Coronavirus SARS-Cov2 (COVID-19)

[shibi]

Authorities are claiming lockdown success in flattening the curve. But what we have achieved is only delaying the inevitable. Doubling of total cases every 11 days is still not good enough- at this rate, we will have around 10 crore cases by Sept. With the relaxation of the lockdown, doubling could happen every 8 or 9 days, which means we could be seeing over 50 crore cases by Sept. Then, the pandemic should end. What’s all this talk of vaccine in 6 (unlikely) or 12 months time?

How do we expect the end game to be played? If there is no solution in sight, wouldn’t it be better to face this virus head-on now when the population is healthier, than later when a large section would be starving and undernourished? The only thing that will probably reduce the spread will be availability of good quality face masks. Maybe the anti-body treatment (Israel/ Dutch studies) if proven successful would be a life saver.

[prasen9]

These cities combined to make up 651 of our 1683 deaths at a 6.71% death rate from 9.7K cases cases, while the rest of the country had 1042 deaths from 39.7K cases, at a 2.62% death rate!! Mind you, big and "bad" cities like Delhi and Chennai are well below the national average and Agra, Hyderabad and even Mumbai are below 4%. So, it is not like you cannot keep the deaths low in good sized cities. Heck, Pakistan has a 2.33 death rate and Bangaldesh has a 1.8% (though counting may be different there). Not tracing and testing early enough is why these deaths happen.

How are you calculating the death rate? This statistic is easy to fudge. I can go out and test a lot of people and then my death rate is down. This certainly means that these places are not testing enough. And, generally, testing more can avoid deaths. But, is it easy to say so many deaths would not happen, which is what I read you saying after the quoted paragraph? That seems like a complex variable to predict. Any rationale behind the claim?

[Sin Hombre]

Authorities are claiming lockdown success in flattening the curve. But what we have achieved is only delaying the inevitable. Doubling of total cases every 11 days is still not good enough- at this rate, we will have around 10 crore cases by Sept. With the relaxation of the lockdown, doubling could happen every 8 or 9 days, which means we could be seeing over 50 crore cases by Sept. Then, the pandemic should end. What’s all this talk of vaccine in 6 (unlikely) or 12 months time?

How do we expect the end game to be played? If there is no solution in sight, wouldn’t it be better to face this virus head-on now when the population is healthier, than later when a large section would be starving and undernourished? The only thing that will probably reduce the spread will be availability of good quality face masks. Maybe the anti-body treatment (Israel/ Dutch studies) if proven successful would be a life saver.

There is no end game.

Idea is to keep cases at a rate where the hospitals do not get overwhelmed; and we keep going until we get a vaccine or we get herd immunity.

At least the US and India do not have an end game.

[prasen9]

Yep. The end game is to delay the losses of life as long and as much as we can. Then, hope for a vaccine or medical treatment to be discovered by then. The longer we can extend the game and reduce the losses including losses of life due to economic reasons and other associated lockdown-related reasons, the better we are.

[prasen9]

Authorities are claiming lockdown success in flattening the curve. But what we have achieved is only delaying the inevitable. Doubling of total cases every 11 days is still not good enough- at this rate, we will have around 10 crore cases by Sept. With the relaxation of the lockdown, doubling could happen every 8 or 9 days, which means we could be seeing over 50 crore cases by Sept. Then, the pandemic should end. What’s all this talk of vaccine in 6 (unlikely) or 12 months time?

In the U.S. doubling was happening every 2-3 days. Why should the pandemic end at 50 crore? Some say that herd immunity only happens at 70% of the population. That is 900 crore. How many will die in this situation?

If there is no solution in sight, wouldn’t it be better to face this virus head-on now when the population is healthier, than later when a large section would be starving and undernourished? The only thing that will probably reduce the spread will be availability of good quality face masks. Maybe the anti-body treatment (Israel/ Dutch studies) if proven successful would be a life saver.

The idea is that hospitals are saving some lives. If you think hospitals and medical establishments are not saving any lives, then, yes, we should not have the lockdown. We need to combine our loss function by taking into account the effects of lockdown (no food, mental health, etc.) and compare it with the effects of no lockdown and then we can find out what is better. I am hoping that the ICMR or whoever is doing the modeling for the Central Government has it right.

[rajitghosh]

https://punemirror.indiatimes.com/pune/ ... 563317.cms

Here are the Pune numbers. Even now there is a difference between the covidindia site and Dr. Bhagavan who seems to know what is going on.

[jayakris]

I am with Sin Hombre on the end-game question. There is really no end game. Just keep going. People get infected, 97% or more should recover and up to 5 or 10% would need no more than 10 to 15 days hospitalization, and 85% or more don't need to even go to the hospital. This is not like cancer or anything. It is a flu. Pretty bad flu. Do the very best to not have older people get it, to reduce deaths. So on...

I also have a similar question as Prasen had - why should we expect there to be a peak at all? In fact, the peak that we are seeing in many countries are only because so many people got infected and were not caught on time, so the daily counts went up like crazy with backlogged numbers, due to late testing. 3 weeks worth of patients were coming in one week, that is, once those countries took it seriously and did something. The daily rate was bound to drop a bit after the rush, and that is all that happened. Some effect like the temperature effect has reduced the infection rate by mid April in many countries so, the curve shows the daily numbers reducing. Once it goes out slowly into more and more areas of the country, it will again build up and will keep going. This is what they call the second wave. In places where it gets colder by september, this wave may really gather speed, and this time it is much more wide-spread and could add huge numbers. But I don't think it will all lead to deaths. The death rate by then may be very well under 0.8 or 0.5 percent because people themselves will be reaching out early enough to start treatments to reduce the viciousness of the flu.

But all of that will be a "second wave" only because those places had an artificial "first wave" and a "false peak" caused by their own incompetence. It seems India never had this, and so we are not looking at any second wave. We are looking at "the wave" and the only wave. Just that the wave is going up much more slowly because of the ways in which we handled it. The wave will accelerate a bit once we open up too. Still we can handle it because 5-6 weeks of time we bought helps us to get set in so many ways, in testing, having PPEs, having ventilators made, having masks produced, etc.

If India had delayed things by a week or two and then moved heaven and earth to do tracing (like Germany did, and UK etc are NOW trying to do), we also would have seen it go up to the current 45K some 3 weeks earlier (adding some 4 and 5K at the "false peak") and then dropping to a 4000 per day by now, with say 125K cases... Then it will keep growing again anyway because India is a big country where it can get out to more and more areas. And we would've had 6 or 7K dead by now.

But knowing that India wouldn't be able to move heaven and earth like Germany, we would be looking at 150K cases without even any flattening by now, if we had also delayed things till we hit 4000 cases like most of the European countries, US, Brazil etc. We got really moving when we had 100 cases and had a lockdown when we hit 550 cases!

There are exceptions on the wave matter. You can have a wave and stop it too, with a lockdown - but that is in smaller educated populations, well-behaved and high-in-hygiene populations, and sometimes less dense populations too (Kerala, Taiwan, HKG, S.Korea, Australia, etc) where early action CAN help contain it and even stop it cold. But that may only be for a period. I will wait till world travel opens up, and see what happens in all these places. It could grow again, and the numbers will be too many for tracing in a timely manner and putting a stop to it like these places have done once. I will place a bet that it will happen in Korea, Australia, Kerala, etc in a couple of months.

The great thing India did is that we prevented the 3 and 4 day doubling that happened in so many countries run by bozo leaders. So the rise of the curve is what is flattened by India so far. It is not the curve itself flattening with less and less daily additions. The daily additions are going up and it will keep going up. Not at a huge rate, so we are a long way from reaching anywhere near the hospital capacities.

[Rajiv]

There is really no end game. Just keep going. People get infected, 97% or more should recover and up to 5 or 10% would need no more than 10 to 15 days hospitalization, and 85% or more don't need to even go to the hospital. This is not like cancer or anything. It is a flu. Pretty bad flu. Do the very best to not have older people get it, to reduce deaths. So on....

Jay , bit frighting to hear those words , but yes for countries like USA, India , Russia , things might be still be more difficult before they get better.My guesstimate would be , that it would take atleast another 3 to 4 more months before they get back to normal

This assumption is based on my experience , as nearly after 3 months of curtailment of all activities , the HKG Govt today officially lifted all of their restrictions , with a "HOPE ON THE HORIZON" campaign and all sporting , cinemas, restaurant's , venues including fitness centres reopened from today onwards , and even the schools too are slated to reopen in 2 weeks from now.
So if we could do it , I pray to God that rest of the countries too can emulate and be back to normal soon in next 3 to 4 months if the present level of testing and tracing is maintained.

On a lighter note looking forward to 3 hours of Tennis today after a gap of 4 months

[jayakris]

Authorities are claiming lockdown success in flattening the curve. But what we have achieved is only delaying the inevitable. Doubling of total cases every 11 days is still not good enough- at this rate, we will have around 10 crore cases by Sept. With the relaxation of the lockdown, doubling could happen every 8 or 9 days, which means we could be seeing over 50 crore cases by Sept. Then, the pandemic should end. What’s all this talk of vaccine in 6 (unlikely) or 12 months time?

This is sort of how it could be, shibi. Continuing on what I said above, it does seem like we will keep having cases come in, and people recovering. It could well be say 16 crore cases in 4 months by the beginning of September. That would mean around 12 crore active cases. If we are doing our job right (in testing, allowing people to easily come to hospitals and get tested early), that would be only say 40 lakhs (3.5%) in hospitals. The others will be at home after hospital trips and proper advice. We will be adding 1 crore each day to the list of sick people, and adding say 3.5 lakhs to hospitals each day... and seeing (hopefully) only 75K die a day. But even this scenario is something India can handle. So many more people are in hospitals for all kinds of other things right now. And this virus doesn't kill like cancer or heart disease.

To expect anything better at this point, will be to expect being lucky somehow... from something that we don't know.

Maybe it will only be a 5% growth after a while because the population is all very aware of not touching their nose and on hand hygiene. That could happen in a couple of months time, once they all see various people near them getting sick like all regular flu (and they will see that people aren't dying at such high numbers as to be scared either). If we get a 5%, then the above numbers could be be about 1/10th of what I said.

How do we expect the end game to be played? If there is no solution in sight, wouldn’t it be better to face this virus head-on now when the population is healthier, than later when a large section would be starving and undernourished?

Yes. We should just open up at this point and face it. We have done all we could do to get prepared. We are not going to prepare anything more in another week or two. So let's open up. That is what we are doing. It is a good thing that the states are acting like the lockdown is staying, just to smoothen things out.

[jayakris]

ICMR update: 1,276,781 samples tested as on 9 AM, May 6th. Previous update: 1,191,946 ... That is 84,835‬ samples tested in a day. We will hit 100K very soon. Remember when ICMR said that 60K by May 15th was their target? Haha .. I don't think anybody expected us to ramp this up so fast. If only about 3 or 4 cities in India ramped up sample collection a little bit more... Actually even our worst cities are all operating under the 10% positivity that WHO recommends, and much better than many many "advanced" countries, but we know that 10% is just a terrible benchmark from WHO for this virus, seeing how infectious it is.

Now only USA, Germany, Russia, Italy, Spain and UK have conducted more tests than us. We have Less than 1/3rd to 1/5th of the cases than any of them. We are 7th in testing, though only 15th in case numbers. No data from China on testing.

[prasen9]

people themselves will be reaching out early enough to start treatments to reduce the viciousness of the flu.

You high on the medicines remdesivir and actemra will work? Otherwise, what treatment?

Also, why not open up in a phased way? Maybe let all agriculture, industry, regular markets, and individual shops open up but keep the big malls, restaurants and bars out (creators of middle-class obesity that is lethal with coronavirus). Just to reduce the relatively unnecessary places still closed. Oh, and the rosogolla stores. Close them. They result in diabetes and diabetes is lethal with coronavirus.

[Rajiv]

If this is a fact , then finally some ray of hope.

https://www.thehindubusinessline.com/ne ... 514972.ece

[jayakris]

people themselves will be reaching out early enough to start treatments to reduce the viciousness of the flu.

You high on the medicines remdesivir and actemra will work? Otherwise, what treatment?

No, I am not expecting any treatment. Basically it is only the body that is fighting the virus, but many (most) deaths happen because of other conditions and it is too late for the doctors to treat them (like hypertension, diabetes, heart trouble) when people are so out of breath when they get to the hospital and something or other hits them.

The deaths due plainly to Covid-19 itself are very very low (and this is why many countries seem to not even follow the WHO recommendation, and resist counting them as Covid deaths. India does count them all as Covid deaths, though Mamata tried not to do that and had to be forced to toe the line). You don't need Covid treatment to avoid deaths. Just reach the hospital a couple of days early because you know (or have been told when you were traced and tested) the seriousness of how soon Covid can deteriorate your body functions. Then people will themselves go to the hospital if any sign of shortness of breath starts. Given a little more time, the docs can simply take care of the other conditions and avoid the death with some oxygen support (no need for even ventilators in many many cases) when the body fights Covid. At least that is my understanding.

There is no reason why Kerala has had just 4 deaths in 502 cases, other than that they got the patients to the hospital way early, so the doctors had a chance to watch the other conditions properly. Not because they had any treatment for Covid, or because they had doctors and medical facilities so much better than in Italy or New York. Just get the patient in 5 days early, and you will save most of the deaths.

What is worse with this, compared to other kinds of flu, is that those do not leave the body so weakened so fast after a few days (rather suddenly too) for something else to hits you and kill you. That is why wrote "early enough to start treatments to reduce the viciousness of the flu". That viciousness is actually in helping other conditions hit the patients and kill them. The other conditions can be treated, if the docs are given time.

[jayakris]

Also, why not open up in a phased way? Maybe let all agriculture, industry, regular markets, and individual shops open up but keep the big malls, restaurants and bars out (creators of middle-class obesity that is lethal with coronavirus). Just to reduce the relatively unnecessary places still closed. Oh, and the rosogolla stores. Close them. They result in diabetes and diabetes is lethal with coronavirus.

That is basically what the central government has suggested. Agriculture was never locked down. Industries can be opened. The states need to make the call on these things, and they are doing that. I would've also liked a bit more uniformity and some stricter guidelines and all that to avoid all the confusion going on, but the state CMs are deciding these things and many are fighting with the center on specific issues (mostly on which are the green, orange and red zones - as a lot of the Central government's rules are on the basis of that). But basically it is a bit of a phased opening. The Indian inefficiencies will make it a phased opening anyway. Liquor and rasagolla shops will open first, whatever you try

[jayakris]

If this is a fact , then finally some ray of hope.
https://www.thehindubusinessline.com/ne ... 514972.ece

Actually, there are dozens of vaccines developed already, and starting trials everywhere. The greatest news is that the Serum Institute in Pune (the world's largest vaccine manufacturer) are about to even start large scale production of one of the most promising vaccines, out of the Jenner Institute of the Oxford University - who are already done with trials on monkeys and about to start human trials. The serum institute wants to have millions of doses ready to go, as soon as that vaccine finishes trials, which will take several months till sometime next year (40 million doses ready by this September is the Serum Institute plan). We had discussed this a couple of day earlier.

It seems the scientists are somewhat encouraged with the mutation patterns of this virus that seems to allow for a vaccine to be figured out quickly (unlike HIV a while ago, they struggles massively then).