17th April Covid World Update: 210 Countries, over 2.18 M cases, Deaths will cross 150,000 today.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

210 Countries, over 2.18 M cases, Deaths will cross 150,000 today with expected deaths over 154005, around 7000 deaths per day, 18.7 deaths per million population

April 9 US: 9,282 health care workers, 723 hospitalization and 27 deaths

India doubling time 8 days (National), 7 days Maharashtra and 19 days Kerala

1st 100,000 in 67 days, 2nd in 11 days, 3rd in 4 days, 4th in 3-day, 5th in 2.5 Days, 6th in 2 days, 7th in 2 days, and subsequent in 1.5 days

First reported Case: 10th January

Situation Around the Globe

Likely minimum deaths (145516 + 56588 x 15 = 8489) = 154005

Cases 2,182,084 (new cases yesterday +95,022)

Deaths: 145,516 (new 6996 yesterday)

Recovered: 547,207

ACTIVE CASES: 1,489,361

Mild: 1,432,773 (96%)

Serious: 56,588 (4%)

Cases per million population (global) 280

Deaths per million population (global) 18.7

India: Confirmed [+1,059] Total 13,430

Active: 11,214

Recovered: [+259] Total 1,768

Deceased: [+26] Total 448

Cases 10 per million population

0.3 deaths per million population

220 tests per million population

India Cases on 17th 13430

Case on 9th April 6729

Doubling time: 8 days

Maharashtra

Cases on 17th 3202

Cases on 10th April 1574

Doubling time: 7 days

Kerala: 394 cases on 17th

202 on 29th March

Doubling time: 19 days

Strategies

1. It’s a National Health Emergency

2. India is on the right direction, doubling time 8 days and even in the worst affected area doubling time in Maharashtra is 7 days.

3. Open health care establishments now

4. Treat every surface and asymptomatic virus carrier

5. COVID 19 may assume a seasonal nature.

6. BCG may be protecting Indians to some extent

7. Prevent ARDS (cytokine storm) as it requires specific ventilator settings, prone ventilation and trained staff with standby ECMO. tPA, heparin, ACE inhibitors, early treatment, plasma therapy, blood/ cord blood transfusion, timely air lift of patients may help.

8. https://mobile.twitter.com/ChestImaging?s=08: Post COVID positive X rays, CT images.

9. Collateral benefits: Reduction in air pollution, Clear Ganges, reduction in overall deaths (low pollution, less stress, more hygiene, no traffic accident deaths).

10. ZIKA Brazil Model: Army used for the crisis

11. Quarantine model: Lock down for forty days (India)

12. Wuhan Model: Selective sealing of the city/state with epicentre

13. Vietnam Model: Sealing of a village with most cases

14. Bhilwara CLUSTER Model: Seal 2 km all around the cluster, sanitise each house, house to house survey for ALI and SARI, isolate infected cases, test all close contacts

15. Bird flu model: April 20, 2016, the Lebanonese Ministry of Agriculture found H5N1 in 2 poultry farms in the border of Lebanon with Syria. 20,000 domestic birds died. The ministry culled all (60K) domestic birds within a 3-km radius. All farms were disinfected, and organic remains were disposed safely.

16. Germany, Sweden and Japan model: Selective isolation of elderly and high-risk comorbid patients

17. S Korea Model: Intensify testing amongst all or high-risk group

18. Italy model: Deploy younger health care workers and women as front-line fighters (2 hospitals posted young doctors < 40 years, 60% women on duties with no mortality in healthcare workers)

19. Singapore Model: Make available surgical masks at reception to be worn by all patients entering the hospital. Give N 95 masks to all health care providers and use AII rooms for all procedures on infected cases

20. Convalescent plasm therapy: India, USA started it

21. Delhi HCW model: Keep all the healthcare workers on duty in hotels

22. Protect healthcare workers

23. New definition: Significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal.

24. New Indian policy: All health workers in health care setting should wear N 95/ surgical and general public should wear cloth mask when on the roads.

25. This is called exploitation: The cost of API used in hydroxychloroquine has touched around Rs 70,000 per kg, from around Rs 6,500 per kg in February. The cost of API for azithromycin, the other drug used in combination with hydroxychloroquine for treating coronavirus, have doubled to Rs 16,000 a kg. China is a major supplier of APIs.

26. China mistakes (AP): A six-day delay: On January 14, top Chinese officials determined they likely were facing a pandemic. The head of China’s National Health Commission, Ma Xiaowei, in a confidential teleconference with provincial health officials, said: "The epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event." Yet in the six days that followed, Wuhan hosted a banquet attended by thousands and millions of Chinese migrated within the country for the Lunar New Year celebrations. On January 20, President Xi Jinping warned the public, saying the outbreak "must be taken seriously". The same day, a leading Chinese epidemiologist, Zhong Nanshan, announced for the first time that the virus was transmissible from person to person on national television. But by then, more than 3,000 people had been infected.

27. 12 days of silence: This was on top of another 12 days of lost time. From Jan. 5 to Jan. 17, China’s Center for Disease Control did not register any case of pneumonia-like disease from local officials. Yet during that time, hundreds of patients were appearing in hospitals not just in Wuhan but across the country. It’s uncertain whether it was local officials who failed to report cases or national officials who failed to record them, reports AP. On January 2, local officials of the Chinese Communist Party punished eight doctors for "rumour mongering" for warning friends on social media about the emerging SARS-like threat. One of the doctors, Dr. Li Wenliang, later died on Feb. 7, and has become a rallying point for critics. [TOI]

28. NY times: The two Chinese companies: 2 M home test kits said to detect antibodies for the coronavirus for at least $20 million, take it or leave it. Money had to be paid upfront. And the buyer would be required to pick up the crate loads of test kits from a facility in China. Yet British officials took the deal and promised tests would be available at pharmacies in as little as two weeks. “As simple as a pregnancy test,” It has the potential to be a total game changer. There was one problem, however. The tests did not work.

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
World	2,181,308	+95,022	145,470	+6,996	547,069	1,488,769	56,602	280	18.7
USA	677,570	+29,567	34,617	+2,174	57,508	585,445	13,369	2,047	105	3,398,140	10,266
Spain	184,948	+4,289	19,315	+503	74,797	90,836	7,371	3,956	413	930,230	19,896
Italy	168,941	+3,786	22,170	+525	40,164	106,607	2,936	2,794	367	1,178,403	19,490
France	165,027	+17,164	17,920	+753	32,812	114,295	6,248	2,528	275	333,807	5,114
Germany	137,698	+2,945	4,052	+248	77,000	56,646	4,288	1,643	48	1,728,357	20,629
UK	103,093	+4,617	13,729	+861	N/A	89,020	1,559	1,519	202	417,649	6,152
China	82,341	+46	3,342	77,892	1,107	95	57	2
Iran	77,995	+1,606	4,869	+92	52,229	20,897	3,594	929	58	310,340	3,695
Turkey	74,193	+4,801	1,643	+125	7,089	65,461	1,854	880	19	518,143	6,144
Belgium	34,809	+1,236	4,857	+417	7,562	22,390	1,182	3,003	419	134,303	11,588
Brazil	30,683	+2,073	1,947	+190	14,026	14,710	6,634	144	9	62,985	296
Canada	30,106	+1,727	1,195	+185	9,729	19,182	557	798	32	487,625	12,920
Netherlands	29,214	+1,061	3,315	+181	250	<td valign="top" style="