Wuhan Coronavirus Resource Thread

[chola]

Germany seems to be doing good compared to its neighbours. What's the trick there? Are they using homeopathy or something?

our current situation reminds me of older days where villagers put wet napkin on forehead and wait it out.

Read this on Germany:
https://www.nytimes.com/2020/04/04/worl ... -rate.html

To sum it up:

1. Average age of infected is 49 compared to over 60 in Italy,

2. Lots of ICU beds and a very prepared medical system,

3. Most importantly: Heavy testing like in South Korea; more cases caught and identified lower death rate; also cases caught early combined with #1 younger average age and #2 ample ICU room means more successful treatment,

4. A trusted government and discipline population allow policies to be followed so that #3 testing can be applied uniformly to both young and old.

Overall, it is just a very disciplined and efficient country even when it is bordered by Italy and France with very high death rates (over 12%.) Germany's death rate is lower than SoKo -- 1.6%.

[chola]

Argentinian describes Beijing today. Could be a paleface 50-center but the steps he described are sensible.

The QR code scan and temperature check everywhere you go is a massive invasion of privacy but it definitely allows Big Brother to track anyone who starts to develop symptoms again.


They have toilet paper, masks and hand sanitizers galore there. Who'd thought I'd be jealous of people having that kind of chit just two weeks ago but I am today.

[syam]

Read this on Germany:
https://www.nytimes.com/2020/04/04/worl ... -rate.html

To sum it up:

1. Average age of infected is 49 compared to over 60 in Italy,

2. Lots of ICU beds and a very prepared medical system,

3. Most importantly: Heavy testing like in South Korea; more cases caught and identified lower death rate; also cases caught early combined with #1 younger average age and #2 ample ICU room means more successful treatment,

4. A trusted government and discipline population allow policies to be followed so that #3 testing can be applied uniformly to both young and old.

Overall, it is just a very disciplined and efficient country even when it is bordered by Italy and France with very high death rates (over 12%.) Germany's death rate is lower than SoKo -- 1.6%.

So basically they are being good boys and following every rule to t. I would have believed it if there is no unruly immigrant population and stupidity running rampant in Germany. sadly that's not the case, chola ji. those 'ariayans' are upto something.

[DrRatnadip]

Primus sir , Thank you for your inputs.. COVID 19 leads not only to SIRS but also CARS (counterregulatory anti inflamatory response syndrome)..

It is also possible that Young previously healthy patients who suddenly detoriate are more likely to have SIRS.. This will explain presence of myocarditis , arrythmias, cardiovascular collapse in such patients.. Role of IL 1 is well known in pathogenesis of myocarditis.. Such patients may be benefited by judicious use of steroids..

While older patients who do well in first wk and detoriate in second wk are likely to be hit by CARS.. profound immunosuppression associated with CARS will lead to annergy , lymphopenia and increased production of anti inflamatory cytokines such as IL10.. Such pt will be easy targets for severe secondary infections like venti associated peumonia, central line associated infections.. This will explain high mortality in ventilated patients.. Steroids will be harmful in this situation unless indicated as last resort option for septic shock..

More research especially regarding levels of various markers of inflamation in each critically ill Covid patient is needed.. It is not only virus which is making people so sick , but body's immune response ,either hyper ( SIRS) or suppressed(CARS) is also playing major part in development of severe illness..

[Rahul M]

Germany seems to be doing good compared to its neighbours. What's the trick there? Are they using homeopathy or something?

our current situation reminds me of older days where villagers put wet napkin on forehead and wait it out.

I read somewhere that they are reporting a covid death only if it was the cause of death. Unlike, say Italy which is reporting a covid death of the patient is covid positive, irrespective of cause of death.
Can't find the article though.

[pgbhat]

More than ventilators, India needs thousands of coronavirus contact-tracers

Ventilators dominate the public discourse, perhaps driven by what Atul Gawande calls the heroic expectation of how medicine works — the image of doctors saving a person from the clutches of certain death is fascinating.

A contact tracer with a clipboard requesting a list of people with whom the patient spent more than 30 mins within two metres proximity in the last seven days appears mundane by contrast. But in discounting the lucid and effective strategy of contact tracing, we forget that in responding to extraordinary pandemic situations, simplicity might be the ultimate sophistication.

[milindc]

Primus sir , Thank you for your inputs.. COVID 19 leads not only to SIRS but also CARS (counterregulatory anti inflamatory response syndrome)..

It is also possible that Young previously healthy patients who suddenly detoriate are more likely to have SIRS.. This will explain presence of myocarditis , arrythmias, cardiovascular collapse in such patients.. Role of IL 1 is well known in pathogenesis of myocarditis.. Such patients may be benefited by judicious use of steroids..

While older patients who do well in first wk and detoriate in second wk are likely to be hit by CARS.. profound immunosuppression associated with CARS will lead to annergy , lymphopenia and increased production of anti inflamatory cytokines such as IL10.. Such pt will be easy targets for severe secondary infections like venti associated peumonia, central line associated infections.. This will explain high mortality in ventilated patients.. Steroids will be harmful in this situation unless indicated as last resort option for septic shock..

More research especially regarding levels of various markers of inflamation in each critically ill Covid patient is needed.. It is not only virus which is making people so sick , but body's immune response ,either hyper ( SIRS) or suppressed(CARS) is also playing major part in development of severe illness..

Thanks for all the guidance thus far. Really helpful for non-medicos. Your way of explaining dumbs its down for us to understand easily
Any guidance on when tocilizumab will be useful. CARS or SIRS ?
And what indications need to be checked before administering 'tocilizumab' drugs ?

[milindc]

Germany seems to be doing good compared to its neighbours. What's the trick there? Are they using homeopathy or something?

our current situation reminds me of older days where villagers put wet napkin on forehead and wait it out.

Read this on Germany:
https://www.nytimes.com/2020/04/04/worl ... -rate.html

To sum it up:

1. Average age of infected is 49 compared to over 60 in Italy,

2. Lots of ICU beds and a very prepared medical system,

3. Most importantly: Heavy testing like in South Korea; more cases caught and identified lower death rate; also cases caught early combined with #1 younger average age and #2 ample ICU room means more successful treatment,

4. A trusted government and discipline population allow policies to be followed so that #3 testing can be applied uniformly to both young and old.

Overall, it is just a very disciplined and efficient country even when it is bordered by Italy and France with very high death rates (over 12%.) Germany's death rate is lower than SoKo -- 1.6%.

I think early intervention is also very key for low mortality. Especially this quote

They call them corona taxis: Medics outfitted in protective gear, driving around the empty streets of Heidelberg to check on patients who are at home, five or six days into being sick with the coronavirus.

They are checking every person with infection and monitoring that person every day. Any decline and that person is hospitalized immediately.

[chola]

Read this on Germany:
https://www.nytimes.com/2020/04/04/worl ... -rate.html

To sum it up:

1. Average age of infected is 49 compared to over 60 in Italy,

2. Lots of ICU beds and a very prepared medical system,

3. Most importantly: Heavy testing like in South Korea; more cases caught and identified lower death rate; also cases caught early combined with #1 younger average age and #2 ample ICU room means more successful treatment,

4. A trusted government and discipline population allow policies to be followed so that #3 testing can be applied uniformly to both young and old.

Overall, it is just a very disciplined and efficient country even when it is bordered by Italy and France with very high death rates (over 12%.) Germany's death rate is lower than SoKo -- 1.6%.

So basically they are being good boys and following every rule to t. I would have believed it if there is no unruly immigrant population and stupidity running rampant in Germany. sadly that's not the case, chola ji. those 'ariayans' are upto something.

I don't know. They have tons infected but they are still able to accept patients from Italy and France:
*https://www.foxnews.com/world/germany-t ... from-italy

*https://www.reuters.com/article/health- ... SL8N2BF0J8

Also when everyone else in the West is short of supplies, they are so well-stocked that other Europeans are screaming that the Germans should share including the ventilators that EVERYONE is asking for:
https://www.nytimes.com/2020/03/17/opin ... rmany.html

[chola]

Read this on Germany:
https://www.nytimes.com/2020/04/04/worl ... -rate.html

To sum it up:

1. Average age of infected is 49 compared to over 60 in Italy,

2. Lots of ICU beds and a very prepared medical system,

3. Most importantly: Heavy testing like in South Korea; more cases caught and identified lower death rate; also cases caught early combined with #1 younger average age and #2 ample ICU room means more successful treatment,

4. A trusted government and discipline population allow policies to be followed so that #3 testing can be applied uniformly to both young and old.

Overall, it is just a very disciplined and efficient country even when it is bordered by Italy and France with very high death rates (over 12%.) Germany's death rate is lower than SoKo -- 1.6%.

I think early intervention is also very key for low mortality. Especially this quote

They call them corona taxis: Medics outfitted in protective gear, driving around the empty streets of Heidelberg to check on patients who are at home, five or six days into being sick with the coronavirus.

They are checking every person with infection and monitoring that person every day. Any decline and that person is hospitalized immediately.

Yes, the testing and tracking regiments are very similar to Korea and Cheen. The uniform testing is what allows efficient early intervention. Germany is not a younger country than France or Italy, the only reason the average age of the infected is 49 is because they tested a larger cross section of the population. Unlike other places where tests are given mainly to people already suffering from symptoms who tend to be older hence the 60 avg age of the infected in France and Italy.

[KL Dubey]

Not sure if this was posted earlier....

March 18
Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro
https://www.nature.com/articles/s41421-020-0156-0

March 23
Insights from nanomedicine into chloroquine efficacy against COVID-19
https://www.nature.com/articles/s41565-020-0674-9

March 31
Comparing HydroxyChloroquine Trials
https://blogs.sciencemag.org/pipeline/a ... ine-trials

Comments ?

On a different note, it seems like the media outlets shouting "Trump pushing HCQ" are all the same ones that we at BRF curse for anti-India and anti-Hindu propaganda...?

[sooraj]

Indian Immunologicals partners with Griffith University to develop COVID-19 vaccine

IIL becomes the fourth Indian vaccine maker to announce vaccine development against COVID-19.

Indian Immunologicals (IIL), the vaccine-maker promoted by the National Dairy Development Board (NDDB) on April 7 said it has partnered with the Griffith University of Australia to develop a live attenuated vaccine against novel coronavirus disease (SARS – CoV-2).

The live attenuated vaccine contains a live but weakened virus. The vaccine is developed on Griffith's codon de-optimization technology which reduces the virulence of the virus. SARS – CoV-2 is an RNA virus known to have high virulence.

Upon completion of the research, the vaccine strain will be transferred to IIL and the vaccine maker will work accordingly with the country’s drug regulator – the Central Drugs Standard Control Organisation (CDSCO) - to further conduct clinical trials which will be taken up in a phased manner.
IIL intends to use its existing Vero cell platform technology for mass production of the virus.

IIL becomes the fourth Indian vaccine maker to announce vaccine development against COVID-19. Earlier, Serum Institute of India, Cadila Healthcare and Bharat Biotech announced vaccine development programmes against COVID-19. Currently, there is no vaccine against COVID-19. But there are more than 30 vaccine projects, most are in pre-clinical and early clinical trials. Experts say it takes at least a year to see a vaccine ready against COVID-19.

The technology looks promising for developing a vaccine for prophylactic, active, single-dose immunization against coronavirus in humans, with an enhanced safety profile, IIL said in a statement.

“IIL’s leadership in producing safe and affordable human and veterinary vaccines will enable us to progress well in this endeavor,” said K Anand Kumar, Managing Director, Indian Immunologicals Limited said,

IIL said it has evaluated various options being followed across the world, before zeroing on live attenuated COVID-19 vaccine based on codon de-optimization technology.

“Our live-attenuated vaccine will be developed using codon de-optimization technology and is expected to provide a long lasting immunity against SARS – CoV-2 following single immunisation and cross-protection against other coronaviruses (e.g. MERS, SARS-CoV-1)," said Professor Suresh Mahalingam, Menzies Health Institute Queensland, Griffith University, Australia.

"As this vaccine will be a live attenuated vaccine it is expected to be highly effective by providing very strong cellular and antibody immune responses against the virus. The other benefit of a live-attenuated vaccine is a proven track record for economical large-scale manufacturing and well-known regulatory approval pathway,” Mahalingam added.

IIL is already working with Griffith for conducting research and development of the Zika virus vaccine which is currently at a pre-clinical toxicology testing stage. The joint project has been progressing well and Indian Immunologicals is expected to submit the application for conducting clinical trials in due course.

The codon de-optimization technology has been successfully employed to reduce the virulence of several RNA viruses including Enterovirus C (Poliovirus), Human Immunodeficiency virus type 1, Zika virus, etc.

[Aarvee]

Codon de-optimisation is fascinating. It has been described as "death by a thousand cuts". Although multiple in vitro studies show successful attenuation, no approved vaccine exists, that has been developed using this technology.

For people who would like to know more, DNA codes for RNA which codes for Protein, This is called as the "Central dogma of Molecular Biology".

In case of this virus, RNA codes for proteins (No DNA stage). Three bases (Called a codon) in DNA/RNA, code for an amino acid (for example ATG-Methionine etc, where A, T and G are the nucleotide bases), and this sequence of amino acids make up a protein. As there are 4 bases and three bases per codon, there are 64 possible combinations. 61 actually code for the 20 or so amino acids while three are stop codons. Most amino acids "Can" be coded by 3 codons. But in most host systems (humans etc..) one codon is disproportionally commonly used to code for an amino acid. This is thought to be because other translational mechanisms (i.e. protein making) are optimised to use this codon (i.e. not to make unnecessary tRNAs etc). This is called Codon optimisation.

If a gene/mRNA/virus is introduced with deoptimised codons i.e. the protein sequence doesnt change but codons that are rarely used to code for amino acids are used, the replication of the virus is significantly diminished. this results in the immune system having enough time to mount a good response. Live atennuated vaccines generally result in a much better immune response than just a sub-unit vaccine. This is the reason Hep-B vaccine has to be taken multiple times/Boosters to maintain a high enough IgG titre.

[pankajs]

viewtopic.php?f=1&t=7788&start=4040#p2426167

https://twitter.com/ShekharGupta/status ... 7460639744

Shekhar Gupta @ShekharGupta

Am learning about this silly Hydroxychloroquine issue with help from @ChandnaHimani, our stellar pharma/health reporter. Sobering to see how little I knew. India consumes 20 lakh (2 mill) HCQ pills/month. It makes 20 cr (200 mill). Rest exported. Can easily scale to 300m/month

Our Non-Covid demand = 2 million / month
Production = 200 million / month
Capacity = 300 million / month

Now this is for current capacity of Tablets I guess. What is our total API demand and internal supply? How far up can the internal supply of API be ramped up and how fast?

Update from Zydus Cadila
https://timesofindia.indiatimes.com/bus ... 038874.cms

MUMBAI: Zydus Cadila, one of the two largest manufacturers of key Covid drug hydroxychloroquine (HCQ), has ramped up its production by nearly 10X to 30 metric tonnes (15 crore tablets of 200mg) per month in view of the huge spike in demand expected due to rising cases of Covid-19.

@ 30 MT (API) (Expanded capacity) == 150 million tablets of 200 mg / month. That is almost equivalent to the total Indian production by ALL companies including IPCA and the rest! Further ...

He added that there are enough stocks in the country and, if need be, it can be scaled up to even 50mt (25 crore tablets).

Can be expanded further to 50 MT (API) == 250 million tablets of 300 mg / month.

All this from a single company and the smaller of the big two. Looks pretty good.

[pankajs]

Another report ..

https://www.businesstoday.in/sectors/ph ... 00419.html

Indian pharmaceutical companies are raising monthly production of anti-malarial drug Hydroxychloroquine (HCQ) four times to 40 metric tonnes (MT) by the end of this month and five to six times to over 70 metric tonnes (MT) by next month. The plan to step up production came after the Government of India indicated it will help countries in dire need of the drug to fight novel coronavirus.

Peak capacity would produce 35 crore (350 million) tablets of 200 mg dosage every month. India's own requirement is unlikely to exceed 10 crore tablets for which the government has already placed an order with leading domestic manufacturers Zydus Cadila and Ipca Laboratories. Industry experts say 10 crore tablets are good enough to treat seven crore people, if required. In India, HCQ costs less than Rs 3 per tablet.

Expanded capacity should be about 70 MT with 30 MT from Zydus and the remaining 40 MT from IPCA and the rest.

1. 70 MT = 35 crore (350 million) tablets of 200 mg / Month.
2. GOI order worth 10 crore (100 million) placed with Zydus and IPCA (About 50% of the current capacity/month and 30% of the expanded capacity)
3. Sufficient to treat about 7 crore people.
4. Compare that to the US stock pile of about 29 million (2.9 crore) doses. What additional amount has the US ordered?
5. Costs about Rs 3 per tablet.

Depending on the depletion of stock GOI will obviously further increase its orders with the manufacturers.

Two major Indian manufacturers - Zydus Cadila and Ipca Laboratories - have backward integrated production capacity - from key raw materials that can be converted to intermediates and then to APIs and to final formulations, in the 12-15 step process to make the medicine.

Most of the other Hydroxychloroquine API manufacturers import some key raw materials and intermediates from China or source them from countries like South Korea, Italy or Finland.

API manufacturers keep an inventory of raw materials for six months. With most of China returning to normalcy, sourcing raw material will not be an issue, industry sources said. An Indian Drug Manufacturers Association (IDMA) spokesperson even told India Today that shipments of intermediate chemicals for making HCQ have commenced from China.

This 6 months inventory would be based on the old demand pattern but no longer valid in the current scenario.

[Rishirishi]

Another report ..

https://www.businesstoday.in/sectors/ph ... 00419.html

Indian pharmaceutical companies are raising monthly production of anti-malarial drug Hydroxychloroquine (HCQ) four times to 40 metric tonnes (MT) by the end of this month and five to six times to over 70 metric tonnes (MT) by next month. The plan to step up production came after the Government of India indicated it will help countries in dire need of the drug to fight novel coronavirus.

Peak capacity would produce 35 crore (350 million) tablets of 200 mg dosage every month. India's own requirement is unlikely to exceed 10 crore tablets for which the government has already placed an order with leading domestic manufacturers Zydus Cadila and Ipca Laboratories. Industry experts say 10 crore tablets are good enough to treat seven crore people, if required. In India, HCQ costs less than Rs 3 per tablet.

Expanded capacity should be about 70 MT with 30 MT from Zydus and the remaining 40 MT from IPCA and the rest.

1. 70 MT = 35 crore (350 million) tablets of 200 mg / Month.
2. GOI order worth 10 crore (100 million) placed with Zydus and IPCA (About 50% of the current capacity/month and 30% of the expanded capacity)
3. Sufficient to treat about 7 crore people.
4. Compare that to the US stock pile of about 29 million (2.9 crore) doses. What additional amount has the US ordered?
5. Costs about Rs 3 per tablet.

Depending on the depletion of stock GOI will obviously further increase its orders with the manufacturers.

Two major Indian manufacturers - Zydus Cadila and Ipca Laboratories - have backward integrated production capacity - from key raw materials that can be converted to intermediates and then to APIs and to final formulations, in the 12-15 step process to make the medicine.

Most of the other Hydroxychloroquine API manufacturers import some key raw materials and intermediates from China or source them from countries like South Korea, Italy or Finland.

API manufacturers keep an inventory of raw materials for six months. With most of China returning to normalcy, sourcing raw material will not be an issue, industry sources said. An Indian Drug Manufacturers Association (IDMA) spokesperson even told India Today that shipments of intermediate chemicals for making HCQ have commenced from China.

This 6 months inventory would be based on the old demand pattern but no longer valid in the current scenario.

Can someone please clarify.
I have heard that 10 malaria tablets are given over a 3 days. But i do not know how powerfull they are. Would 350 million tabelts be sufficient to treat only 35 million people ?? I would imagine that at least 3-400 million people must be treated worldwide??

[syam]

I read somewhere that they are reporting a covid death only if it was the cause of death. Unlike, say Italy which is reporting a covid death of the patient is covid positive, irrespective of cause of death.
Can't find the article though.

even if they are not adding up numbers from other deaths, it still very less numbers.

Also when everyone else in the West is short of supplies, they are so well-stocked that other Europeans are screaming that the Germans should share including the ventilators

they are preparing for tests back in january itself. also they are neighbours to italy. must be expecting to have their own cases. so prepared well in advance.

one of the theories i have is, germany situation is very normal like rest of the world. there is no miracle happening there. it's to do with the testing. they are testing as many people as possible. unlike france and other countries which are testing only the sick. i know i am repeating what you guys saying. but it's very different situation here.

france has - 109,069 cases and 10,328 deaths
germany has - 107,663 cases and 2016 deaths.
belgium has - 22,194 cases and 2035 deaths
netherlands has - 19,580 cases and 2101 deaths.

s.korea has - 10,384 cases and 200 deaths.

germany and s.korea have very similar ratio of deaths and cases. on other hand, france, belg and neth not testing everyone. so the numbers look different. france might be having 500,000+ infected people. we may be having 1 death for every 50 infected cases.

so the virus is very extremely contagious and kills 1 out of every 50 infected persons.

[nam]

Wrong way to look at the data. The death rate should be against the population size.

Even if Germany tests the entire country, what will they achieve? You are just finding asymptomatic patients to prevent future spread. Positive cases are the ones who already got infected a week back.

There are no cure, so finding all of the patients in the country is only to ask them to stay at home. What if the ones tested negative, go out and get infected?

Will Germany test their entire population again?

[syam]

Wrong way to look at the data. The death rate should be against the population size.

it will be the infected people who will die. if we can find exact number of infections, we can calculate how many people are dying per given infections.

[srai]

^^^
It’s not about blindly testing everyone. More about testing a representative sample of the population to figure out infection rates, hotspots, transmission patterns, and infection tracing. Quality data for a more informed decision making by the governing bodies.

[Kaivalya]

^^^

For example Chennai is split into 16000 smaller units of the 100 blocks or so. Each of these 16000 is getting a group of people including volunteers and healthcare workers. They are responsible to pick test areas within their 100 blocks and are surveying people for symptoms, using rapid test kits etc. Hopefully today's result from the TN health secretary Bila Rajesh will have no more tableeghis and less than the last 5 days average of 60-70 cases

I assume that these smaller units inform administrators about increasing lockdown measures, additional testing measures in the next 5 days or slowly reduce the efforts as well. TN is learning and trying to replicate the model in all the cities in the past couple of days (based on TV reports)


Update 1 : Today's count in TN is 48 of which 42 is linked to TJ.

[nam]

Precisely. It is about isolation. Finding the infected region. Isolating it down to city, then to part of the city, down to lanes, down to household.


Isolation & Contact tracing is what is missing from European countries. So they have to go do mass testing as possible and make them sit at home.

US, Europe are not geared for pandemics, because they never had one for decades.

[brar_w]

one of the theories i have is, germany situation is very normal like rest of the world. there is no miracle happening there. it's to do with the testing. they are testing as many people as possible. unlike france and other countries which are testing only the sick. i know i am repeating what you guys saying. but it's very different situation here.

france has - 109,069 cases and 10,328 deaths
germany has - 107,663 cases and 2016 deaths.
belgium has - 22,194 cases and 2035 deaths
netherlands has - 19,580 cases and 2101 deaths.

Testing gives you insight so that you have good and relevant situational awareness on the spread of the virus when you are taking policy decisions or allocating resources. It can give you that insight, potentially multiple weeks before you start seeing first hand evidence of the scale of the infections (through hospitalization data and ICU utilization for example). This allows you to put into motion a containment strategy. It allows you to more accurately predict where and when the next hotspot is likely to be and when it will likely peak (though even that isn't perfect as we find out with the flu every year).

Those who began testing at scale earlier enjoyed the benefits that it gave them in that they could take lock down measures quicker, and move resources to the expected hot spots. The idea would to enforce stricter restrictions, and dedicate more resources, into areas that are known to have high prevalence so that you delay that as much as possible. One hypothesis is that Germany was able to act early and through testing and social distancing change the heat map of the virus to their advantage (avoided huge hot spots) that prevented their health systems from being inundated.

But then again, New York has tested nearly 400,000 people (with 1/4 Germany's population) and they haven't had similar results, perhaps because they started late. I think where your cases are and how they are spread (very few hot spots or multiple, less severe geographic areas) ends up playing a critical role in terms of deaths and managing very seriously sick. If you end up needing overflow capacity then your care delivery systems will just collapse under that weight and you will see higher mortality, particularly in those cohorts that require ICU stay.

[chola]

Wrong way to look at the data. The death rate should be against the population size.

Even if Germany tests the entire country, what will they achieve? You are just finding asymptomatic patients to prevent future spread. Positive cases are the ones who already got infected a week back.

There are no cure, so finding all of the patients in the country is only to ask them to stay at home. What if the ones tested negative, go out and get infected?

Will Germany test their entire population again?

Read the article.

The more you test, the quicker you identify the population you need to treat, track and isolate. Without testing you are going in blind.

Germany's response is no joke. For them to be in that epicenter with such a low death rate is not a fluke. The same can be said for Korea. Their response are nearly the same. Test, track, isolate to very granular levels.

On New York, they started late for one but worse is they were under-equipped unlike Germany. The frontline personnel were down to re-using PPE and were being infected in massive numbers. The governor of New York needed to go to Cheen to get PPE and ventilators because they couldn't what they needed from the federal government. The US had more time to prepare than Germany and blew it.

[brar_w]

On New York, they started late for one but worse is they were under-equipped unlike Germany. The frontline personnel were down to re-using PPE and were being infected in massive numbers. The governor of New York needed to go to Cheen to get PPE and ventilators because they couldn't what they needed from the federal government. The US had more time to prepare than Germany and blew it.

One of the main differences between NY State and Germany is that the former let it get out of hand and did not act early, particularly in their one hot spot. New York City has nearly 80,000 confirmed cases as of this morning. Germany on the other hand, with 10 times NYC's population (and high per capita testing) has a total of just 107,000 with no region having more than 30,000 confirmed cases.

Avoiding huge hot spots allows one to utilize existing national resources more effectively. The entire state of new york only had about 3,000 ICU beds going into this crisis out of which more than half are usually occupied during the flu season (utilization is much higher than that (probably in the 70-80% range) in big cities). If you have huge, uncontrolled, spikes in large population centers you will run out of resources very quickly. This is what Germany seems to have avoided while NYC's Mayor was fighting over keeping schools open for as long as possible and the citizens of that city are paying a big price for that boneheaded decision.

[syam]

Testing gives you insight so that you have good and relevant situational awareness on the spread of the virus when you are taking policy decisions or allocating resources. It can give you that insight, potentially multiple weeks before you start seeing first hand evidence of the scale of the infections (through hospitalization data and ICU utilization for example). This allows you to put into motion a containment strategy. It allows you to more accurately predict where and when the next hotspot is likely to be and when it will likely peak (though even that isn't perfect as we find out with the flu every year).

Those who began testing at scale earlier enjoyed the benefits that it gave them in that they could take lock down measures quicker, and move resources to the expected hot spots. The idea would to enforce stricter restrictions, and dedicate more resources, into areas that are known to have high prevalence so that you delay that as much as possible. One hypothesis is that Germany was able to act early and through testing and social distancing change the heat map of the virus to their advantage (avoided huge hot spots) that prevented their health systems from being inundated.

But then again, New York has tested nearly 400,000 people (with 1/4 Germany's population) and they haven't had similar results, perhaps because they started late. I think where your cases are and how they are spread (very few hot spots or multiple, less severe geographic areas) ends up playing a critical role in terms of deaths and managing very seriously sick. If you end up needing overflow capacity then your care delivery systems will just collapse under that weight and you will see higher mortality, particularly in those cohorts that require ICU stay.

saab, you are talking about the situation where the infected is already in the society and the state has no way of tracking them down. they will look for the people who get admitted to hospitals. also do the sweep. it's next phase for the state after losing track of the earlier infected people.

germany and soko situation is different. they didn't lose the track of the infected people and they had access to their whole location history. aggressive contact tracing allowed them to find the possible suspects within the area of the infected. that's why their numbers are most accurate. i bet they are using their supercomputers too to track and predict the virus 'movement'. that's why i considered german and korean figures as most accurate.

[brar_w]

saab, you are talking about the situation where the infected is already in the society and the state has no way of tracking them down. they will look for the people who get admitted to hospitals. also do the sweep. it's next phase for the state after losing track of the earlier infected people.

germany and soko situation is different. they didn't lose the track of the infected people and they had access to their whole location history. aggressive contact tracing allowed them to find the possible suspects within the area of the infected. that's why their numbers are most accurate. i bet they are using their supercomputers too to track and predict the virus 'movement'. that's why i considered german and korean figures as most accurate.

All I'm saying is that countries that begun testing early (had the ability to do it) could get into containment and manage the spread more easily. Testing also helped them identify potential hotspots much earlier and allocate scarce resources accordingly. Those who began testing later in their curve, are forced to enforce more stricter mitigation measures and have to just prepare for an onslaught of cases coming into hospitals because those spikes in infection occurred at a time they were doing nothing. By early March, Germany allready had expanded (or put into motion) testing and even drive-in testing. In contrast, the US didn't even approve the first commercial covid-19 test till mid march. When you ramp up your testing is almost more important than your overall test numbers.

[DrRatnadip]

https://m.timesofindia.com/india/corona ... 046993.cms

prime minister says lockdown will not be lifted in one go..

[sajo]

Maharashtra Government seems to have bungled this up.
8 Corona deaths in Pune alone today, with 5 yesterday. As per news channels it's a total of 14 this week.
Instead of encouraging doorstep deliveries of essentials through e-commerce, they are hell bent on thrashing delivery boys. That's what an xpressbees guy (firstcry) told me. They could have totally gone online themselves connecting farmers and producers to consumers, with the help of large number of taxi drivers, rickshaw drivers. And now with total sealing of areas, even essential items would not be allowed to pass.

[suryag]

Folks BD and SL are getting into the hot zone, will try to trawl through some english dailies there and post here. BD's karkhanas where people are packed up like Sardines are perfect petridish for CV, hope the GoBd is congnizant and aware of the challenges. SL is a relatively simpler case

[vijayk]

Maharashtra Government seems to have bungled this up.
8 Corona deaths in Pune alone today, with 5 yesterday. As per news channels it's a total of 14 this week.
Instead of encouraging doorstep deliveries of essentials through e-commerce, they are hell bent on thrashing delivery boys. That's what an xpressbees guy (firstcry) told me. They could have totally gone online themselves connecting farmers and producers to consumers, with the help of large number of taxi drivers, rickshaw drivers. And now with total sealing of areas, even essential items would not be allowed to pass.

The DUMB AH Thackreys and scum Pawar are hell bent upon getting accolades from BIF/Islamist gangs. Intead of delivering free food, morons are keeping long queues. No brains. No plan.

[syam]

you know what's freaking me out,
india has 175 corona deaths. my earlier 1 death per 50 cases, gives 8750 infections. maharastra alone has 72 deaths, putting the possible infections at 3600.

so far total indian cases are 5741. and mh has 1135 cases. mh has huge difference b/w projected and the cases reported, like 2465 cases. rest of india has very little gap, 4606 against estimated 5150. even basic maths showing gloomy picture for mumbai.

my numbers can be wrong. better be safe than sorry. be careful with everything, mh people. wash hands and stay at home.

another odd state is madhya pradesh with 290 cases and 21 deaths. estimated cases for them is like 1050. huge difference.

[sajo]

The DUMB AH Thackreys and scum Pawar are hell bent upon getting accolades from BIF/Islamist gangs. Intead of delivering free food, morons are keeping long queues. No brains. No plan.

I agree. And the only reason I can think of they are letting this happen is that :
1. Scarcity leads to blackmarketing, an area that the Pawars and their ilk are familiar in. Online retailers dont really leave that big a scope.
2. They are probably going to collapse shortly, so they dial up the discontent a notch and blame Modi.

[KJo]

US and India both have the similar death rates as of today. In the 3% range. US mismanaged this at the beginning so it exploded so it's a bigger problem than India (currently), but assuming that one gets CV, the death rate is the similar.

US Cases growth is declining, now at 8% and steady. India is at 11% but fluctuating a lot which makes me worry that it is not under control.

[Kaivalya]

Further to the TN spread single handedly caused by TJ, Rajasthan, MP,UP,Delhi all moving towards hotspot management

To me this article summarizes Indian response and the rest of the world
https://www.reuters.com/article/us-heal ... SKBN21Q16J

Thanks to the lockdown we are close to identifying the hotspots:

More than 80% of confirmed COVID-19 cases in India, also the world's second most populous country, have been traced to 62 districts representing less than 10% of India's landmass, according to government data.

Now that hotspots are identified, Bhilwara model is contemplated :
Lockdown within a lockdown that will be even more stringent even in terms of people allowed to go out for essentials till more testing and isolation can be done.

I wish there was a map with districts, areas hotspot managed so the people living there can be helped etc.

[vera_k]

The DUMB AH Thackreys and scum Pawar are hell bent upon getting accolades from BIF/Islamist gangs. Intead of delivering free food, morons are keeping long queues. No brains. No plan.

Tell us more? Or is it about this part? Agree that having stores open for just 2 hours would lead to queues.

Large parts of Pune sealed from Tuesday

Shops related to essential services, excluding medicals and hospitals, will remain open only for two hours, from 10 am to 12 pm

[suryag]

India's response to Wuhan Coronavirus

1. First high level meeting on Covid-19 held by the Prime Minister’s Office on 25 January, five days before the first case of India was reported in Kerala on 30 January.

2. GoI first travel advisory for travellers coming from China on 17 January(despite World Health Organisation statement on 14 January that there was no evidence of human to human transmission of Covid-19)

3. On 26 February, when India still had no case and all the previous three from Kerala had got discharged, it issued another advisory stating that everyone coming from China will be quarantined and people returning from South Korea, Iran and Italy or having history of travel to these countries may be quarantined for 14 days on arrival to India.

4. On 2 March, in a fresh advisory, the government stated that anyone coming from China, South Korea, Iran, Italy and Japan will be quarantined. That day, India had only two active cases.

5. On 11 March, when India had only 70 cases and the WHO declared Covid-19 a pandemic, the government declared that anyone coming from or having visited China, Italy, Iran, Republic of Korea, France, Spain and Germany after 15th February, 2020 shall be quarantined for a minimum period of 14 days.

6. On 15 March, the WHO declared Europe as the new epicentre for Covid-19. Next day, the government banned all flights from Europe and Turkey.

7. India effectively came under nationwide lockdown starting 22 March and all international flights were banned and Indian Railways stopped operations from the next day. At this juncture, India had less than 400 cases.

Source Swarajya - Govt. of India steps on Covid-19

[Gerard]

Pakistan Scrambles to Quarantine 100,000 Who Attended Muslim Event

[SriKumar]

India's response to Wuhan Coronavirus

1. First high level meeting on Covid-19 held by the Prime Minister’s Office on 25 January, five days before the first case of India was reported in Kerala on 30 January.

THIs is exactly 1 day after Chinese govt locked down Wuhan city. The GOI reacted immediately upon the news (and may have realized the numbers released by Govt of China were fake). THe reaction could not have been faster.

2. GoI first travel advisory for travellers coming from China on 17 January(despite World Health Organisation statement on 14 January that there was no evidence of human to human transmission of Covid-19)

This is (a) a rash statement for WHO to make, and, if they made it after input from China, which it likely did because China had the max # of cases then, the input/advisement is criminal, as far as I am concerned (though I dont believe there is an international law that requires countries to tell the truth). THere was an article published by CaiXin linked by Arun Prabhu about 2 months ago of an interview with a Chinese doctor fmro Wuhan (Who is also a professor in some medical school there). He said that he had to convince the Wuhan city health officials mid December to exclude the criterion of a patient neededing to visit the wet market to be counted as a Covid case. They agreed a week or two later. Wuhan city officials knew in December that there was person to person transmission.

[chetak]

sometimes one wonders if everyone is on the same page

they are taking away any motivation from the private companies to make more test kits. Corona test kits as it is are very expensive to build. Zero profit would still have been better but asking them to take the hit is a dangerous precedent.

they will simply say that we do not have any kits or qualified personnel.

Akhilesh Sharma@akhileshsharma1
BIG NEWS: Supreme Court interim order: All Covid 19 tests should be done free of cost whether done by government or private laboratories. Govt asked to issue necessary direction in this regard immediately.
6:52 PM · Apr 8, 2020