Corona update: Total cases increasing, deaths increasing BUT total daily cases declining or stationary

CMAAO Update 11^th February on Corona 2019 nCoV

“Let’s not shake hands,” said President Xi Jinping of China

Total cases increasing, deaths increasing BUT total daily cases declining or stationary

Confirmed cases: 43099, Countries 28, Deaths 1018

New cases on 11^th: 2546 ( 6% change)

11^th: 849 new serious cases (including 839 in Hubei)

Cases: 82% mild, 15% severe, 3% critical, 2% deaths

Currently infected: 38038, Mild cases: 30693 (81%), Serious or critical: 7345 (19%, mortality 15%)

Cases with outcome: 5061, Recovered or discharged 4043

Likely deaths 1101+1018 = 2119 with the present trend and available treatment

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Summary

Behaves like SARS ( may not become endemic and end up as hit and run in six months without mutation), with 2 % case fatality (15% of admitted cases),  time to death 14 days,  time to pneumonia 9 days, 3-4 reproductive number R0, has its origin from bats, spreads like large droplets and predominately from people having lower respiratory infections and hence universal droplet and hand hygiene precautions the answer.

More than 60 new cases of the virus have been confirmed on a ship quarantined in Japan, bringing the total to 136.

PM Modi writes to Xi Jinping, offers assistance. Ship Indians ask Modi for help.

WHO warned that "trolls and conspiracy theories"

1.     Russia's Channel One, the host links the virus to US President Donald Trump, and claims that US intelligence agencies or pharmaceutical companies are behind it.

2.     British media linked the virus to a video of a Chinese woman eating bat soup. However, it was filmed in 2016 and was in Palau, in the western Pacific Ocean - not China.

3.     A discredited scientific study released linked the new coronavirus to snakes

4.     Philippines: "keep your throat moist", avoid spicy food and "load up on vitamin C" . The information is said to be from the country's Department of Health but it does not match the advice on the DOH website or its official press releases on the outbreak.

5.     Avoiding cold or preserved food and drinks, such as ice cream and milkshakes, for "at least 90 days". ForChange accompanied the post with a video of a parasite being removed from a person's lips. Altnews fact-checkers pointed out, the video is in fact three months old and unrelated to the virus.

6.     That at first glance appear to suggest experts have been aware of the virus for years. They shared a link to a 2015 patent filed by the Pirbright Institute in Surrey, England, that talks about developing a weakened version of coronavirus for potential use as a vaccine to prevent or treat respiratory diseases. Sather used the fact that the Bill & Melinda Gates Foundation is a donor to both Pirbright and vaccine development to suggest that the current outbreak virus has somehow been deliberately manufactured to attract funding for the development of a vaccine. But Pirbright's patent is not for the new coronavirus. Instead, it covers the avian infectious bronchitis virus, a member of the wider coronavirus family that infects poultry.

7.     The virus was part of China's "covert biological weapons programme" and may have leaked from the Wuhan Institute of Virology. Many accounts pushing the theory cite two widely-shared Washington Times articles both of which quote a former Israeli military intelligence officer for the claim. However, no evidence is provided for the claim in the two articles, and the Israeli source is quoted as saying that "so far there isn't evidence or indication" to suggest there was a leak.

8.     Linked the virus to the suspension of a researcher at Canada's National Microbiology Laboratory. Virologist Dr Xiangguo Qiu, her husband and some of her students from China were removed from the lab following a possible "policy breach," according to a report by Canada's national broadcaster CBC last year. Police told CBC News there was "no threat to public safety".

9.     Dr Qiu had visited the Wuhan National Biosafety Laboratory of the Chinese Academy of Sciences twice a year for two years.

10.  That Dr Qiu and her husband were a "spy team", had sent "pathogens to the Wuhan facility", and that her husband "specialised in coronavirus research". None of the three claims in the tweet can be found in the two CBC reports and the terms "coronavirus" and "spy" do not appear even once in either.

11.  Different versions of a "whistleblower" video, alleged to have been taken by a "doctor" or a "nurse" in Hubei province, have racked up million views on various social media platforms and mentioned in numerous online reports. The most popular version was uploaded to YouTube by a Korean user, and included English and Korean subtitles - the video has since been taken down.

According to the English subtitles, the woman is a nurse in a Wuhan hospital. However, she does not claim to be either a nurse or a doctor in the video at all. The woman, who does not identify herself, is wearing protective suit in an unknown location. However, her suit and mask do not match the ones worn by medical staff in Hubei. But she makes a number of unsubstantiated claims about the virus, making it unlikely for her to be a nurse or a paramedic. She also claims the virus has a "second mutation", which can infect up to 14 people. But the WHO has preliminarily estimated the number of infections an individual carrying the virus can cause is 1.4 to 2.5

12. Fact-checking website Snopes has debunked the claim that China wants to kill 20,000 coronavirus patients is totally false. The site is linked to a sex website.

Case Definition

1.     Fever (subjective or confirmed)

OR signs/symptoms of lower respiratory illness (cough or shortness of breath)

PLUS, any person, including health care workers, who has had close contact with a laboratory-confirmed 2019-nCoV patient within 14 days of symptom onset.

2.     [Contact means: Being within approximately 6 feet (2 meters) or within the room or care area of a 2019-nCoV case for a prolonged period of time while not wearing recommended personal protective equipment (gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection); close contact can include caring for, living with, visiting, or sharing a health care waiting area or room with a 2019-nCoV case OR having direct contact with infectious secretions of a 2019-nCoV case (e.g., being coughed on) while not wearing recommended personal protective equipment.]

3.     Fever and signs/symptoms of lower respiratory illness (cough or shortness of breath) PLUS a history of travel from Hubei Province, China within 14 days of symptom onset

4.     Fever and signs/symptoms of lower respiratory illness (cough or shortness of breath) requiring hospitalization PLUS a history of travel from mainland China within 14 days of symptom onset.

Continue asking patients with suspected flu or diarrhoea if they, or someone they have been in contact with, recently returned from corona affected area. [ in US confirmed case they 2019-nCoV RNA in a stool specimen collected on day 7 of the patient’s illness.]

Take Home Messages

Delhi Help line number: +91-11-23978046, ncov2019@gmaildotcom, mohfw.gov.in/node/4904

Virus: Single-strand, positive-sense RNA genome ranging from 26 to 32 kilobases in length, Beta corona virus

Family: Corona virus family. ‘corona’ means crown or the halo surrounding the sun. Heart is considered crown and hence coronary arteries. In electron microscope, it is round with spikes poking out from its periphery.

Origin: Wuhan, China December 2019

1^st case informed to the world by Dr. Li Wenliang died Feb 6^th

Virus is killed by sunlight, temperature, humidity. Survive on stainless steel surface for 36 hours 9 Hong Kong report). Sunlight cuts the virus ability to grow in half so the half-life will be 2.5 minutes and in the dark it’s about 13m to 20m.  The virus can remain intact at 4 degrees or 10 degrees for a longer period of time. But at 30 degrees then you get inactivation. High humidity the virus doesn’t like it either. SARS stopped around May and June in 2003 due to more sunlight and more humidity.  Alive on surface: 3-12 hours

Types of Transmission: Droplet or direct (Corona); Contact from surface ( Corona), aerosol or nuclei ( TB, Corona ??)

Kissing scenes banned in movies: China

Air crew exempted from breath analyser tests: Kerala

Burial:  China has banned death ceremonies, people gathering together,

Link to ACE: 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans.

Lockdown: 50 million people in China

Feb 10

New confirmed cases: 2,478 (2,097 in Hubei province)

New cases of suspected infections: , 3,536  (1,814 in Hubei)

New serious cases: 849 (839 in Hubei)

Deaths: 108

Released from hospitals after being cured: 716 (427 in Hubei)

 26,724 people who had had close contact with infected patients were freed from medical observation.

Feb 10, the National Health Commission

42,638 reports of confirmed cases

1,016 deaths

3,996 patients had been cured and discharged from hospital

Remained 37,626 confirmed cases (including 7,333 in serious condition) and 21,675 suspected cases.

428,438 people have been identified as having had close contact with infected patients.

187,728 are now under medical observation. 

70 confirmed infections had been reported in the Hong Kong and Macao special administrative regions and Taiwan province: 42 in Hong Kong (1 death), 10 in Macao (1 had been cured and discharged from hospital) and 18 in Taiwan (1 had been cured and discharged from hospital).

Three deadly human respiratory coronaviruses viruses: Severe acute respiratory syndrome coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus [MERS-CoV]) and 2019-nCoV: The virus is 75 to 80% identical to the SARS-CoV

30^th January 2010: Emergency: It is a Public Health Emergency of International Concern  (mandatory to report to WHO human and animal cases).

Prior 5 PHEIC’s: 

26^th April 2009 Swine flu: shift toward mortality among persons less than 65 years of age. 10 August 2010, WHO announced that the H1N1 influenza virus has moved into the post-pandemic period. However, localized outbreaks of various magnitudes are likely to continue.

 

May 2014 Polio: resurgence of wild polio after its near-eradication. Global eradication was deemed to be at risk with small numbers of cases in Afghanistan, Pakistan, and Nigeria. In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia, was reviewed and remains a PHEIC. It was extended on 11 December 2019.

 

August 2014 Ebola: It was the first PHEIC in a resource-poor setting.

 

Feb 1 2016 Zika: link with microcephaly and Guillain–Barré syndrome. This was the first time a PHEIC was declared for a mosquito‐borne disease. This declaration was lifted on 18 November 2016.

2018–20 Kivu Ebola: A review of the PHEIC had been planned at a fifth meeting of the EC on 10 October 2019^[44] and as of 18 October 2019, it continues to be a PHEIC.

Kerala: state public health emergency. Three primary cases in North, South and Central

Kerala (Kasaragod district is in north Kerala, Thrissur in central Kerala and Alappuzha in South Kerala]. Four Karnataka districts bordering Kerala — Kodagu, Mangaluru, Chamarajanagar and Mysuru have been put on high alert.

Median age: 59 years (2-74 years); Male to female ratio: 56% male

Link to Huanan Seafood Wholesale Market: 55% with onset before January 1, 2020 and 8.6% of the subsequent cases. The Chinese government has banned the wildlife trade until the epidemic passes. 

Mean incubation period: 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days.

Epidemic doubling time: In its early stages, every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19)

Contagiousness or Basic reproductive number: 2.2 (95% CI, 1.4 to 3.9).  The reproduction number R0 or “r naught” refers to the number of additional people that an infected person typically makes sick.  An outbreak with a reproductive number of below 1 will gradually disappear. The Ro for the common flu is 1.3 and for SARS it was 2.0.

Comorbid conditions: 71%, deaths in comorbid cases, SARS affected people in their 30 or 50 years. And MERS affected people with co-morbidity. The China data indicate that it’s those with the co-morbidity are most at risk like seasonal influenza.

0-15 years age: Just like SARS, it mostly does not affect children 15 years or less of age

Daily deaths:  73 deaths on 5^th (15% rise), 66 on 4^th, 64 on 3^rd Feb.

Anticipates: one lac already infected.

Secondary cases: Thailand, Taiwan, Germany, Vietnam, Japan, France and the United States

Deaths outside China: Philippines on Feb 2 (44 Chinese man M) and 2^nd in Hong Kong ( 39 M, local)  on February 4, both had co-morbid conditions. Both acquired infection from Wuhan.

ICU need: 20% needed ICU care with 15% of them died

Fever: In all (no fever no corona)

Cough: 75% cases

Weakness or muscle ache: 50%^

Shortness of breath: 50%

TLC: low

Liver transaminase levels: raised

Case fatality: 2% [Dr John Nicholls, University of Hong Kong} China is only reporting those who come for test, stricter guidelines, actual mortality may be 0.8%-1% like outside China

Case fatality in admitted cases: 15%

Time to death:  14 days

Time to pneumonia:  9 days

Origin: Bats

Mode of spread: Large droplets and predominately from people having lower respiratory infections

Answer: Universal droplet precautions the answer.

Incubation period:  up to 2 weeks, according to WHO. Mean 5.5 days

Transmission: Predominantly a large droplet and contact and less so by means of aerosols and fomites

Once it was disclosed that SARS also spread through the fecal oral route there was much less emphasis on the masks and far more emphasis on disinfection and washing hands. HK has far more cleanliness (than China) and they are very aware of social hygiene. And other countries will be more aware of the social hygiene (than China). So in those countries you should see less outbreaks and spreading. [Dr John Nicholls]

Healthcare Workers: In Hong Kong with SARS there was a lot of infection of healthcare workers as they are close and doing invasive procedures. But this time around there is not much evidence of the healthcare workers getting sick or dying (unless China is not reporting it) so this may suggest that it is not being spread by close aerosol contact but more by the fecal-oral route or with droplets. So, it may not be as contagious within hospitals. Makeshift hospitals will help.

Lab precautions: BSL 2 or 3

Human to human contact period: Requires contact of ten minutes within six feet

Travel preferable seat: Choosing a window seat and staying lowers the risk

Travel advisory:  Level 1 in all countries (Exercise normal safety precautions), Level 2 in all  affected countries and states including Kerala ( Exercise a high degree of caution), Level 3 in all countries with secondary cases (Reconsider your need to travel) and Level 4 in China ( Do not travel). Hong Kong has imposed 14 days quarantine on people arriving from china. The Karnataka government has ordered that anybody arriving from the 23 coronavirus affected countries must stay in isolation at home for 28 days. The home isolation requirement is irrespective of the virus symptoms.

To date, 72 countries are implementing travel restrictions.

Travel and trade restrictions: WHO says no to countries

Leave china all together: UK

Entry ti India not allowed: foreigners who went to China on or after January 15

Visas Suspended: All visas issued to Chinese nationals before February 5 (not applicable to aircrew)

Flight suspended: IndiGo and Air India have suspended all of their flights between the two countries. SpiceJet continues to fly on Delhi-Hong Kong route.

High viral load: Detection of 2019-nCoV RNA in specimens from the upper respiratory tract with low Ct values on day 4 and day 7 of illness is suggestive of high viral loads and potential for transmissibility. [NEJM]

Risk to other Asian countries including India: Currently, people at risk are healthcare workers caring for 2019-nCoV patients and other close contacts of 2019-nCoV patients. For the general public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low at this time.

It is less likely to have the serious illness in other countries. As patients with breathlessness are unlikely to board and patients will mild illness or asymptomatic illness are less likely to transmit infections.

Zoonotic but unlikely to spread through seafood: It is closely related to several bat coronaviruses. Bats are the primary reservoir for the virus. SARS-CoV was transmitted to humans from exotic animals in wet markets, whereas MERS-CoV is transmitted from camels to humans. In both cases, the ancestral hosts were probably bats.

The virus has been traced to snakes in China. Snakes often hunt for bats in wild. Reports indicate that snakes were sold in the local seafood market in Wuhan, raising the possibility that the 2019-nCoV might have jumped from the host species - bats - to snakes and then to humans at the beginning of the outbreak. However, it remains a mystery as to how the virus could adapt to both the cold-blooded and warm-blooded hosts.

Infectiousness to humans: 2019-nCoV grows better in primary human airway epithelial cells than in standard tissue-culture cells, unlike SARS-CoV or MERS-CoV. It is likely that 2019-nCoV will behave more like SARS-CoV.

Both SARS-CoV and MERS-CoV infect intrapulmonary epithelial cells more than cells of the upper airways. Consequently, transmission occurs primarily from patients with recognized illness and not from patients with mild, nonspecific signs. Though NEJM has reported a case of 2019-nCoV infection acquired outside of Asia in which transmission appears to have occurred during the incubation period in the index patient but the same has been challenged now.

2019-nCoV uses the same cellular receptor as SARS-CoV (human angiotensin-converting enzyme 2 [hACE2]), so transmission is expected only after signs of lower respiratory tract disease develop.

SARS is high [unintelligible] kind of inducer. This means that when it infects the lower part of the lung, the body develops a very severe reaction against it and leads to lots of inflammation and scarring. In SARS what we found is that after the first 10 to 15 days it wasn’t the virus killing the patients it was the body’s reaction. Is this virus in the MERS or SARS kind picture or is this the other type of virus which is a milder coronavirus like the NL63 or the 229. It may be the mild (unintelligible) kind inducer. [Dr John Nicholls University of Hong Kong]

No sore throat: This new virus attacks the lungs and not just the throat. Patients so far have not presented with a sore throat, the reason being that the 2019-nCoV launches an attack at the intraepithelial cells of lung tissue.

Asymptomatic transmission: One report of a small cluster of five cases suggested transmission from asymptomatic individuals during the incubation period; all patients in this cluster had mild illness. Another case got infected while using gown, but eyes not covered. NEJM reported a transmission from asymptomatic case but the same has been challenged.

Mass Quarantine May Spark Irrational Fear, Anxiety, Stigma

Evacuation: Tokyo, Japan, India have evacuated their citizens trapped in China affected areas.  All 645 evacuees from Wuhan test negative for the deadly infection in India. Close to 80 Indian students are still stuck in Wuhan. 70 of the 80 chose to stay behind at the time of the evacuation operation. 10 had expressed willingness to return to India but could not board after they failed the screening process at the airport.

Bangladesh has scrapped plans to bring back its 171 nationals stuck. Refusal from crew members to fly. State-run Biman Airlines' Boeing 777-300 ER aircraft on February 1 brought back 312 Bangladeshis.

Legal implications in India: Section 270 in The Indian Penal Code: 270. Malignant act likely to spread infection of disease danger­ous to life.—Whoever malignantly does any act which is, and which he knows or has reason to believe to be, likely to spread the infection of any disease dangerous to life, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both.

Asymptomatic: Unlike SARS, patients were symptomatic at about day 5, some of these cases may be asymptomatic until about day 7. Asymptomatic is probably the first 5 days. 

Case fatality of coronavirus 2%

Case fatality of MERS 34% (2012, killed 858 people out of the 2,494 infected)

Case fatality of SARS 10% (Nov. 2002 - Jul. 2003, originated from Beijing, spread to 29 countries, with 8,096 people infected and 774 deaths) 

Case fatality of Ebola 50%,

Case fatality of Smallpox 30-40%

Case fatality of Measles 10-15% developing countries

Case fatality of Polio 2-5% children and 15-30% adults

Case fatality of Diphtheria 5-10%

Case fatality of Whooping cough 4% infants < 1yr, 1% children < 4 years

Case fatality of Swine flu < 0.1-4 %

Case fatality of seasonal flu 0.01%.

Case fatality of current virus in Wuhan 4.9%.

Case fatality of current virus in Hubei Province 3.1%.

Case fatality of current virus in Nationwide 2.1%.

Case fatality of current virus in other provinces 0.16%.

Number of flu deaths every year: 290,000 to 650,000 (795 to 1,781 deaths per day)

Lab tests: There are two ways to detect a virus: through the genetic material DNA or RNA or to detect the protein of the virus. The rapid tests look at the protein. It takes 8-12 weeks to make commercial antibodies. So right now, for the diagnostics tests they are using PCR which give you a turnaround in 1-2 hours.

Treatment: No proven antiviral treatment.

With SARS, in 6 months the virus was gone and it never came back. Pharmaceutical companies may not spend millions and millions to develop a vaccine for something which may never come back.

Evidence of E-coli: Secondary infection are most likely the cause of deaths of the patients in the Philippines and HK.

SARS Experience: A combination of lopinavir and ritonavir showed promise in lab

MERS experience: Combination of lopinavir, ritonavir and recombinant interferon beta-1b has been tried

Recreation of Virus: Scientists in Australia have reportedly recreated a lab-grown version of coronavirus.

Chloroquine: had potent antiviral activity against the SARS-CoV, has been shown to have similar activity against HCoV-229E in cultured cells and against HCoV-OC43 both in cultured cells and in a mouse model.

Thai experience: Oseltamivir along with lopinavir and ritonavir, both HIV drugs.

Experimental drug: Rrom Gilead Sciences Inc., called remdesevir (started on 6^th Feb as a trial)

Russia and China drug: Arbidol, an antiviral drug used in Russia and China for treating influenza, could be combined with Darunavir, the anti-H.I.V. drug, for treating patients with the coronavirus. {the corona virus shares some similarity to HIV virus also)

PVP-I mouthwashes and gargles significantly reduce viral load in the oral cavity and the oropharynx. PVP-I has high potency for viricidal activity against hepatitis A and influenza, MERS and SARS

DCGI Approval: The Drug Controller General of India has approved the "restricted use" of a combination of drugs (Lopinavir and ritonavir) used widely for controlling HIV infection in public health emergency for treating those affected by novel coronavirus.

Steroids: In SARS, people were put on long term steroids ending with immunosuppression and late complications and death. The current protocol is short term treatment.

Universal respiratory droplets precautions

Self-quarantining: 2 weeks

Adherence: Strict

Soap and water: Wash your hands often and  for at least 20 seconds.

Alcohol-based hand sanitizer: if soap and water is not available

Avoid touching:  your eyes, nose, and mouth with unwashed hands.

Avoid close contact:  (3-6 feet) with people who are sick with cough or breathlessness

Stay home:  when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces.

Surgical Masks: For patients

N 95 Masks: For health care providers and close contacts

The world is facing a chronic shortage of gowns, masks, gloves and other protective equipment in the fight.

Ten Common Myths

1.     People receiving packages from China are not at risk of contracting the new coronavirus as the virus does not survive long on objects, such as letters or packages.

2.     There is no evidence that companion animals/pets such as dogs or cats can be infected with the new coronavirus. However, it is good to wash your hands with soap and water after contact with pets. To prevent transmission of common bacteria such as E. coli and Salmonella.

3.     Pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.

4.     Regularly rinsing the nose with saline does not protect people from infection with the new coronavirus or respiratory infections although it can help people recover more quickly from the common cold.

5.     There is no evidence that using mouthwash will protect you from infection with the new coronavirus although some brands or mouthwash can eliminate certain microbes for a few minutes in the saliva in your mouth.

6.     Garlic is a healthy food that may have some antimicrobial properties, however, there is no evidence that eating garlic protects people from the new coronavirus.

7.     Sesame oil does not kill the new coronavirus. Chemical disinfectants that can kill the 2019-nCoV on surfaces are bleach/chlorine-based disinfectants, either solvents, 75% ethanol, peracetic acid and chloroform. However, they have little or no impact on the virus if you put them on the skin or under your nose. It can even be dangerous to put these chemicals on your skin.

8.     People of all ages can be infected by the new coronavirus (2019-nCoV). Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus.  WHO advises people of all ages to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene?

9.     Antibiotics do not work against viruses, only bacteria.  Hence antibiotics should not be used as a means of prevention or treatment of new coronavirus unless you suspect bacterial co-infection.

10. To date, there is no specific medicine recommended to prevent or treat the new coronavirus (2019-nCoV).

Role of CMAAO and other Medical Associations

1.     All countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of the virus and to share full data with WHO. 

2.      All countries are legally required to share information with WHO under the IHR. 

3.      Any detection of 2019-nCoV in an animal (including information about the species, diagnostic tests, and relevant epidemiological information) should be reported to the World Organization for Animal Health (OIE) as an emerging disease.

4.      All countries should emphasise on reducing human infection, prevention of secondary transmission and international spread.

PMO Suggestions sent

7^th January: CMAAO Alert: WHO to monitor China's mysterious pneumonia of unknown virus outbreak

8^th Jan: CMAAO warns Asian citizens travelling China over mystery pneumonia outbreak

10^th January: I wrote an editorial: Corona virus strain causing pneumonia in Wuhan, China, It’s a new strain of corona virus in the china pneumonia

13^th January:
China Virus Outbreak Linked to Seafood Market:

15^th January:
First Case China Pneumonia Virus Found Outside China in Thailand

17^th January: WHO issues warning after 'mysterious' Chinese corona virus spreads to Japan

 

17^th Jan: India at threat of Corona. CMAAO urges travel advisory on coronavirus: http://www.drugtodayonline.com/medical-news/nation/10379-cmaao-urges-travel-advisory-on-coronavirus.html

 (18^th Indian govt issues travel advisory as China's mysterious 'Coronavirus' spread in other countries)

18^th Jan: WHO issues warning after mysterious Chinese Coronavirus spreads to Japan [http://blogs.kkaggarwal.com/tag/who/]

18-20 Jan: Three countries meet, also discussed Corona virus

22^nd Jan: Still not being declared to be a notifiable disease, N 95 to be included in the list of essential drugs and prise capped, Oseltamivir, should also be prise capped, air flights should have available air masks for all passengers, not declaring flu like symptoms while boarding or landing should be a punishable offence (23^rd India advisory to airports)

24^th: Inter Ministerial Committee needs to be formed on Corona Virus (PMO took a meeting on 24^th evening)

25^th Jan: Indian government should pay for Indians affected with the virus in China

26 Jan: Need of National droplet Infection Control program, Policy to ban export of face masks, policy to evacuate Indians and neighbouring countries from China affected areas, Time to collaborate on Nosode therapy (Exports of masks banned on 31^st January by Indian Government) Action:  [ Feb 1^st: Ibrahim Mohamed Solih thanked India for the evacuation of seven Maldivian nationals from the coronavirus-hit Chinese city of Wuhan. India evacuated 647 people]

[ on 30^th India banned gloves, PEP and masks but on 8^th lifted the ban on surgical masks/disposable masks and all gloves except NBR gloves. All other personal protection equipment, including N-95 and equipment accompanying masks and gloves shall remined banned.] 

27: History of anti-fever drugs at airports should be taken

28: Do research on Nosodes

29: Closure of live markets all over the world, India should take a lead

30: Paid flu leave, surgical mask at public places, N 95 for health care providers

31: Respiratory hygiene advisory schools, Pan India task force to be made  

1^st Feb: Disaster Budget is the need of the hour

3^rd Feb: 100 crore budget for Corona virus; Private labs to be recognised; one dedicated corona National help line, MTNL BSNL to have a line of advisory in their bills, isolation wards to be single rooms or two beds separated with six feet distance, national insurance to cover cost of treatment,  Sea ports to have same precautions, prize caps for masks, and gloves, National droplet control program, clarification that import of goods is not risky And suspend AI flights to China and Hong Kong

[Feb 4 Air India on Tuesday suspended flight services to Hong Kong from Friday until March 28. Earlier, Air India had cancelled its flight to Shanghai from January 31 to February 14 and on 5^th Feb the Ministry of Defence is setting up 10 new laboratories across the country, primarily to conduct research on viruses]

4^th Feb: Kerala travel advisory needed [The Union Ministry of Health and Family Welfare issued a fresh travel advisory on Monday urging people to refrain from visiting China]

5^th Feb: PM should talk about Corona in Man Ki Baat or a special address

6^th Feb: Time to have makeshift bed policy to tackle deaths in Kota, Muzaffarpur and Corona [Uttarakhand to set up two dedicated hospitals to tackle coronavirus : https://www.hindustantimes.com/india-news/uttarakhand-to-set-up-two-dedicated-hospitals-to-tackle-coronavirus/story-NYxBOw6XHTbugznTWa3CXK.html]

7^th Feb: IPC 269 should be applicable to corona virus

8^th Feb: teleconsultation should be allowed to flu and corona consultation

Search:

Country	Cases	Deaths	Region
China	42,638	1,016	Asia
Japan	161	0	Asia
Singapore	45	0	Asia
Hong Kong	42	1	Asia
Thailand	32	0	Asia
South Korea	27	0	Asia
Malaysia	18	0	Asia
Taiwan	18	0	Asia
Australia	15	0	Australia/Oceania
Vietnam	14	0	Asia
Germany	14	0	Europe
United States	12	0	North America
France	11	0	Europe
Macao	10	0	Asia
United Arab Emirates	8	0	Asia
United Kingdom	8	0	Europe
Canada	7	0	North America
Philippines	3	1	Asia
Italy	3	0	Europe
India	3	0	Asia
Russia	2	0	Europe
Spain	2	0	Europe
Nepal	1	0	Asia
Finland	1	0	Europe
Sweden	1	0	Europe
Sri Lanka	1	0	Asia
Cambodia	1	0	Asia
Belgium	1	0	Europe

Total Cases of Novel Coronavirus (2019-nCoV)

Date	Total Cases	Change in Total	Change in Total (%)
Feb. 10	43,099	2,546	6%
Feb. 9	40,553	3,001	8%
Feb. 8	37,552	2,676	8%
Feb. 7	34,876	3,437	11%
Feb. 6	31,439	3,163	11%
Feb. 5	28,276	3,723	15%
Feb. 4	24,553	3,925	19%
Feb. 3	20,628	3,239	19%
Feb. 2	17,389	2,837	19%
Feb. 1	14,552	2,604	22%
Jan. 31	11,948	2,127	22%
Jan. 30	9,821	2,008	26%
Jan. 29	7,813	1,755	29%
Jan. 28	6,058	1,477	32%
Jan. 27	4,581	1,781	64%
Jan. 26	2,800	785	39%
Jan. 25	2,015	698	53%
Jan. 24	1,317	472	56%
Jan. 23	845	266	46%

Daily Cases of Novel Coronavirus (2019-nCoV)

Date	Daily Cases	Change in Daily	Change in Daily (%)
Feb. 10	2,546	-455	-15%
Feb. 9	3,001	325	12%
Feb. 8	2,676	-761	-22%
Feb. 7	3,437	274	9%
Feb. 6	3,163	-560	-15%
Feb. 5	3,723	-202	-5%
Feb. 4	3,925	686	21%
Feb. 3	3,239	402	14%
Feb. 2	2,837	233	9%
Feb. 1	2,604	477	22%
Jan. 31	2,127	119	6%
Jan. 30	2,008	253	14%
Jan. 29	1,755	278	19%
Jan. 28	1,477	-304	-17%
Jan. 27	1,781	996	127%
Jan. 26	785	87	12%
Jan. 25	698	226	48%
Jan. 24	472	206	77%
Jan. 23	266	133	100%

Total Deaths of Novel Coronavirus (2019-nCoV)

Date	Total Deaths	Change in Total	Change in Total (%)
Feb. 10	1,018	108	12%
Feb. 9	910	97	12%
Feb. 8	813	89	12%
Feb. 7	724	86	13%
Feb. 6	638	73	13%
Feb. 5	565	73	15%
Feb. 4	492	66	15%
Feb. 3	426	64	18%
Feb. 2	362	58	19%
Feb. 1	304	45	17%
Jan. 31	259	46	22%
Jan. 30	213	43	25%
Jan. 29	170	38	29%
Jan. 28	132	26	25%
Jan. 27	106	26	33%
Jan. 26	80	24	43%
Jan. 25	56	15	37%
Jan. 24	41	16	64%
Jan. 23	25	8	47%

Daily Deaths of Novel Coronavirus (2019-nCoV)

Date	Daily Deaths	Change in Daily	Change in Daily (%)
Feb. 10	108	11	11%
Feb. 9	97	8	9%
Feb. 8	89	3	3%
Feb. 7	86	13	18%
Feb. 6	73	0	0%
Feb. 5	73	7	11%
Feb. 4	66	2	3%
Feb. 3	64	6	10%
Feb. 2	58	13	29%
Feb. 1	45	-1	-2%
Jan. 31	46	3	7%
Jan. 30	43	5	13%
Jan. 29	38	12	46%
Jan. 28	26	0	0%
Jan. 27	26	2	8%
Jan. 26	24	9	60%
Jan. 25	15	-1	-6%
Jan. 24	16	8	100%
Jan. 23	8	0	0%