Wuhan Coronavirus Resource Thread

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Re: Wuhan Coronavirus Resource Thread

Postby Rahul M » 03 Apr 2020 11:27

suryag wrote:I am getting very worried, the number increases in India are following the US trend thanks to the Tableeghis, the next few days will tell us, btw I get different dates for this shitty conference from different sources, one of them even says it went on until Mar30th ? whats the truth ? Asking because, it gives us an idea on how long to prolong this lockdown

Suryag, I pass through nijamuddin area in my daily office commute. Believe me, south east asian and central Asian looking muslims are there all year round. This is over and above the busloads of sub continental looking muslims who are also there on a perennial basis. The numbers wax and wane but there's always a steady stream. Now some may be pilgrims to the dargah but I don't see that itself is particularly different as a covid incubator. So don't believe media et al when they say this is a one off thing.

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Re: Wuhan Coronavirus Resource Thread

Postby sum » 03 Apr 2020 11:30

sajo wrote:
Prime Minister Narendra Modi on Friday appealed to everyone to voluntarily adopt a blackout at 9 pm on Sunday and light a lamp,


I think he is gauging for compliance fatigue. The leftrolls are out in full force. Some even predict that like Janata Curfew was a precursor to a full lockdown, this is a precursor to a total shutdown including power, supplies etc.

There is always some method to the madness and I'm curious what it is.

In the meanwhile, it has really, really ignited the diya of all my "liberal" friends who are currently going ape-$hi* all over the place after the video

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Re: Wuhan Coronavirus Resource Thread

Postby shaun » 03 Apr 2020 11:34

sajo wrote:
Prime Minister Narendra Modi on Friday appealed to everyone to voluntarily adopt a blackout at 9 pm on Sunday and light a lamp,


I think he is gauging for compliance fatigue. The leftrolls are out in full force. Some even predict that like Janata Curfew was a precursor to a full lockdown, this is a precursor to a total shutdown including power, supplies etc.

compliance can be checked by calculating the peek demand at 9 pm

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Re: Wuhan Coronavirus Resource Thread

Postby ricky_v » 03 Apr 2020 11:46

First i thought it was substantial for an hour or so, it is for 5 minutes, what is that going to do? if the lt consumers stop everything at the same time, keeping in mind that our country is conncted by a single grid at 50 hz, and then back up in short phases we will enjoy voltage dips and grid blackouts; surely such exercise has more pupose and reasoning behind it and is not merely a pointless gimmick for solidarity and oneness purposes.

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Re: Wuhan Coronavirus Resource Thread

Postby nandakumar » 03 Apr 2020 12:02

Rahul M wrote:
suryag wrote:I am getting very worried, the number increases in India are following the US trend thanks to the Tableeghis, the next few days will tell us, btw I get different dates for this shitty conference from different sources, one of them even says it went on until Mar30th ? whats the truth ? Asking because, it gives us an idea on how long to prolong this lockdown

Suryag, I pass through nijamuddin area in my daily office commute. Believe me, south east asian and central Asian looking muslims are there all year round. This is over and above the busloads of sub continental looking muslims who are also there on a perennial basis. The numbers wax and wane but there's always a steady stream. Now some may be pilgrims to the dargah but I don't see that itself is particularly different as a covid incubator. So don't believe media et al when they say this is a one off thing.

This is what I have learnt from people in the know. Tableeghi Jamaat has preachers all over the world. They have to periodically undergo refresher course/training as part of their responsibilities. The Nizamuddin Centre is one such. So people come over all through the year. Another thing that I have learnt is that during this refresher courses they form small communities amongst themselves. They live, eat and sleep together as a group. So much so, they eat from the same plate. We know, saliva based contamination is the most common. Not surprising that the infection rate is so high.

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Re: Wuhan Coronavirus Resource Thread

Postby sajo » 03 Apr 2020 12:03

Unlike the Janata Curfew day where the main message was to remain home and the appreciation window was a side note, this new announcement was purely for "Andheri Raat mein Diya Tere haath mein" as the left liberals are terming it.
He could have simply tweeted about it.

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Re: Wuhan Coronavirus Resource Thread

Postby Arun.prabhu » 03 Apr 2020 12:05

The weekly death statistics haven't exceeded the historical averages and is not deviating significantly from the weekly death averages for other years.

Further from the Swiss doctor's article:
"The mortality profile remains puzzling from a virological point of view because, in contrast to influenza viruses, children are spared and men are affected about twice as often as women. On the other hand, this profile corresponds to natural mortality, which is close to zero for children and almost twice as high for 75-year-old men as for women of the same age."

And yes, the death statistics in Italy are intentionally skewed, btw. If you died of an accident while carrying the disease, they seem inclined to record cause of death as ncovid-19.

pgbhat wrote:
Arun.prabhu wrote:Analysis of ncovid-19 mortality and other things...
https://swprs.org/a-swiss-doctor-on-covid-19/

March 22, 2020 (I)
Regarding the situation in Italy: Most major media falsely report that Italy has up to 800 deaths per day from the coronavirus. In reality, the president of the Italian Civil Protection Service stresses that these are deaths „with the coronavirus and not from the coronavirus“ (minute 03:30 of the press conference). In other words, these persons died while also testing positive.

Shanghai Statistics?
Why would you word it like this? Are they saying they would have died anyways with/without Coronavirus at the same time?

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Re: Wuhan Coronavirus Resource Thread

Postby jpremnath » 03 Apr 2020 13:04

Amidst all this, have you noticed how the Pakis somehow managed to reduce the growth in numbers? From double our numbers of infected a week back, they are at par now...
Even if we discount the nizamudheen fiasco, our rising numbers is a bit concerning. It is gonna take one more week for the lockdown influence to kick in i guess.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 03 Apr 2020 13:05

Arun.prabhu wrote:The weekly death statistics haven't exceeded the historical averages and is not deviating significantly from the weekly death averages for other years.

Further from the Swiss doctor's article:
"The mortality profile remains puzzling from a virological point of view because, in contrast to influenza viruses, children are spared and men are affected about twice as often as women. On the other hand, this profile corresponds to natural mortality, which is close to zero for children and almost twice as high for 75-year-old men as for women of the same age."

And yes, the death statistics in Italy are intentionally skewed, btw. If you died of an accident while carrying the disease, they seem inclined to record cause of death as ncovid-19.

pgbhat wrote:
Shanghai Statistics?
Why would you word it like this? Are they saying they would have died anyways with/without Coronavirus at the same time?


Article states that Current all-cause mortality in Europe and in Italy is still normal or even below-average..This is surprising..

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Re: Wuhan Coronavirus Resource Thread

Postby madhu » 03 Apr 2020 13:09

sajo wrote:Unlike the Janata Curfew day where the main message was to remain home and the appreciation window was a side note, this new announcement was purely for "Andheri Raat mein Diya Tere haath mein" as the left liberals are terming it.
He could have simply tweeted about it.

this is to test the population for extending the lockdown with even more stringent measures. it was done during janata curfew. looking at its success lockdown was initiated. need to see how long people will adhere or get cracked under lockdown pressure.

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Re: Wuhan Coronavirus Resource Thread

Postby shaun » 03 Apr 2020 13:13

More updated ..correct me if there is discrepancy
Image
Last edited by shaun on 03 Apr 2020 16:28, edited 2 times in total.

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Re: Wuhan Coronavirus Resource Thread

Postby Cyrano » 03 Apr 2020 13:52

Google has published google maps based tracking data of mobile phone users (using Android presumably) for a lot of countries which you can get from:
https://www.google.com/covid19/mobility/

The mobility trends report for India (pdf) compared to baseline starting beginning of February:
https://www.gstatic.com/covid19/mobility/2020-03-29_IN_Mobility_Report_en.pdf

Quick comparison between India and France :
Retail & recreation Mobility trends for places like restaurants, cafes, shopping centers, theme parks, museums, libraries, and movie theaters.

INDIA -77% FRANCE -88%

Grocery & pharmacy Mobility trends for places like grocery markets, food warehouses, farmers markets, specialty food shops, drug stores, and pharmacies.

INDIA -65% FRANCE -72%

Parks Mobility trends for places like national parks, public beaches, marinas, dog parks, plazas, and public gardens

INDIA -57% FRANCE -82%

So going by this admittedly partial view which is nevertheless quite insightful, the lockdown is working, but compliance is not strong enough in India. To get over the hill and flatten the curve, these numbers should be >80%.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 03 Apr 2020 15:21

More I think about exiting lockdown more I realize how tough it is going to be.. If we see sudden increase in cases after curfew is lifted , people will start questioning very purpose of this 21 days lockdown.. If govt increases lockdown further we will see less and less compliance from people and more clashesh with police..
Obvious aim of govt will be to allow enough movement of people so that sense of somewhat normalcy returns without sudden increase in COVID pts to overwhelm existing healthcare system..
Few ways to achieve this could be:
1) Everyone who can work from home should continue it..This can continue for may be 2 -3 months or more..
2) Regions can be divided in Red zone ( high risk of community spread ), yellow zone (moderate risk of community spread) , Green zone ( low risk of community spread).. This will be dynamic division and area can be reclassified as situation evolves.
3) Red zones will require extended quarantine.. No public transport here.. Everything to mantain social distancing should be strictly enforced for longer time say one more month..No in and out movement from these areas permitted
4)In Yellow zones return of low risk individuals should be allowed in community.. strong public motivation will be needed to keep high risk individuals i.e. elderly and those with multiple co morbidities.. We can use all available data from adhar/ insurance / PMJAY to tag and encourage high risk individuals to stay home so that young , healthy people can restart work and contribute to herd immunity.. Unless herd immunity develops transmission of virus is not going to slow down.. Again no movement in and out of region can be permitted..
5) many regions havn't seen Covid patients yet .. these Green zones can resume pre lockdown activities .. strict monitoring of every person coming in with quarantine whenever should be enforced.
6) Any mass movement of public by train etc should be discouraged for at least one more month.. Crowded trains with closed enviornment will spread infection easily and to far away regions..

obvious problems in this exit plan are:
1) I know this division cant be watertight and transport of goods , milk, agri products will be required ..
2) Most our economic centers will fall in red zone and extended curfew here will affect economy badly..
This is just Raw idea and I hope we all can improve it or comeup with better idea to exit this lock down..

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Re: Wuhan Coronavirus Resource Thread

Postby nam » 03 Apr 2020 15:46

The 21 days would allow us to find out the infection cluster. First and foremost the region/district would be locked down. A hard lock down.

Testing expanded on that district to find out more cases. You then bring to household level. You isolate and lockdown the house hold.

This allows us to free the remaining part of the society, by disinfecting the places.

It is tough on the infected household. Some may be unlucky to show symptoms quite late in the lockdown. However we have no choice. They need to be supported financially.

Bilwara in Rajasthan is under very hard lockdown. It was the worst effected region. No new cases since 3 days. Regionwise lock down, testing and isolation helps to create the place.

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Re: Wuhan Coronavirus Resource Thread

Postby sooraj » 03 Apr 2020 17:54

Intranasal COVID-19 vaccine: Bharat Biotech ties up with FluGen, UW-Madison virologists

CoroFlu could be in human clinical trials by fall (September-December) of 2020, Bharat Biotech statement said.

Vaccine maker Bharat Biotech, on April 4, said it had joined hands to develop a unique intranasal vaccine against COVID-19 in collaboration with US-based vaccine company FluGen and virologists at the University of Wisconsin–Madison.

Bharat Biotech will manufacture the vaccine, conduct clinical trials and prepare to produce almost 300 million doses of vaccine for global distribution.

"Under the collaboration agreement, FluGen will transfer its existing manufacturing processes to Bharat Biotech to enable the company to scale up production and produce the vaccine for clinical trials," said Dr. Raches Ella, Head of Business Development at Bharat Biotech.

An intranasal vaccine is delivered through the nose, something like a nasal spray. It is considered to be effective and convenient for self administration, but the formulation is highly complex. There is no vaccine for COVID-19 at the moment. Along with Bharat Biotech, dozens of companies are trying to develop vaccines including Indian companies, such as Serum Institute of India and Cadila Healthcare.


Bharat Biotech has said the refinement of the CoroFlu vaccine concept and testing in laboratory animal models at UW–Madison is expected to take three to six months. Bharat Biotech in Hyderabad, India will then begin production scale-up for safety and efficacy testing in humans.

CoroFlu will build on FluGen's flu vaccine candidate known as M2SR. That vaccine was based on research by UW-Madison virologists and FluGen co-founders Yoshihiro Kawaoka and Gabriele Neumann, is a self-limiting version of the influenza virus that can induce an immune response against the flu.

Kawaoka's lab plans to insert gene sequences from SARS-CoV-2, the official name of the new coronavirus that causes COVID-19, into M2SR so that the new vaccine will also induce immunity against the coronavirus, according to a UW-Madison statement.

Four Phase I and Phase II clinical trials involving hundreds of subjects have shown the M2SR flu vaccine to be safe and well tolerated. This safety profile, M2SR’s ability to induce a strong immune response, and the ability of influenza viruses to carry sequences of other viruses make M2SR an attractive option for rapidly developing CoroFlu as a safe and effective SARS-CoV-2 vaccine.

“We are going to modify M2SR by adding part of the coding region for the coronavirus spike protein that the virus uses to latch onto cells and begin infection,” says Gabriele Neumann, a senior virologist in Kawaoka’s lab and co-founder of FluGen.

“CoroFlu will also express the influenza virus hemagglutinin protein, which is the major influenza virus antigen, so we should get immune responses to both coronavirus and influenza,” he added.

M2SR is a unique form of the flu virus. It lacks a gene called M2, which restricts the virus to undergoing only a single round of replication in cells.

“The single replication means the virus can enter the cell, but it can’t leave,” says FluGen co-founder, president and CEO Paul Radspinner. “So, in essence it tricks the body into thinking it’s infected with flu, which triggers a full immune response. But since it can’t replicate further, you don’t get sick.”

CoroFlu, like M2SR, will be delivered intranasally. This route of administration mimics the natural route of infection by coronavirus and influenza and activates several modes of the immune system. Intranasal delivery is more effective at inducing multiple types of immune responses than the intramuscular shots that deliver most flu vaccines.

The Kawaoka group will insert genetic sequences from SARS-CoV-2 into M2SR and then assess CoroFlu’s safety and efficacy in animal models at UW–Madison’s Influenza Research Institute. The institute has a high-level biosafety facility designated Biosafety Level 3 Agriculture with the ability to safely handle and study pathogens like highly pathogenic influenza viruses and the novel coronavirus.

M2SR was developed by FluGen and includes technology exclusively licensed through the Wisconsin Alumni Research Foundation (WARF), which manages patents for UW–Madison. “To confront a global challenge, this is collaborative discovery at its best,” says Erik Iverson, CEO of WARF. “The partners in this endeavor — University of Wisconsin researchers, a biotech startup, and an international vaccine developer — are moving forward with a sense of urgency and integrity incumbent upon us as scientists and world citizens.”

Bharat Biotech has commercialized 16 vaccines, including a vaccine developed against the H1N1 flu that caused the 2009 pandemic.

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Re: Wuhan Coronavirus Resource Thread

Postby sooraj » 03 Apr 2020 18:05

Novel coronavirus vaccine: Prospects in India

Dr Seema Mishra, Assistant Professor of Bioinformatics and Systems biology laboratory in the Department of Biochemistry at University of Hyderabad, talks to THE WEEK as she races against time in developing a vaccine that can fight the novel coronavirus.


You have developed a potential vaccine to fight COVID-19. Please tell us in detail about it.

The novel coronavirus 2019-nCoV vaccine is currently at design stage. This is a potential peptide-based vaccine. These peptides are taken from coronavirus structural (proteins which make up the virus structure) and non-structural proteins. As there is less data on the nature of a particular coronaviral protein as being virulent, all ten coronaviral proteins were taken into account to design potential vaccine candidates. This peptide vaccine is based on the fact that immune cells inside the body, called T cells, recognise the viral peptide (also called T cell epitope) on the cell surface as foreign and quickly mount an immune response to destroy that cell in order to clear the infection. Choosing these peptides, among thousands of other peptides, which can help mount the immune response is a cumbersome process.


Usually any vaccine discovery takes years on end....

Usually, it takes about 15 years to fully develop a peptide-based vaccine starting from design to development and human clinical trials. Even the first basic step, which is the laboratory exploratory stage to identify antigenic epitopes, takes 2-4 years! However, utilizing powerful immunoinformatics approaches with computational softwares developed, within a short span of time--in my case, 10 days—and lesser cost, one can design and select a peptide (T cell epitopes) list for further experimental trials.


When did you start with it, and how did it progress?

My work using immuninformatics actually started at AIIMS, New Delhi, while designing potential T cell epitope vaccines for cancer immunotherapy way back in 2005. Then, my research took another direction in computational systems biology approaches in cancer. So, when the time came for a swift action to tackle coronavirus and contribute in fight for survival against this deadly pathogen, I jumped into the fray. The principles and software tools required for designing vaccine candidates against cancer and nCoV are the same, and so it was not difficult to establish. Within a matter of 10 days during the government lockdown in March, I used the work-from-home opportunity to full advantage to provide the scientific community this candidate epitope set to work with.


Have you shared it with the scientific community at large?

Yes, this work has been disseminated swiftly to the scientific community through ChemRxiv preprint platform at ChemRxiv.org. This preprint platform is managed by American Chemical Society, Royal Society of Chemistry, The Chemical Society of Japan among others. The beauty of preprints is that you can rapidly disseminate your initial findings to the world and establish priority of a discovery as well as be free to publish in a peer-reviewed journal at a later stage. Conventional peer-reviewed journals take a time of about 3 to 6 months for publishing and by then, much of the useful information is lost when time is of the essence.


What further work does remain to be done to make it ready for use? How do you plan to test it?

Further fine-tuning of more such candidate epitopes needs to be done. Structural and conservancy analyses will help narrow down this list to few key candidates. There is a battery of wet lab assays to be done as well as pre-clinical and clinical trials. It may take about one to one-and-a-half-years to fully develop a safe and effective vaccine, if we act fast.


What is your analysis of the present situation of COVID-19 in the country with regard to its spread?

Our country has acted swiftly and it is a good initiative of our Honourable Prime Minister to ensure the lockdown and prevention of further spread of the virus. This is a much needed initiative and now it all needs to be complied strictly by the people of India with self-discipline till the situation demands.


How is the western world preparing a vaccine against COVID-19? Could you compare our vaccine development against theirs?

World Health Organization (WHO) has shared a draft report of COVID-19 candidate vaccines with us. As of March 20, 2020, two candidate vaccines are at clinical evaluation and 42 at pre-clinical stage. These vaccines are being developed using a variety of platforms like DNA-based, subunit peptide-based, live attenuated and even adenovirus-based vaccines. From this list, we are informed that from India, two companies are in the list—one is Zydus Cadila using replicating viral vector platform and other is Serum Institute of India in partnership with Codegenix, USA using live attenuated virus platform. To the best of my knowledge, this work is the first one from India establishing subunit peptide vaccine platform which is safer than using live attenuated viruses. We hope to develop a safe and effective vaccine, which can withstand immune backfiring, as one has to look out for developing immunopathologies, too, and avoid this pitfall.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 03 Apr 2020 18:30

DrRatnadip wrote:More I think about exiting lockdown more I realize how tough it is going to be.. If we see sudden increase in cases after curfew is lifted , people will start questioning very purpose of this 21 days lockdown.. If govt increases lockdown further we will see less and less compliance from people and more clashesh with police..
Obvious aim of govt will be to allow enough movement of people so that sense of somewhat normalcy returns without sudden increase in COVID pts to overwhelm existing healthcare system..
Few ways to achieve this could be:
1) Everyone who can work from home should continue it..This can continue for may be 2 -3 months or more..
2) Regions can be divided in Red zone ( high risk of community spread ), yellow zone (moderate risk of community spread) , Green zone ( low risk of community spread).. This will be dynamic division and area can be reclassified as situation evolves.
3) Red zones will require extended quarantine.. No public transport here.. Everything to mantain social distancing should be strictly enforced for longer time say one more month..No in and out movement from these areas permitted
4)In Yellow zones return of low risk individuals should be allowed in community.. strong public motivation will be needed to keep high risk individuals i.e. elderly and those with multiple co morbidities.. We can use all available data from adhar/ insurance / PMJAY to tag and encourage high risk individuals to stay home so that young , healthy people can restart work and contribute to herd immunity.. Unless herd immunity develops transmission of virus is not going to slow down.. Again no movement in and out of region can be permitted..
5) many regions havn't seen Covid patients yet .. these Green zones can resume pre lockdown activities .. strict monitoring of every person coming in with quarantine whenever should be enforced.
6) Any mass movement of public by train etc should be discouraged for at least one more month.. Crowded trains with closed enviornment will spread infection easily and to far away regions..

obvious problems in this exit plan are:
1) I know this division cant be watertight and transport of goods , milk, agri products will be required ..
2) Most our economic centers will fall in red zone and extended curfew here will affect economy badly..
This is just Raw idea and I hope we all can improve it or comeup with better idea to exit this lock down..


I really like this, Doctor. A blanket lockdown for extended period would damage the economy which is needed to generate the resources needed to combat the virus. The PPE problem is a defining example, even highly industrialized countries cannot produce key items when in lockdown. India is a continental sized country, it needs the parts that are not or less infected to resume economic activities that can resource the fight in places that are in lockdown.

The key is how we supply and sustain the red and yellow regions until they are healed.

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Re: Wuhan Coronavirus Resource Thread

Postby Deans » 03 Apr 2020 18:40

jpremnath wrote:Amidst all this, have you noticed how the Pakis somehow managed to reduce the growth in numbers? From double our numbers of infected a week back, they are at par now...
Even if we discount the nizamudheen fiasco, our rising numbers is a bit concerning. It is gonna take one more week for the lockdown influence to kick in i guess.


Pak probably ran out of test kits. Also, people dying of respiratory ailments are not being checked for the Virus.
There are just 3 hospitals in Punjab province where you can be admitted for Corona.

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Re: Wuhan Coronavirus Resource Thread

Postby Deans » 03 Apr 2020 18:50

amar_p wrote:Google has published google maps based tracking data of mobile phone users (using Android presumably) for a lot of countries which you can get from:
https://www.google.com/covid19/mobility/

The mobility trends report for India (pdf) compared to baseline starting beginning of February:
https://www.gstatic.com/covid19/mobility/2020-03-29_IN_Mobility_Report_en.pdf

Quick comparison between India and France :
Retail & recreation Mobility trends for places like restaurants, cafes, shopping centers, theme parks, museums, libraries, and movie theaters.

INDIA -77% FRANCE -88%

Grocery & pharmacy Mobility trends for places like grocery markets, food warehouses, farmers markets, specialty food shops, drug stores, and pharmacies.

INDIA -65% FRANCE -72%

Parks Mobility trends for places like national parks, public beaches, marinas, dog parks, plazas, and public gardens

INDIA -57% FRANCE -82%

So going by this admittedly partial view which is nevertheless quite insightful, the lockdown is working, but compliance is not strong enough in India. To get over the hill and flatten the curve, these numbers should be >80%.


This can be a bit misleading. For e.g. in restaurants, a lot of staff are home delivery executives who have to keep their location on, for the customer to track. They visit the restaurant multiple times a day. Assume a restaurant has 20 customers allowing their location to be shown and 1 delivery boy making 10 trips/day. After lockdown, this reduces to 0 customers and 12 home deliveries. It will show a 70% fall (41-12)/41, whereas the reality is a 100% drop in visitors.

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Re: Wuhan Coronavirus Resource Thread

Postby DrRatnadip » 03 Apr 2020 18:53

chola wrote:
DrRatnadip wrote:More I think about exiting lockdown more I realize how tough it is going to be.. If we see sudden increase in cases after curfew is lifted , people will start questioning very purpose of this 21 days lockdown.. If govt increases lockdown further we will see less and less compliance from people and more clashesh with police..
Obvious aim of govt will be to allow enough movement of people so that sense of somewhat normalcy returns without sudden increase in COVID pts to overwhelm existing healthcare system..
Few ways to achieve this could be:
1) Everyone who can work from home should continue it..This can continue for may be 2 -3 months or more..
2) Regions can be divided in Red zone ( high risk of community spread ), yellow zone (moderate risk of community spread) , Green zone ( low risk of community spread).. This will be dynamic division and area can be reclassified as situation evolves.
3) Red zones will require extended quarantine.. No public transport here.. Everything to mantain social distancing should be strictly enforced for longer time say one more month..No in and out movement from these areas permitted
4)In Yellow zones return of low risk individuals should be allowed in community.. strong public motivation will be needed to keep high risk individuals i.e. elderly and those with multiple co morbidities.. We can use all available data from adhar/ insurance / PMJAY to tag and encourage high risk individuals to stay home so that young , healthy people can restart work and contribute to herd immunity.. Unless herd immunity develops transmission of virus is not going to slow down.. Again no movement in and out of region can be permitted..
5) many regions havn't seen Covid patients yet .. these Green zones can resume pre lockdown activities .. strict monitoring of every person coming in with quarantine whenever should be enforced.
6) Any mass movement of public by train etc should be discouraged for at least one more month.. Crowded trains with closed enviornment will spread infection easily and to far away regions..

obvious problems in this exit plan are:
1) I know this division cant be watertight and transport of goods , milk, agri products will be required ..
2) Most our economic centers will fall in red zone and extended curfew here will affect economy badly..
This is just Raw idea and I hope we all can improve it or comeup with better idea to exit this lock down..


I really like this, Doctor. A blanket lockdown for extended period would damage the economy which is needed to generate the resources needed to combat the virus. The PPE problem is a defining example, even highly industrialized countries cannot produce key items when in lockdown. India is a continental sized country, it needs the parts that are not or less infected to resume economic activities that can resource the fight in places that are in lockdown.

The key is how we supply and sustain the red and yellow regions until they are healed.


Supplying essentials will be difficult.. Only way to manage this will be ICU like PPE at point of loading /unloading..drivers returnining from yellow / red zones will also need to be quarantined for certain period.. It seems hard but it is certainly less hard than total lockdown

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Re: Wuhan Coronavirus Resource Thread

Postby Zynda » 03 Apr 2020 19:02

India Finds Itself At The Back Of The Line For Virus Test Kits

As India races to head off the novel coronavirus pandemic, it's empowered almost 200 state-run and private labs to conduct tests to determine who among its dense population has the virus.
Yet weeks into an outbreak that's caused a national lockdown, those labs are largely standing idle. The 123 state-run labs are operating at only 36% capacity, while the 49 accredited private labs managed just an average of eight tests each on Monday, according to the Indian Council of Medical Research.

They say they lack test kits as India struggles to secure the foreign-made ones now in urgent demand globally. Meanwhile, red tape is slowing the deployment of locally made test kits.

"We don't have kits at all," said Nilesh Shah, the president of Metropolis Healthcare Ltd., one of the accredited private diagnostics firms, adding that government labs don't have supplies either. "The priorities are going to countries where there is a major outbreak like Italy and Spain and the U.S. and the U.K. So all the major international vendors are saying I'm not sure how much I can allot for India."

The number of tests in India stood at just 42,788 on March 31, one-thirtieth the pace of the U.S and even further behind that of top testing countries like South Korea.

The low rate has sparked speculation that India's official tally of just under 2,000 infections is underestimating the true size of its outbreak as nations doing more testing report much higher case numbers. Densely packed cities and meager public finances make the country uniquely exposed to the kind of fast-moving contagion that's overwhelmed health-care systems around the world.

Tracking India's Steps to Contain Economic Fallout of the Virus

While the danger of Covid-19 has prompted Prime Minister Narendra Modi to impose the world's biggest lockdown, India has to compete with much richer countries for the chemicals used to assess a patient's sample. While India has a vast manufacturing sector devoted to churning out generic drugs, its bio-pharmaceutical industry's ability to make higher-end medication and devices -- like the virus test kits which identify the pathogen's genetic sequence in a patient's sample -- is still lacking.

The Indian Council for Medical Research referred questions on the impact of the testing kit shortage to the Ministry of Health and Family Welfare. A spokeswoman for the ministry didn't respond to calls, emails and text messages requesting comment.

"Currently there is more demand than supply so everything is overpriced," said Akoriaswamy Velumani, managing director of Thyrocare Technologies Ltd., another diagnostics company recruited for testing. "We buy test kits and sell the services. We don't have adequate test kits, and adequate test kits are not available in the market."

Can't Get to Pune

With the bottleneck in foreign imports, pressure is growing for India to use locally-made kits. The government will accept kits already approved by the U.S. and European authorities, but local manufacturers need to go through a regulatory approval process which up to now has been conducted only by one government facility in the city of Pune, a three-hour drive from Mumbai.

With all trains, flights and railway services halted in the three-week lockdown, that means that any kit maker not based in Pune has not been able to get approval. Pune-based startup Mylab Discovery Solutions is the sole local maker approved at present and has the capacity to make 20,000 tests a day. It's working to ramp that up, the company said in an emailed statement.

Others have been hampered. Trivitron Healthcare, a Chennai-based maker of medical devices, said it's not been able to reach Pune but is hopeful that the planned addition of an evaluation center in Delhi, where Trivitron has its own office, may help it win approval for its own test kit as early as next week, said Managing Director G.S.K. Velu. Its test kit can produce results at a cost of 500 rupees ($6.50) per patient.

"Internationally it's much more expensive," he said. "The U.S. is paying much more. In India we have to innovate and bring it down to very low cost so people can actually afford it."


Can't the local companies ask/apply for a travel pass and "drive" themselves to Pune for submission of the kits?

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Re: Wuhan Coronavirus Resource Thread

Postby arshyam » 03 Apr 2020 19:04

As some of you had clarified to my question yesterday...

Questionable Hygiene Practices At Delhi Centre Of Tablighi Jamaat May Have Played A Role In It Being A ‘Super-Spreader’ Of Covid-19 - Swati Goel Sharma, Swarajya

“We ate from the same utensil. We ate in a batch of four and used one big plate to put bread, rice and curry. We all ate from it together and would not use spoon or cutlery. Then we would leave the plate as it was. Another batch of four would come and eat from the same plate. This would continue for six or seven batches,” he says.
Johny further says that the building had a “small swimming pool kind of a water area” for ‘Wudu’. Wudu is a purification ritual among Muslims where they wash their faces, hands, arms and feet with water before performing namaz. “As all of us used the same water for Wudu, spread of such a virus is guaranteed,” he says.


Read full article on the site. Quite interesting, if not disgusting.

This is good news, actually. When I posed the question yesterday, I was worried about a new virulent strain coming through. But if the hygiene levels are so abysmal, the existing strain itself would happily transmit. But this silver lining here once these people are taken out of this contagious environment, the lower rate of transmission we have seen in general would start appearing again, of course, as long as these idiots don't go around sharing more plates, toilets or su-su. This is where the states have been proactive in identifying and catching these idiots, and the lockdown has helped damp further transmission in general.

So, net net, while this jump was alarming, I think we can breathe a bit better with greater hopes of seeing this through. Of course, we have to continue to follow other good practices like cooperating with the lockdown, personal hygiene, social distancing, etc. for some time to come.
Last edited by arshyam on 03 Apr 2020 19:07, edited 1 time in total.

arshyam
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Re: Wuhan Coronavirus Resource Thread

Postby arshyam » 03 Apr 2020 19:06

Another good article that makes these points using numbers:

Data Story: Even Counting For Tablighi Jamaat’s Recklessness, India Containing Covid-19 At Stage Two Itself - Venu Gopal Narayanan, Swarajya

Image

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Re: Wuhan Coronavirus Resource Thread

Postby arshyam » 03 Apr 2020 19:10

Zynda wrote:India Finds Itself At The Back Of The Line For Virus Test Kits

The low rate has sparked speculation that India's official tally of just under 2,000 infections is underestimating the true size of its outbreak as nations doing more testing report much higher case numbers. Densely packed cities and meager public finances make the country uniquely exposed to the kind of fast-moving contagion that's overwhelmed health-care systems around the world.

Ah, NDTV. Never fails, does it?

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Re: Wuhan Coronavirus Resource Thread

Postby Kaivalya » 03 Apr 2020 19:14


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Re: Wuhan Coronavirus Resource Thread

Postby chanakyaa » 03 Apr 2020 19:14

DrRatnadip wrote:...
Few ways to achieve this could be:
1) Everyone who can work from home should continue it..This can continue for may be 2 -3 months or more..
2) Regions can be divided in Red zone ( high risk of community spread ), yellow zone (moderate risk of community spread) , Green zone ( low risk of community spread).. This will be dynamic division and area can be reclassified as situation evolves.
3) Red zones will require extended quarantine.. No public transport here.. Everything to mantain social distancing should be strictly enforced for longer time say one more month..No in and out movement from these areas permitted
4)In Yellow zones return of low risk individuals should be allowed in community.. strong public motivation will be needed to keep high risk individuals i.e. elderly and those with multiple co morbidities.. We can use all available data from adhar/ insurance / PMJAY to tag and encourage high risk individuals to stay home so that young , healthy people can restart work and contribute to herd immunity.. Unless herd immunity develops transmission of virus is not going to slow down.. Again no movement in and out of region can be permitted..
5) many regions havn't seen Covid patients yet .. these Green zones can resume pre lockdown activities .. strict monitoring of every person coming in with quarantine whenever should be enforced.
6) Any mass movement of public by train etc should be discouraged for at least one more month.. Crowded trains with closed enviornment will spread infection easily and to far away regions..

Great suggestions. Controlled de-escalation of lockdown would be ideal. The success of something similar requires massive enforcement of such boundaries (red/yellow/green) . Also the ability to lock down/open up micro regions can be a challenge, but can be done. Ideally, if super low cost test strips were to be developed and widely distributed, my guess is that people would be very willing to proactively report and quarantine, using micro small health centers around the country (near temples, mosques, churches, parks, shopping centers, traffic light, markets etc.). It is good for people who have lost jobs from the shutdown to be employed at these centers with some basic/limited medical on-the-job training. Need to take taboo away, It is okay to be infected with coronavirus.

Added later: most importantly, just before opening up the economy, pass a law -- 6 months of imprisonment if you do not report or under report COVID-19 related symptoms.

This is just to create some fear in population. We saw how people properly behave when cops won't hesitate to use danda.

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Re: Wuhan Coronavirus Resource Thread

Postby yensoy » 03 Apr 2020 19:40

Kaivalya wrote:Tamilnadu update:
100 of the new 102 cases are related to the jamaat
https://www.thenewsminute.com/article/tamil-nadu-reports-102-new-covid-19-cases-total-rises-411-121781


Which raises the question - are we wasting precious test resources and time on a lost cause and losing track of the virus in non-jamaati population?

Now obviously we don't want to not test the jamaatis and their ilk. The question is whether jamaati testing is coming at the cost of the wider population.

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Re: Wuhan Coronavirus Resource Thread

Postby Zynda » 03 Apr 2020 19:45

chanakyaa wrote: Ideally, if super low cost test strips were to be developed and widely distributed, my guess is that people would be very willing to proactively report and quarantine, using micro small health centers around the country (near temples, mosques, churches, parks, shopping centers, traffic light, markets etc.). .

Can antibodies test used as a screening mechanism? But the sheer numbers of people that needs to be tested (even if we are gonna test lets say only between certain age groups (18-50) in metro cities to start with) could stretch the testing time in to months...

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Re: Wuhan Coronavirus Resource Thread

Postby anmol » 03 Apr 2020 20:06

Largest Statistically Significant Study by 6,200 Multi-Country Physicians on COVID-19 Uncovers Treatment Patterns and Puts Pandemic in Context

Sermo Reports on Hydroxychloroquine Efficacy, Rise in Prophylaxis Use; Over 80% Expect 2nd Outbreak

April 02, 2020 09:00 AM Eastern Daylight Time

NEW YORK--(BUSINESS WIRE)--Widespread confusion, conflicting reports, inconsistent testing, and off-indication use of existing and experimental drugs has resulted in no single source of information from the frontlines. To create a centralized and dynamic knowledge base, Sermo, the largest global healthcare polling company and social platform for physicians, leveraged its capabilities to publish results of a COVID-19 study with more than 6,200 physicians in 30 countries. The study was completed in three days. Data covers current treatment and prophylaxis options, timing to the outbreak peak, ethical choices, effectiveness of government responses, and much more. Multiple study waves including a deeper dive into treatments will be conducted over the next several weeks. To view results and countries visit sermo.com.Key findings; Sermo Real Time Barometer *:

Treatments & Efficacy

  • The three most commonly prescribed treatments amongst COVID-19 treaters are 56% analgesics, 41% Azithromycin, and 33% Hydroxychloroquine
  • Hydroxychloroquine usage amongst COVID-19 treaters is 72% in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in the U.S., 17% in Germany, 16% in Canada, 13% in the UK, and 7% in Japan
  • Hydroxychloroquine was overall chosen as the most effective therapy amongst COVID-19 treaters from a list of 15 options. (37% of COVID-19 treaters)
    • 75% in Spain, 53% Italy, 44% in China, 43% in Brazil, 29% in France, 23% in the U.S., and 13% in the UK
  • The two most common treatment regimens for Hydroxychloroquine were:
    • (38%) 400mg twice daily on day one; 400 mg daily for five days
    • (26%) 400mg twice daily on day one; 200mg twice daily for four days
  • Outside the U.S., Hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the U.S. it was most commonly used for high risk diagnosed patients
  • Globally, 19% of physicians prescribed or have seen Hydroxychloroquine prophylactically used for high risk patients, and 8% for low risk patients

Second Wave of Outbreak

  • The second global outbreak is anticipated by 83% of global physicians, 90% of U.S. physicians but only 50% of Chinese physicians

Average Testing Time

  • On average tests in the U.S. take 4-5 days, and in 10% of cases the wait is more than 7 days
  • 14% of U.S. physicians and over 50% in all of Europe and Japan report getting test results in 24 hours; in China 73% of doctors get tests back in 24 hours, while 8% get tests back within the hour

Prioritizing Treatment if Ventilator Shortage

  • In all countries except China, the top criteria for deciding who should receive a ventilator first was patients with the highest chance of recovery (47%) followed by those most ill and at highest risk of death (21%), then first responders (15%)
    • In China the priorities were reversed as the most ill and highest risk of death received ventilators
  • First responders were more important in the U.S.
  • France, Japan, and Italy prioritized age
  • Brazil and Russia prioritized higher risk patients

Peak Timing & Restrictions

  • In the U.S., 63% of physicians recommend restrictions be lifted six or more weeks from now and 66% believe the peak is at least 3-4 weeks away
For the full methodology click here.

Methodology

Results are reported for individual countries with a minimum sample size of 250. Such a sample size provides for point estimates with a +/- 6% precision at a 94% confidence level. Thirty countries included in the study are the United States, Canada, Argentina, Brazil, Mexico, Germany, Italy, the United Kingdom, France, Spain, Belgium, the Netherlands, Sweden, Turkey, Poland, Russia, Finland, Ireland, Switzerland, Austria, Denmark, Norway, Greece, Taiwan, Japan, South Korea, Australia, China, India, and Hong Kong. No incentive was offered to respondents. Full methodology.

About Sermo

Sermo is the largest healthcare data collection company and social platform for physicians, reaching 1,3MM HCPs across 150 countries. The platform enables doctors to anonymously talk real-world medicine, review treatment options via our proprietary Drug Ratings platform, collectively solve patient cases, and participate in medical market research. For more information, visit sermo.com.Image

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Re: Wuhan Coronavirus Resource Thread

Postby arvin » 03 Apr 2020 20:28

arshyam wrote:As some of you had clarified to my question yesterday...

Questionable Hygiene P aractices At Delhi Centre Of Tablighi Jamaat May Have Played A Role In It Being A ‘Super-Spreader’ Of Covid-19 - Swati Goel Sharma, Swarajya
.

Even in big IT companies few pious educated muslims put their legs in wash basins to wash before prayers, where normally regular employees wash hands and faces. So much so that facility management has explicit instructions forbiding this particular practice in emails sent company wide.

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Re: Wuhan Coronavirus Resource Thread

Postby chola » 03 Apr 2020 20:52

arvin wrote:
arshyam wrote:As some of you had clarified to my question yesterday...

Questionable Hygiene P aractices At Delhi Centre Of Tablighi Jamaat May Have Played A Role In It Being A ‘Super-Spreader’ Of Covid-19 - Swati Goel Sharma, Swarajya
.

Even in big IT companies few pious educated muslims put their legs in wash basins to wash before prayers, where normally regular employees wash hands and faces. So much so that facility management has explicit instructions forbiding this particular practice in emails sent company wide.


That is so f-ing disgusting and completely disrespectful to everyone else. There is no consideration given to anyone not of their ilk. I could see why Cheen simply put all of them in camps.

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Re: Wuhan Coronavirus Resource Thread

Postby vera_k » 03 Apr 2020 20:58

^ Given the lack of compliance, COVID-19 will be an ideal virus to spread around once a treatment or vaccine is identified.

Effect of SARS-CoV-2 infection upon male gonadal function

the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19

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Re: Wuhan Coronavirus Resource Thread

Postby Avtar Singh » 03 Apr 2020 21:04

That is disgusting, my sympathies to all of you that endure these behaviours...

You should not waste testing kits on these pious fools just assume and quarantine..........
In their own religious establishments, their god should take care of them
No doubt easier said than done thanks to commies and fake liberal brigade.

Worst than that will be all the valuable treatment resources wasted on these types.

Shock and awe is due for all these groups, but nobody to deliver it;
FLICs... Fake Liberals Islamist Communists

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Re: Wuhan Coronavirus Resource Thread

Postby Primus » 03 Apr 2020 21:13

Excellent points Sanjay Ji. Here you go:

sanjaykumar wrote:
There are several vaccine trials gearing up.


One, may have already been posted: Microneedle array Delivered Recombinant Corona virus vaccine

Keep the vulnerable, the elderly, diabetic, obese sequestered. Get the antibody test and 'passport' done. Demonstrate recovered patients are immune. Get them into the workforce. Develop the passive immunisation approach as viable. Do plasmapheresis if there are unacceptable immune reactions (serum sickness), work on anti anti idiotypic antibodies (humanised monoclonal). Develop competitive inhibitors to the ACE Type 2 binding interaction. This will require hydrolytic enzyme(peptidase) inhibition and peptide modification or inhibitors to any specific peptidase that is found to degrade the competitive oligo peptide. May need synthetic molecules to mimic the three dimensional structure of the binding site if a simple oligopeptide is inadequate. Do a large study on the drugs patients were on when they developed the infection. Determine if statins, ARBs etc have any survival advantage.

There are no shortcuts, biologists are at work.


Already some data coming in.

Trial Drug Can Significantly Block early Covid-19 stage in human engineered tissues

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Re: Wuhan Coronavirus Resource Thread

Postby Mollick.R » 03 Apr 2020 21:19

ricky_v wrote:First i thought it was substantial for an hour or so, it is for 5 minutes, what is that going to do? if the lt consumers stop everything at the same time, keeping in mind that our country is conncted by a single grid at 50 hz, and then back up in short phases we will enjoy voltage dips and grid blackouts; surely such exercise has more pupose and reasoning behind it and is not merely a pointless gimmick for solidarity and oneness purposes.


Sir, here we go :D :-o
PM Modi's solidarity call: Here's why the 9-minute challenge is 'unprecedented' for the power industry

What happens when 130 crore Indians switch off lights in their homes, together?

That's the question that engineers in India's power sector are now grappling with, after Prime Minister Narendra Modi called upon the nation to do so, in solidarity amidst the COVID-19 crisis.

"It's like suddenly putting a brake of a car in motion, or suddenly pushing the accelerator to the floor...it is difficult to predict how the car will exactly behave. It is the same predicament, but much more complicated, that we all are facing," said a senior executive from the power sector.

According to industry executives, they have two days time to plan for those nine minutes. "It is a challenge, and something unprecedented. But it is possible," said another executive from the industry.

To clearly understand the challenge, one needs to know how the power sector functions.

How you get electricity?

Three important stakeholders come to play to ensure electricity reaches our homes - power generators like Tata Power and NTPC; the distribution companies that each state has; and finally the state load dispatch centres, or SLDCs, who play a critical role in matching the supply, with demand of power.

"It's like you have the aircraft, airport and the ATC. The SLDC functions like the ATC, which ensures aircraft take off and land smoothly and without any delay," explained Gopal Jain, Senior Advocate, Supreme Court of India, and advises on regulatory and policy matters

Like the ATC, the SLDC coordinates between generators and distributors to decide how much power is supplied into the grid. A day is divided into 96 time blocks of 15 minutes each, and the SLDC in each state prepares a schedule of demand and supply for every block.

"It is a highly automated and scientific process," added Sitesh Mukherjee, a lawyer specialising in infrastructure regulatory disputes.

SLDC has a very critical role. It has to ensure that the frequency of power that runs in the power grid lines should be between 48.5 and 51.5 hertz.

"If it goes too high (when the supply is too high) or too low (when the demand goes haywire), then lines can trip, leading to outages," he said.

Something similar to what happened in the 2012 blackout - the biggest in the world - when a sudden surge in demand led to tripping and almost 600 million Indians went without electricity.

Controlling supply

On April 5, instead of demand, the danger is of supply surging and disrupting the frequency when Indian switch off lights all at once at 9 pm. This could trip the line, and lead to a blackout.

But, assure senior engineers in the sector, it can be handled as they have the time to plan.

The critical part is to manage the supply.

Track this blog for latest updates on coronavirus outbreak

India gets power from different sources - thermal, hydel, gas, wind and solar. Which of these sources can be adjusted to reduce the supply?

"Solar doesn't generate in the night. Wind is continuous and can't be stopped. But it is possible to completely shut down a hydel and gas plant," said an engineer. And it is not a herculean task to restart a hydel or gas plant.

Not so with a thermal plant. "It can take hours to restart a thermal plant," said an executive.

Fortunately, because of the coronavirus impact, thermal plants are already running on low capacity. At the same time, they can't be shut completely to reduce the supply on April 5. What they can do is to keep capacity utilisation at the lowest for those nine minutes on Sunday.

"From the moment the Prime Minister made the announcement, the stakeholders - power generators, DISCOMs and SLDCs - have started planning for Sunday," said one of the senior executives quoted above.

Nine minutes

The nine minutes are a challenge because it doesn't constitute a time block of 15 minutes, and the sophisticated systems can't be re-configured at a short notice.

What will help the industry is that on April 5, it will be only the lights that will go off. "People won't switch off fans or air conditioners. Also, street lights and those in other public places will be on. Moreover, there will be some percentage of people who will forget to switch off!" says an engineer.

Executives in the industry expect the fluctuation to be of about 9-10 percent of the total power requirement. "It is not very high. At the same time, adjusting the electricity supply won't be easy. It is a challenge, says an executive.

Particularly challenging could be the 10th minute, when everyone probably will put on the lights again. Will the supply meet the sudden spurt in demand?

"It will be interesting to know," is how one executive put it.

With inputs from Jitendra Gupa

https://www.moneycontrol.com/news/companies-2/pm-modis-solidarity-call-heres-why-the-9-minute-challenge-is-unprecedented-for-the-power-industry-5104731.html

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Re: Wuhan Coronavirus Resource Thread

Postby yensoy » 03 Apr 2020 21:26

^^^^ I find it hard to believe that home lighting will affect power consumption in such a major way. This is the era of LED and CFL bulbs, and people have other energy hogging appliances & devices which are not going to be switched off (TVs, fans, airconditioners, pumps, fridges, computers), so I think this is much ado about nothing.

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Re: Wuhan Coronavirus Resource Thread

Postby saip » 03 Apr 2020 21:28

[quote="arshyam"]As some of you had clarified to my question yesterday...

Questionable Hygiene Practices At Delhi Centre Of Tablighi Jamaat May Have Played A Role In It Being A ‘Super-Spreader’ Of Covid-19 - Swati Goel Sharma, Swarajya

This guy attended that congregation in November but according to him he was infected at that time with something. But the first case in India was reported on January 31. Even China traced their first case to Nov 17th. May be he was not infected with COVID 19 but some other ailment. But definitely the hygiene practices definitely would contribute to the spread of any communicable diseases, prayers not withstanding.

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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 03 Apr 2020 21:52

Karnataka allows defence industries to resume operations as they are part of global suppy chains for Boeing and Airbus


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Re: Wuhan Coronavirus Resource Thread

Postby hanumadu » 03 Apr 2020 21:57

Without the TJ idiots, new covid cases in India over the past three days seem to be less than 100. Considering that there were 15 lakh international arrivals to India and we haven't seen a lot of cases from them, its a good sign.

If many of them were infected but not showing signs, it's an even better sign.

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Re: Wuhan Coronavirus Resource Thread

Postby John » 03 Apr 2020 22:10

I am not surprised by how it spread so fast in US because of 2 reasons:
Arrogance, I remember reading and hearing a lot of comments in channels such as fox news and other similar platforms that Coronavirus is an "Asian" thing or 3rd world diseases and it won't have much of impact on US. As we are cleaner, better prepared, we don't need masks washing hands is better etc.

Poor central planning and lack of coordination. Needless to say Trump admin was poorly prepared and cut backs to CDC greatly hurt the response. The states were are also poorly prepared and still are, you need to have centralized response not just let the state/cities do whatever they want.

Current projection calls for mill cases in US by end of April


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