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

India race with Brazil

Coronavirus Cases: 16,412,794

Deaths: 652,039

Recovered: 10,042,362

ACTIVE CASES 5,718,393

Currently Infected Patients 5,652,148 (99%) in Mild Condition

66,245 (1%) Serious or Critical

CLOSED CASES 10,694,401

Cases which had an outcome: 10,042,362 (94%) Recovered / Discharged

652,039 (6%) Deaths

#	Country, Other	Total Cases	New Cases	Total Deaths	New Deaths	Total Recovered	Active Cases	Serious, Critical	Tot Cases/ 1M pop	Deaths/ 1M pop	Total Tests	Tests/ 1M pop	Population
	World	16,405,543	+216,340	651,678	+4,104	10,037,788	5,716,077	66,244	2,105	83.6
1	USA	4,371,839	+56,130	149,849	+451	2,090,129	2,131,861	18,986	13,202	453	54,219,575	163,736	331,139,904
2	Brazil	2,419,901	+23,467	87,052	+556	1,634,274	698,575	8,318	11,379	409	4,911,063	23,093	212,665,350
3	India	1,436,019	+50,525	32,812	+716	918,735	484,472	8,944	1,040	24	16,291,331	11,797	1,380,937,553

Doubling Time 21 days

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: It’s a COVID-19 Pandemic 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.
20. Formulas [Deaths in symptomatic cases 1; Deaths X 100= expected number of symptomatic cases; Cases after seven days: Cases today x 2 (doubling time 7 days); Cases expected in the community: Number of deaths occurring in a five-day period and estimate the number of infections required to generate these deaths based on a 6.91% case.                                            – 

    KK Aggarwal

    President CMAAO, HCFI and Past National President IMA

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Numbers of deaths and cases are usually lower on the weekend because of patchy reporting. Experts say the true totals are likely far higher due to a lack of testing.

More than 630 new coronavirus-related deaths were confirmed in Brazil in the past 24 hours, bringing the country’s total Covid-19 death toll up to over 72,000 according to the latest data from the Health Ministry.

In the past 24 hours, 24,831 new cases and 631 new deaths from Covid-19 were confirmed, according to Sunday health ministry data. Brazil’s total coronavirus death toll stands at 72,100, while the total number of cases is at 1,864,681.

Critics say the government of far-right President Jair Bolsonaro has failed to give a unified message on how to combat the virus, with state governors leading the response.

Bolsonaro has even gone so far as to flout containment measures such as social distancing and the wearing of face masks, and blasted governors over lockdowns that have hurt the economy.

The 65-year-old revealed last week he had contracted the virus, but said he was feeling “fine.”

He said he’d taken the anti-malaria medication hydroxychloroquine and that “it worked” – although its effectiveness has not been formally proven and the issue is deeply dividing the global scientific community.

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Multiple fires billowing huge plumes of smoke into the air were seen across a vast area of the northwestern state of Rondonia on Friday when journalists flew over the area.

Several residents in the capital, told on Saturday that what appeared to be light clouds hanging over the city of half a million people, was actually smoke from the blazes that had scorched swaths of land and left tree trunks smoldering on the ground.

I’m very worried because of the environment and health,” Delmara Conceicao Silva told AFP. “I have a daughter with respiratory problems and she suffers more because of the fires.”

The fires in the world’s largest rainforest have triggered a global uproar, and are a major topic of concern at the G7 meeting in Biarritz in southern France.

Official figures show 78,383 forest fires have been recorded in Brazil this year, the highest number of any year since 2013. Experts say the clearing of land during the months-long dry season to make way for crops or grazing, has aggravated the problem.

More than half of the fires are in the massive Amazon basin, where more than 20 million people live. Some 1,663 new fires were ignited between Thursday and Friday, according to Brazil’s National Institute for Space Research (INPE).

The new data came a day after Brazil President Jair Bolsonaro authorized the deployment of the military to fight the fires and crackdown on criminal activity.

Seven states, including Rondonia, have requested the army’s help in the Amazon, where more than 43,000 troops are based and available to combat fires, officials said. Firefighters and planes are also being deployed.

Six aircraft, including two Hercules C-130s equipped to carry 12,000 liters (3,170 gallons) of water each, have been sent to Rondonia to fight the fires. They are expected to be joined by 30 firefighters on Sunday.

‘Help is welcome’
U.S. President Donald Trump and British Prime Minister Boris Johnson, both attending the G7 summit, have offered their countries’ assistance in fighting the fires.

“Any help is welcome in respect to the fires,” Brazil’s Defense Minister Fernando Azevedo e Silva told reporters on Saturday

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