World Covid Update 18th April : 210 Countries, over 2.25 M cases, Deaths crosses 175,000,

Dr KK Aggarwal (President CMAAO, HCFI and Past National President IMA)

with minimum expected deaths over 162826, around 8500 deaths per day, 19.8 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 (154256 + 57136 x 15 = 8570) = 162826

Cases 2,250,737 (new cases yesterday 86497)

Deaths: 154,256 (new deaths yesterday 8672)

Recovered: 572,110

ACTIVE CASES: 1,524,371

Currently Infected Patients Mild: 1,467,235 (96%)

Serious: 57,136 (4%)

CLOSED CASES: 726,366

Recovered: 572,110 (79%)

Died: 154,256 (21%)

Cases per million population (global) 289

Deaths per million population (global) 19,8

India: Confirmed 14352

Active: 11825

Recovered: 2041

Deaths: 486

Cases 10 per million population

0.4 deaths per million population

243 tests per million population

India Cases on 18th 14352, Case on 10th April 7600, Doubling time: 8 days

Lower doubling times needs more attention MP, Gujarat

Growth factor 1.2

GF is the factor by which a quantity multiplies itself over time. The formula used is every day’s new cases / new cases on the previous day. For example, a quantity growing by 7% every period (in this case daily) has a growth factor of 1.07. A growth factor above 1 indicates an increase, whereas one which remains between 0 and 1 it is a sign of decline, with the quantity eventually becoming zero, whereas a growth factor constantly above 1 could signal exponential growth.

Strategies

1. It’s a National Health Emergency

2. If you are on HCQS prophylaxis fill https://www.surveymonkey.com/r/6KPW8CR

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

4. Open health care establishments now

5. Treat every surface and asymptomatic virus carrier

6. COVID 19 may assume a seasonal nature.

7. BCG may be protecting Indians to some extent. ICMR has started a study

8. 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.

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

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

11. ZIKA Brazil Model: Army used for the crisis

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

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

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

15. 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

16. 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.

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

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

19. 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)

20. 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

21. Convalescent plasm therapy: India, USA started it

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

23. Protect healthcare workers

24. 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.

25. 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.

26. 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.

27. 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.

28. 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]

29. 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	2,248,864	+86,497	154,145	+8,672	571,573	1,523,146	56,963	289	19.8
USA	709,735	+32,165	37,154	+2,535	60,510	612,071	13,509	2,144	112	3,572,257	10,792
Spain	190,839	+5,891	20,002	+687	74,797	96,040	7,371	4,082	428	930,230	19,896
Italy	172,434	+3,493	22,745	+575	42,727	106,962	2,812	2,852	376	1,244,108	20,577
France	147,969	+1,909	18,681	+761	34,420	94,868	6,027	2,267	286	463,662	7,103
Germany	141,397	+3,699	4,352	+300	83,114	53,931	5,013	1,688	52	1,728,357	20,629
UK	108,692	+5,599	14,576	+847	N/A	93,772	1,559	1,601	215	438,991	6,467
China	82,692	+325	4,632	+1,290	77,994	66	85	57	3
Iran	79,494	+1,499	4,958	+89	54,064	20,472	3,563	946	59	319,879	3,808
Turkey	78,546	+4,353	1,769	+126	8,631	68,146	1,845	931	21	558,413	6,621
Belgium	36,138	+1,329	5,163	+306	7,961	23,014	1,140	3,118	445	139,387	12,027
Brazil	33,682	+2,999	2,141	+194	14,026	17,515	6,634	158	10	62,985	296
Russia	32,008	+4,070	273	+41	2,590	29,145	8	219	2	1,718,019	11,773
Canada	31,927	+1,821	1,310	+115	10,543	20,074	557	846	35	507,701	13,452
Netherlands	<span style="font-size:11.5pt;line-height:107%;font-family:"Arial",sans-serif;color:#36