Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
Update: 48 countries, 82,166 cases, 2800 deaths, 32,812 recovered, 46,554
Currently Infected Patients, 37,686 (81%)
in Mild Condition, 8,868 (18%) Serious or Critical, likely deaths ( 2773 +
8868x15) = 4130 with the present trend
and available treatment; more cases outside China (903) than in China (435), emergency in San
Francisco, Saudi
Arabia suspends entry for Muslim pilgrims, 8 deaths outside China yesterday,
total 3667 cases outside China
Number of tests
and positivity rate for Covid-19 as of today
- UK: 7,132 concluded tests,
of which 13 positive (0.2%
positivity rate).
- Italy: 9,462
tests, of which 470 positive (5.0%
positivity rate),
- France: 762
tests, of which 17 positive (2.2%
positivity rate), 179 awaiting results.
- Austria: 321
tests, of which 2 positive (0.6%
positivity rate),
- United States: 445
concluded tests, of which 14 positive (3.1%
positivity rate).
COVID 19 SUTRAS
1.
Possibly behaves like SARS; causes mild illness in 82%, severe illness in 15%, critical illness in 3%
and death in 2 % cases ( 15% of admitted serious
cases, 71% with comorbidity); affects all ages but predominately males ( 56%)
with median age 59 years ( 2-74 years, less in children below 15); with variable incubation period days ( 2-14; mean 3 based on 1,324 cases, 5.2 days based on
425 cases, 6.4 days in travellers
from Wuhan); mean time to symptoms 5 days,
mean time to pneumonia 9 days, mean time to death 14 days, 3-4 reproductive number R0 ( flu 1.2, SARS 2), epidemic doubling time
7.5 days ( Korea 1 day probably due to super spreader), Tripling time in Korea 3
days, has origin possibly from bats, spreads like large droplets and
predominately from people having lower respiratory infections and hence
standard droplet precautions the answer for the public and close contacts and
air born precautions for the healthcare workers dealing with the secretions.
2. Clinically
all patients have fever, 75% have cough; 50% weakness; 50% breathlessness with
low total white count and deranged liver enzymes. 20% need ICU care and 15% of
them are fatal. Treatment is symptomatic though chloroquine, anti-viral and
anti-HIV drugs have shown some efficacy.
3.
Only 20% will have symptoms and will go
for testing, rest may self-quarantine, 15% of serious will die. In Iran 16 died of 95 tested means they are
only testing serious patients.
Phases
1. Public Health Emergency of International Concern 30th
Jan 2020: Mandatory to report to WHO each
human and animal case. Prior 5 PHEIC’s: 26th April 2009 - 10th August
2010 Swine flu; May 2014 Polio: resurgence of wild polio; August 2014 Ebola: It was the first PHEIC in a
resource-poor setting; Feb 1, 2016 to 18 Nov 2016 Zika
and 2018–20 Kivu Ebola
2.
Public Health Emergency of
state Concern: Kerala lifted
on 12th Feb.
3. Pandemic Alert 21st February: US CDC: Tremendous Public Health Threat.
4. 21st Feb: Community threat: WHO: "… we are concerned about the
number of cases with no clear epidemiological link, such as travel history to
China or contact with a confirmed case". Community
spread: Cases
are detected in Singapore, South Korea, Taiwan, Vietnam, Hong Kong and Japan in
community where it's not known what the source of the infection was.
5. 24th Feb: We're in a phase of preparedness for a potential pandemic.
6. 25th Feb: Preparing for community transmission
of the COVID-19 coronavirus
7. Close contacts of COVID 19 patients definition will
change with community spread: Close contacts are people
providing direct care to patients, working with infected health care workers, visiting
infected patients or staying in the same close environment, working together in
close proximity or sharing the same classroom environment with an infected patient,
traveling together with infected patient in any kind of conveyance, living in
the same household as an infected patient. The epidemiological link may have
occurred within a 14-day period before or after the onset of illness in the
case under consideration. But once the
community spread occurs the definition will no longer be correct.
8. Final phase of community
spread closing borders will not contain the virus. All cases with flu like
illness will be presumed to be VOVID 19 AND ONLY patients with breathlessness
will be tested.
9. 26th
February: The US CDC has suggested that the risk of a coronavirus pandemic is likely. Francisco
declared a state of emergency even if at the moment there are no confirmed
cases of Covid-19 in the area.
10. High risk countries: China,
Macau, Hong Kong, Taiwan, South Korea, Singapore, Italy, Iran, and Japan.
IMA Preparedness for community spread: CMAAO – IMA Mitigation guidelines
Some salient points
1.
Corona Namaste: Let’s not shake hands, IMA and CMAAO promotes
the concept of Corona Namaste.
2.
Its time for
facts, not fear; for rationality, not rumours and for solidarity, not stigma.
3.
Help line: 23978046
4.
Total number = Lab confirmed + CT Diagnosed
Cases (12-19 February) and before and after only lab confirmed cases
5. No or little evidence to support the
possibility of vertical transmission from the mother to the baby. [Lancet Feb
20]
6.
Sudden jump in deaths and new cases on 12th due to
inclusion of CT diagnosed cases.
7.
Coronavirus vaccine could be ready in 18 months (WHO)
8.
Human to human contact Requires prolonged
contact (possibly ten minutes or more) within three to six feet.
9. 14th Feb: 1,716 medical workers have contracted the virus and
six of them have died. 1,502 were in Hubei Province, with 1,102 of them in
Wuhan. The
numbers of infected workers represented 3.8 percent of China’s overall
confirmed infections as of Feb. 11 with 0.3% deaths. (18th Feb:
Director of Wuhan Hospital died). Over 3000 workers involved so far.
10. Two workers who were sent to Wuhan in January end to help build
new hospital have been infected with it
11.
The
central banking authorities of China are disinfecting, stashing and reportedly
even destroying cash to stop the spread of the coronavirus. People’s Bank of
China says that the cash collected by commercial banks must be disinfected
before being released back to customers.
12. Maharishi Valmiki hospital in Delhi stops
biometric attendance
13.
China has more than 80
running or pending clinical trials on potential treatments for COVID-19.
14. 691 infected
people were found among 3,011 passengers and crew members tested (23% infection
rate) out of 3,711 total people on the ship. 4 Deaths, 36 serious. Total likely
deaths 10
15. Growing number of clusters of coronavirus cases: a
party in a boat in Japan Tokyo with 90 guests where one case spread to more
than a dozen, or a church where 43 were infected. There are two likely
explanations for the spread of these clusters of infected people: a “super-spreader,”
or person who has the propensity to spew more germs than others; or people
catching the virus from infected surfaces. We don’t know how long the germs
stay on surfaces, but similar viruses can live for a week.
16. Chinese researchers published the largest analysis of
coronavirus cases to date. They found that although men and women have been
infected in roughly equal numbers, the death rate among men was 2.8 percent,
compared with 1.7 percent among women.
17. Despite CDC protest, 14 Americans
infected with coronavirus on the Diamond Princess cruise ship shared a plane back
to the U.S. with healthy passengers, separated by plastic sheeting. (New York Post)
18. An
outlier of a 24
days incubation period has been observed. WHO said it
could actually reflect a second exposure rather than a long incubation
period, and that it wasn't going to change its recommendations? Hubei Province
local government on Feb. 22 has reported a case with an incubation period
of 27 days.
19. A court
temporarily blocked the U.S. government from sending up to 50 people infected
with a new virus from China to a Southern California city for quarantine after
local officials argued that the plan lacked details about how the community
would be protected from the outbreak.
Travel
Restrictions
Level 1 in all countries
(Exercise normal standard hygiene precautions)
Level 2 in all affected
countries (Exercise a high degree of caution)
Level 3 in all countries with
secondary cases (Reconsider your need to travel)
Level 4 in affected parts of
China and Korea (Do not travel)
Case fatality
COVID 19 2% ; MERS 34% (2012, killed 858 people
out of the 2,494 infected); SARS 10% (Nov. 2002 - Jul. 2003,
originated from Beijing, spread to 41 countries, with 8,096 people infected and
774 deaths); Ebola 50%; Smallpox 30-40%; Measles 10-15% developing countries; Polio 2-5% children and 15-30% adults;
Diphtheria 5-10%; Whooping cough 4% infants < 1yr, 1%
children < 4 years; Swine flu <
0.1-4 %; Seasonal flu 0.01%;
COVID 19 in Wuhan
4.9%; COVID in Hubei Province 3.1%; COVID 19 in Nationwide 2.1%; COVID 19 in other provinces 0.16%.
Number of flu deaths every year: 290,000 to 650,000 (795 to 1,781 deaths per day)
About the Virus
‘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.
Single-strand, positive-sense RNA genome ranging from 26 to 32
kilobases in length, Beta corona virus from Corona family.
One
of the three deadly human respiratory coronaviruses. Others are Severe acute respiratory syndrome
coronavirus [SARS-CoV] and Middle East respiratory syndrome coronavirus
[MERS-CoV]). COVID 19 is 75 to 80%
identical to the SARS-CoV
Origin: Wuhan, China
December 2019. 1st case informed to the world by Dr. Li Wenliang
died on 6th Feb.
Virus is likely to be
killed by sunlight, temperature, humidity. SARS stopped around May and June in
2003 due to more sunlight and more humidity.
Pathogenesis
High viral load: Detection of COVID 19
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]
COVID
19 uses the same cellular receptor as SARS-CoV (human angiotensin-converting
enzyme 2 [hACE2]), so transmission is expected more 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]
COVID
19 grows better in primary human airway epithelial cells than in standard
tissue-culture cells, unlike SARS-CoV or MERS-CoV. It is likely that COVID 19
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 COVID 19 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.
Transmission
Zoonotic and linked to
Huanan Seafood Wholesale Market as 55% with onset before
January 1, 2020 were originated there but only 8.6% of the subsequent cases.
The Chinese government has banned the wildlife trade until the epidemic
passes.
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.
It transmits predominantly with droplets like common flu
and not like air born (TB, Measles, Chicken pox). Kissing scenes have been banned
in movies in China. In Kerala air crew are exempted
from breath analyser tests and China has banned death ceremonies, people
gathering together,
NEJM reported a small
cluster of five cases suggested transmission from asymptomatic individuals
during the incubation period; all patients in this cluster had mild illness. But
the same has been challenged. Another case got infected while using gown, but
eyes not covered.
Initial serious illness
in other countries were less as patients with breathlessness are unlikely to
board and patients will mild illness or asymptomatic illness are less likely to
transmit infections.
Legal
Implications 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.
Quarantine has Limitations
China imposed unprecedented
quarantines across Hubei, locking in about 56 million people, in a bid to stop
it spreading.
Villages in Vietnam with 10,000 people close to
the nation's capital are placed under quarantine on 13th Feb after
six cases of the deadly new coronavirus were discovered there.
1.
22% quarantined in Diamond Ship got
infected.
2.
The people on quarantine are kept
under a 14-day quarantine. If they are placed together and if anyone is
diagnosed during that period, the quarantine will add another 14 days.
3.
The longer you have several
thousand people cohoused you will continue to propagate waves of infection.
4.
A better way to quarantine is to
break up these people into smaller groups and quarantine them separately.
5.
Why quarantine children < 15
years when the virus is not risky for them.
6.
Why not separate elderly people
with comorbid conditions at high risk of deaths and quarantine them separately
in one to one or small groups.
7.
Why allow people to celebrate and
have cultural programs during quarantine. As was seen in India people dances
together with surgical masks during quarantine period,
8.
Ventilation system connects one
room to the next. There has been previous concern that the coronavirus can
spread through pipes
9.
Stress and anxiety are known to
suppress the immune system, making people more susceptible to contracting the
virus.
10. Quarantine them the way it was done in TB sanitoriums with both
sun-balconies and a rooftop terrace where the patients would lie all day either
in beds or on specially designed chairs.
Standard Respiratory Droplets Precautions
At triage: Surgical 3 layered mask to
the patient; Isolation of at least three feet distance, Cough etiquette and Hand
hygiene
Droplet
precautions: Three-layer surgical mask by patients,
their contacts and health care workers, in an adequately ventilated isolation
room, health care workers while caring with the secretions should use eye
protection, face shields/goggles. One should limit patient movement, restrict attendants
and observe hand hygiene.
Contact
precautions: When entering room - gown,
mask, goggles, gloves – remove before leaving the room; Dedicated equipment/
disinfection after every use; Care for environment- door knobs, handles,
articles, laundry; Avoid patient transport and Hand hygiene
Airborne
precautions when handling virus in the lab and while performing
aerosol-generating procedures. Room should be with negative pressure with
minimum of 12 air changes per hour or at least 160 litres/second/patient in
facilities with natural ventilation. There should be restricted movement of
other people and all should use gloves, long-sleeved gowns, eye protection, and
fit-tested particulate respirators (N95 or equivalent, or higher level of protection)
Public
Strict
self-quarantine if sick with flu like illness: 2 weeks
Wash your
hands often and for at least 20 seconds with soap and water or use an alcohol-based
hand sanitizer.
Avoid
touching: Eyes, nose, and mouth with
unwashed hands.
Avoid
close contact: (3-6 feet) with people who are sick with cough or breathlessness
Cover
your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and
disinfect frequently touched objects and surfaces.
Masks
Surgical 3 layered
Masks: For patients and close contacts
N 95 Masks: For health
care providers when handling respiratory secretions.
Lab tests
1.
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.
2.
BOTH the upper
respiratory tract (URT; nasopharyngeal and oropharyngeal) AND lower respiratory
tract (LRT; expectorated sputum, endotracheal aspirate, or bronchoalveolar
lavage)
3.
Use PPE in the lab
4.
Use viral swabs (sterile Dacron or rayon, not cotton) and
viral transport media
5.
In US January, all testing had to be
done in CDC laboratories. However, on February 4, the US FDA issued an
emergency-use authorization for the CDC's COVID 19 Real-Time RT-PCR Diagnostic
Panel, which allows it to be used at any CDC-qualified laboratory in the United
States.
6.
Lab precautions: BSL 2 (3 for viral culture labs)
Treatment
1.
No proven antiviral treatment.
2. 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.
3.
Secondary infection, E
Coli, are most likely the cause of deaths of the patients in the Philippines
and HK.
4.
A combination of lopinavir and
ritonavir showed promise in lab in SARS. Combination of lopinavir, ritonavir
and recombinant interferon beta-1b was tried in MERS.
6. 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.
7.
Thailand: Oseltamivir along with lopinavir and
ritonavir, both HIV drugs.
8.
Experimental drug: Rrom Gilead Sciences Inc.,
called remdesevir (started on 6th Feb as a trial)
9.
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 COVID 19 shares some similarity to HIV virus also)
10. 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
11.
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.
12.
In SARS, people were put-on
long-term steroids ending with immunosuppression and late complications and
death. The current protocol is short term treatment.
Common Facts
1.
People receiving packages from China are
not at risk of contracting the COVID 19 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 COVID 19.
3.
Pneumococcal vaccine and Hib vaccine do
not provide protection against COVID 19.
4. Regularly
rinsing the nose with saline does not protect people from infection with COVID 19 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 COVID 19 although some brands or mouthwash can eliminate
certain microbes for a few minutes in the saliva in your mouth.
6. There
is no evidence that eating garlic protects people from COVID 19.
7. Sesame
oil does not kill the new coronavirus. Chemical disinfectants that can kill the
COVID 19 on surfaces are bleach/chlorine-based disinfectants, either solvents,
75% ethanol, peracetic acid and chloroform.
8. People of
all ages can be infected by COVID
19. 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.
9. Antibiotics
do not work against viruses.
10. To
date, there is no specific medicine recommended to prevent or treat it.
Trolls and conspiracy theories: Not validated and
are fake news
1.
COVID
19 is linked to Donald
Trump, and US
intelligence agencies or pharmaceutical companies are behind it.
2.
That
eating snakes, wild animals or drinking bat soup causes corona
3.
Keep
your throat moist, avoid spicy food and load up on vitamin C
4.
Avoiding
cold or preserved food and drinks, such as ice cream and milkshakes, for "at
least 90 days".
5.
Experts
have been aware of the virus for years.
6.
The
virus was part of China's "covert biological weapons programme" and
may have leaked from the Wuhan Institute of Virology.
7.
Linked
to the suspension of a researcher at Canada's National Microbiology Lab.
8.
China
wants to kill 20,000 COVID 19 patients is totally
false. The site is linked to a sex website.
Role of CMAAO and other Medical
Associations
Get 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. All countries should emphasise on reducing
human infection, prevention of secondary transmission and international spread.
Intensify IEC activities.
CMAAO IMA FOMA MAMC Recommendations
1.
Prise control of PPE
2.
Accreditation of private labs for testing
3.
Private insurance should cover the infection
4.
IEC and CME activities to be intensified
5.
Allow paid leaves for air born and droplet
infections
6.
Allow teleconsultations in flu like
diseases
7.
CSR funds for vaccine research
8.
Surgical three-layered masks at public
places
9.
Start National program on respiratory
secretions born illnesses
10. In
India incorporate respiratory infection control under swatch bharat
Case Definitions
Suspect
case
A.
Patients with severe acute respiratory infection (fever, cough, and requiring
admission to hospital), AND with no other etiology that fully explains the
clinical presentation AND at least one of the following:
· a
history of travel to or residence in the city of Wuhan, Hubei Province, China
in the 14 days prior to symptom onset, or
· patient
is a health care worker who has been working in an environment where severe
acute respiratory infections of unknown etiology are being cared for.
B.
Patients with any acute respiratory illness AND at least one of the following:
· close
contact with a confirmed or probable case of COVID 19 in the 14 days prior to
illness onset, or
· visiting
or working in a live animal market in Wuhan, Hubei Province, China in the 14
days prior to
· symptom
onset, or
· worked
or attended a health care facility in the 14 days prior to onset of symptoms
where patients with hospital associated COVID 19 infections have been reported.
Probable
case
A
suspect case for whom testing for COVID 19 is inconclusive or for whom testing
was positive on a pan-coronavirus assay.
Confirmed
case
A
person with laboratory confirmation of COVID 19 infection, irrespective of
clinical signs and symptoms.
Severe
acute respiratory infection (SARI)
An ARI with history of
fever or measured temperature ≥38 C° and cough; onset within the last ~10 days;
and requiring hospitalization. Absence of fever does NOT exclude viral infection
SARI
in a person, with history of fever and cough requiring admission to hospital,
with no other etiology that fully explains the clinical presentation
(clinicians should also be alert to the possibility of atypical presentations
in patients who are immunocompromised)
AND
any of the following:
a)
A history of travel to Wuhan, Hubei Province China in the 14 days prior
to symptom onset; or
b)
the disease occurs in a health care worker who has been working in an
environment where patients with severe acute respiratory infections are being
cared for, without regard to place of residence or history of travel; or
c)
the person develops an unusual or unexpected clinical course, especially
sudden deterioration despite appropriate treatment, without regard to place of
residence or history of travel, even if another etiology has been identified
that fully explains the clinical presentation
OR
A person with acute respiratory illness of any degree of severity who, within
14 days before onset of illness, had any of the following exposures:
a)
close physical contact with a confirmed case of COVID 19 infection, while
that patient was symptomatic: or
b)
a healthcare facility in a country where hospital associated COVID 19
infections have been reported
Uncomplicated illness
Patients with
uncomplicated upper respiratory tract viral infection, may have non- specific
symptoms such as fever, cough, sore throat, nasal congestion, malaise,
headache, muscle pain or malaise. The elderly and immunosuppressed may present
with atypical symptoms. These patients do not have any signs of dehydration,
sepsis or shortness of breath
Mild pneumonia
Patient with pneumonia
and no signs of severe pneumonia. Child with non-severe pneumonia has cough or
difficulty breathing + fast breathing: fast breathing (in breaths/min): <2
months, ≥60; 2–11 months, ≥50; 1–5 years, ≥40 and no signs of severe pneumonia
Severe pneumonia
Adolescent or adult: fever or suspected respiratory infection, plus one of
respiratory rate >30 breaths/min, severe respiratory distress, or SpO2
<90% on room air
Child with cough or difficulty in breathing, plus at least one of
the following: central cyanosis or SpO2 <90%; severe respiratory distress
(e.g. grunting, very severe chest indrawing); signs of pneumonia with a general
danger sign: inability to breastfeed or drink, lethargy or unconsciousness, or
convulsions. Other signs of pneumonia may be present: chest indrawing, fast
breathing (in breaths/min): <2 months, ≥60; 2–11 months, ≥50; 1–5 years,
≥40.
The diagnosis is
clinical; chest imaging can exclude complications.
Acute Respiratory
Distress Syndrome
Onset: new or worsening respiratory symptoms within one week of
known clinical insult.
Chest imaging
(radiograph, CT scan, or lung ultrasound): bilateral opacities, not fully explained by effusions, lobar
or lung collapse, or nodules.
Origin of oedema: respiratory failure not fully explained by cardiac failure or
fluid overload. Need objective assessment (e.g. echocardiography) to exclude
hydrostatic cause of oedema if no risk factor present.
Oxygenation (adults):
Mild ARDS: 200 mmHg <
PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥5 cm H2O, or non-ventilated)
Moderate ARDS: 100 mmHg
< PaO2/FiO2 ≤200 mmHg with PEEP ≥5 cm H2O, or non-ventilated)
Severe ARDS: PaO2/FiO2 ≤
100 mmHg with PEEP ≥5 cmH2O, or non- ventilated)
When PaO2 is not
available, SpO2/FiO2 ≤315 suggests ARDS (including in non-ventilated patients)
Oxygenation (children;
note OI = Oxygenation Index and OSI = Oxygenation Index using SpO2)
Bilevel NIV or CPAP ≥5
cmH2O via full face mask: PaO2/FiO2 ≤ 300 mmHg
or SpO2/FiO2 ≤264
Mild ARDS (invasively
ventilated): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5
Moderate ARDS
(invasively ventilated): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3
Sever Sepsis
Adults: life-threatening organ dysfunction caused by a dysregulated
host response to suspected or proven infection, with organ dysfunction.
Signs of organ
dysfunction include altered mental status, difficult or fast breathing, low
oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold
extremities or low blood pressure, skin mottling, or laboratory evidence of
coagulopathy, thrombocytopenia, acidosis, high lactate or hyperbilirubinemia.
Children: suspected or proven infection and ≥2 SIRS criteria, of
which one must be abnormal temperature or white blood cell count
Septic
shock
Adults: persisting hypotension despite volume resuscitation,
requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate level >2
mmol/L
Children: any hypotension (SBP <5th centile or >2 SD below
normal for age) or 2-3 of the following: altered mental state; tachycardia or
bradycardia (HR <90 bpm or >160 bpm in infants and HR <70 bpm or
>150 bpm in children); prolonged capillary refill (>2 sec) or warm
vasodilation with bounding pulses; tachypnoea; mottled skin or petechial or
purpuric rash; increased lactate; oliguria; hyperthermia or hypothermia
e ARDS (invasively
ventilated): OI ≥ 16 or OSI ≥ 12.3
•
Search:
•
|
Country,
Other |
Total Cases |
New
Cases |
Total
Deaths |
New
Deaths |
Total
Recovered |
Serious,
Critical |
|
China
|
78,499
|
+435
|
2,744
|
+29
|
32,502
|
8,745
|
|
S. Korea
|
1,595
|
+618
|
12
|
+1
|
24
|
18
|
|
Diamond Princess
|
705
|
+14
|
4
|
10
|
36
|
|
|
Italy
|
470
|
+147
|
12
|
+1
|
3
|
35
|
|
Japan
|
172
|
+11
|
3
|
+2
|
23
|
13
|
|
Iran
|
139
|
+44
|
19
|
+3
|
25
|
|
|
Singapore
|
93
|
+2
|
62
|
7
|
||
|
Hong Kong
|
89
|
+4
|
2
|
18
|
6
|
|
|
USA
|
60
|
+3
|
6
|
|||
|
Thailand
|
40
|
+3
|
22
|
2
|
||
|
Bahrain
|
33
|
+10
|
||||
|
Taiwan
|
32
|
+1
|
1
|
5
|
1
|
|
|
Germany
|
27
|
+9
|
15
|
2
|
||
|
Kuwait
|
26
|
+15
|
||||
|
Australia
|
23
|
+1
|
15
|
|||
|
Malaysia
|
22
|
20
|
||||
|
France
|
18
|
+4
|
2
|
+1
|
11
|
1
|
|
Vietnam
|
16
|
16
|
||||
|
Spain
|
13
|
+4
|
2
|
|||
|
U.K.
|
13
|
8
|
||||
|
U.A.E.
|
13
|
3
|
2
|
|||
|
Canada
|
12
|
+1
|
3
|
|||
|
Macao
|
10
|
6
|
||||
|
Iraq
|
5
|
|||||
|
Oman
|
4
|
|||||
|
Philippines
|
3
|
1
|
2
|
|||
|
Croatia
|
3
|
+2
|
||||
|
India
|
3
|
3
|
||||
|
Austria
|
2
|
|||||
|
Finland
|
2
|
+1
|
1
|
|||
|
Israel
|
2
|
|||||
|
Lebanon
|
2
|
+1
|
||||
|
Pakistan
|
2
|
+2
|
||||
|
Russia
|
2
|
2
|
||||
|
Sweden
|
2
|
+1
|
||||
|
Afghanistan
|
1
|
|||||
|
Algeria
|
1
|
|||||
|
Belgium
|
1
|
1
|
||||
|
Brazil
|
1
|
|||||
|
Cambodia
|
1
|
1
|
||||
|
Egypt
|
1
|
1
|
||||
|
Georgia
|
1
|
+1
|
||||
|
Greece
|
1
|
+1
|
||||
|
North Macedonia
|
1
|
+1
|
||||
|
Nepal
|
1
|
1
|
||||
|
Norway
|
1
|
+1
|
||||
|
Romania
|
1
|
+1
|
||||
|
Sri Lanka
|
1
|
1
|
||||
|
Switzerland
|
1
|
•
Highlighted in green
•
= all cases have recovered from the infection.
•
Highlighted in grey
•
= all cases have had an outcome (there are no active cases).
Inputs:
Dr Rajan Sharma, Dr RV Asokan, Dr KK Kalra,
Dr Sushil Kumar, Dr Anita Arora, Dr Upasana Arora, Dr SS Srivastava, Dr Shilpi
Khanna, Ms Swati, Dr Rahiul Shukla, Dr Arti Verma, Dr Anil Kumar, Dr G S Gyani,
Dr Sonal Saxena, Dr CM Bhagat, Dr Vikas Manchanda, Dr Nandani Sharma, Dr
Suneela Garg, Dr TK Joshi, Dr Mamta Jajoo, Dr Shariga Qureshi, Dr Manish Kumar,
Dr Harmeet Singh, Dr Rai, Dr VK Monga, Dr AP Singh, Dr Ramesh Datta, Dr Maj Prachi Garg, Dr Anil
Kumar, Dr Ragini Agrawal, Dr Rajeev
Kumar, Dr Harish Grover, Dr Mini Mehta,
Dr Lalan Bharti, Dr Rajeev Sood, Dr N V
Kamat, Dr Atin Kumar, Dr RN Tandon, Dr Kaushik Sinha Deb, Dr Tarun Mittal, Dr
Dinesh Sahay, Dr SK Poddar
CMAAO _ Suggestions so far
1. 7th January: CMAAO Alert: WHO to monitor China's
mysterious pneumonia of unknown virus outbreak
2. 8th
Jan: CMAAO
warns Asian citizens travelling China over mystery pneumonia outbreak
3.
10th January: Editorial: COVID 19 strain
causing pneumonia in Wuhan, China, It’s a new strain of corona virus in the china pneumonia
4.
13th Jan: China Virus Outbreak
Linked to Seafood Market
5.
15th Jan: First Case China
Pneumonia Virus Found Outside China in Thailand
6. 17th
Jan: WHO
issues warning after 'mysterious' Chinese COVID 19 spreads to Japan
7. 17th Jan: India
at threat of Corona. CMAAO urges travel advisory on coronavirus: drugtodayonline.com/medical-news/nation/10379-cmaao-urges-travel-advisory-on-coronavirus.html (18th Indian govt issues travel
advisory as China's mysterious 'Coronavirus' spread in other countries)
8. 18th Jan: WHO issues warning after
mysterious Chinese Coronavirus spreads to Japan [http://blogs.kkaggarwal.com/tag/who/]
9. 18-20 Jan: Three countries CMAAO meet, also
discussed COVID 19
10. 22nd 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 (23rd
India advisory to airports)
11. 24th: Inter Ministerial Committee
needs to be formed on COVID 19 (PMO took a meeting on 24th evening)
12. 25th Jan: Indian government should
pay for Indians affected with the virus in China
13. 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 31st January by Indian
Government) Action: [ Feb 1st:
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 30th India banned
gloves, PEP and masks but on 8th 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.]
14. 27th Jan:
History of anti-fever drugs at airports should be taken
15. 28th Jan: Do research on Nosodes
16. 29th Jan: Closure of live markets all
over the world, India should take a lead
17. 30th
Jan: Paid flu leave, surgical mask at public places, N 95 for health care
providers
18. 31st
Jan: Respiratory hygiene advisory schools, Pan India task force to be
made
19. 1st
Feb: Disaster Budget is the need of the hour
20. 3rd Feb: 100 crore budget for COVID
19; Private labs to be recognised; one dedicated COVID 19National 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 5th Feb the Ministry of
Defence is setting up 10 new laboratories across the country, primarily to
conduct research on viruses] [ 14th Feb: Japan to earmark $140
million to combat coronavirus. The
government will earmark 15.3 billion yen (approximately $140 million) for
emergency measures, including ones to bolster testing and medical treatment
capacity, to double mask production to more than 600 million a month, and
credits for small and medium-sized businesses hurt by the outbreak.
21. 4th 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]
22. 5th Feb: PM should talk about COVID
19in Man Ki Baat or a special address
23. 6th Feb: Time to have makeshift bed
policy to tackle deaths in Kota, Muzaffarpur and
COVID 19[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]
24. 7th
Feb: IPC 270 should be applicable to COVID 19
25. 8th Feb: teleconsultation should be
allowed to flu and COVID 19consultation
26. 9th
Feb: Schools should start droplet prevention program
27. 10th
Feb: Pharma freebee how to handle
28. 11th
Feb: IMR should be classified as preventable vs non preventable
29. 12th
Feb: Swatch Bharat should include COVID 19 prevention
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