World Latest Covid19 Update: 210 Countries, over 2.48 M cases, Deaths crosses 200,000

Updates[DKA1]

1. 30% of India cases are from Tablighi Jamaat

2. Extra pulmonary manifestations: Encephalitis, Guillain Barry Syndrome 96 cases), Diarrhoea, Loss of smell, loss of taste, AKI (5%, tremendously catabolic with hyperkalemia, hyperphosphatemia, and profound metabolic acidosis to a degree not seen in typical kidney failure patients); hepatopathy,conjunctivitis, Diabetes and hyperglycemia among people without prior diabetes, Thrombocytopenia (20.7%)

3. Australia and New Zealand relax restrictions: Both countries have managed to keep the coronavirus outbreak mostly contained. For eight straight days, Australia has recorded fewer than 50 new cases.

4. Singapore’s coronavirus caseload has more than doubled in the past few days, with more than 8,000 confirmed cases as of Monday, the highest in Southeast Asia. Most of the new infections are in the crowded dormitories where migrant laborers live. The spike has exposed the very different experiences of rich and poorer expatriates in a city-state where 40 percent of residents are foreign-born.

5. Hong Kong reported no new coronavirus cases on Monday, the first time since a second wave of infections hit the city in early March.

6. In Delhi all the 186 novel coronavirus cases found positive in the capital on Saturday were asymptomatic.

7. In New York City in a universal testing of pregnancy trial they found 13.7 % were COVID infection (87.9% were asymptomatic and 12.1% were pre symptomatic)

8. In India it is affecting younger people (< 50 years) with mild symptoms

9. A pandemic is National Health Emergency

10. All healthcare worker and on HCQS prophylaxis should fill the form https://www.surveymonkey.com/r/6KPW8CR

11. India doubling time is > 7days

12. Make health care establishments fully functional

13. Concentrate on polio, measles, rota virus, routine immunisation and TB notification. Isolate all MDR and TB positive cases till sputum negative

14. Consider every surface and asymptomatic person as virus carrier

15. COVID 19 may assume a seasonal nature.

16. BCG may be protective. ICMR has started a study. Cases in India 11 per million population against 299 global

17. Diagnose and treat early to reduce viral load and prevent cytokine storm AND e for prevalence test after days (antibodies test will take 7 days to detect)

18. Both ARDS and silent hypoxia requires specific non ventilatory and ventilatory prone settings with standby ECMO. tPA, heparin, ACE inhibitors, early treatment, plasma therapy, blood/ cord blood transfusion, timely air lift of critical patients may help.

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

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

21. ZIKA Brazil Model: Army used for the crisis. Keep Army at standby.

22. Quarantine models

India: Early lock down for forty days

Wuhan: Selective sealing of epicentre

Vietnam: Sealing of a village with most cases

Bhilwara CLUSTER: Seal 2 km all around, fumigate each house, house to house survey for ALI and SARI, isolate infected cases, test all close contacts

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.

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

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

Italy: 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)

Singapore: 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

Germany: Random testing for antibodies is key in Germany’s strategy. (New York Times)

23. Convalescent plasm therapy: start early to reduces viral load. One patient can give it to ten patients.

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

25. Significant exposure to Covid-19: 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 minimal.

26. Mask Policy: All health workers in health care setting should wear N 95/ surgical and general public should wear cloth mask when on the roads.

27. The cost of API used in hydroxychloroquine touched Rs 70,000 per kg, from Rs 6,500 per kg in February. The cost of API for azithromycin has doubled to Rs 16,000 a kg. China is a major supplier of APIs.

28. A six-day delay by China: On January 14, top Chinese officials sensed 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.

29. 12 days of silence added to the fuel: From Jan. 5 to Jan. 17, China’s CDC 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. 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.

30. Two Chinese companies sold UK 2 M home test kits for $20 million on upfront payment on take it or leave it terms. The simple pregnancy test like option was a potential game changer but the tests did not work.

31. More doubt on coronavirus’s Wuhan origin: in a paper published earlier this month, geneticists said it may have started spreading as early as mid-September, and from elsewhere in China. (PNAS, Newsweek)

32. The coronavirus crisis has killed more than 7,000 people at nursing homes across the country, The New York Times has determined, and has even ravaged facilities with sterling reputations.