time infection data from Johns Hopkins University's Coronavirus Resource Center to model disease transmission and project how many Americans will die. The researchers then estimate how many Americans are wearing masks or using social distancing, which can change the final model.
The rate of infection in a population is based on the "R0," or reproduction number. R0 is the average number of people who will catch the disease from a single infected person, in a population that's never seen the disease before. So, if R0 is 3, that means one case will create an average of three new cases. When that transmission rate of infection occurs at a specific time, it's called an "effective R," or "Rt." When the R0 is less than 1, that means the epidemic is under control; and when it's higher than 1, it is still spreading.
Deaths for the week ending Aug. 27, it found "effective R over 1 in Oklahoma. In all other states the effective R is less than 1.
2. CDC: Relies on positive tests results. CDC report these as confirmed cases. The positivity rate indicates how hard or easy it is to find a case, which reflects both the spread of COVID-19 and how widespread testing is. If the rate of positive tests is 20%, you don't have to look hard to find a case, versus 1%, which means you have to do a lot of tests to get one positive one. The more COVID-19 spreads, the higher the positivity rate. A 60% positivity rate may mean testing is only being done in a nursing home during an outbreak or a hospital where the most obvious cases are and not the general population where cases may be milder.
3. Maryland's COVID-19 dashboard: Reports the daily positivity percentage (percentage of positive tests and total testing volume since March). When you're looking at testing, you want to know how many tests were done historically with the ability to compare back and know whether the number has gone up or down or is stable and the percentage that comes back positive. Maryland and Pennsylvania report a 7-day rolling average of the daily positivity percentages. The 7-day average rate smooths out fluctuations during the week and is a better indicator of a trend than daily numbers.
4. The testing numbers often fluctuate, depending on where testing is done and when the labs report test results. A sudden spike in testing numbers may reflect a large number of tests done in a group setting such as a nursing home or prison on a single day. Laboratories and hospitals report test results on weekdays, so it's common to see those numbers decline on weekends.
5. A key goal during the coronavirus epidemic has been to "flatten the curve" to maintain local hospital capacity. After expected COVID-19 surges, many hospitals limited surgeries and admissions to preserve their resources, including hospital beds, ventilators, and health care personnel.
Infra Structure Capacity
1. If that reaches 80%, you may have to stop admitting patients; otherwise, the hospital may be overwhelmed.
2. To plan for surges and increase capacity: One must know the number of people who tested positive and were admitted to the hospital with symptoms of COVID-19
3. Pennsylvania's COVID-19 dashboard: has a hospital preparedness page that lists the number of hospitalized COVID-19 patients and the number and percentage of available beds by unit, including intensive care, medical/surgical, and airborne isolation.
4. Pennsylvania: Reports the number of ventilators COVID-19 patients and non-COVID-19 patients use daily.
5. Illinois list the recovery rate: In Illinois, the recovery rate of 95% is calculated as the recovered cases divided by recovered cases plus confirmed deaths. This [metric] is important because it indicates the quality of medical care and the severity of disease.
6. Cases will double after the average doubling time of the country at that time
7. Cases expected in the community:
Get number of deaths occurring in a five-day period
Estimate the number of infections required to generate these deaths based on the country or area case fatality rate
Compare that to the number of new cases actually detected in the five-day period.
This can then give us an estimate of the total number of cases, confirmed and unconfirmed
8. Lock down effect = Reduction in cases after average incubation period (5 days)
9. Lock down effect in reduction in deaths: Reduction in number of deaths on day 14 (average time to death of that country)
10. Requirements of ventilators on day 9: 1-3% of number of new cases detected
11. Requirement of future oxygen on day seven: 10 of total cases detected today
12. Number of people which can be managed at home care: 90% of number of cases today
13. Requirements of ventilators: 1-3% of Number of cases admitted 7-9 days back
14. Requirement of oxygen beds today: 10% of total cases admitted seven days back
15. 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)
16. Number of asymptomatic cases (for 6 symptomatic cases 200 asymptomatic cases, CHINA); (1.78 M tests in Hong Kong, 32 asymptomatic cases, 10 symptomatic cases)
17. Delhi: Sero positivity 33%, 30% positive had no antibodies
18. India 700 MPS, 30 positive
19. Oxygen requirement on that day in the hospital at 6am: Number of cases detected to have hypoxia on six minutes walk tes