[SoumenD]

Originally Posted by Latheesh

Not just tests per million population. Have a look at absolute numbers a week ago. All these states you listed - KA, DL, and UP were behind MH, RJ and KL. Sudden spike in total test numbers happened during last 1 week.

It's a known fact and past can't be changed. What matters is now tests are happening. Although it needs to still go up substantially.

Originally Posted by V.Narayan

Yes I meant it as XXX tests per million of population. For example UP's 28k tests on a population of 20 crores looks criminally poor compared to Delhi State's 24k tests on a population base 22 times smaller. Of course West Bengal leads!!!

Agreed. WB situation scares the daylights out of me. My parents are there and they were worried looking at the local markets during initial days of lockdown. However now looks like the administration is getting strict with the implementation.

Btw I got to know from them today that someone from centre has landed in WB to monitor the proceedings about which the state government is not happy? It was apparently in local News channel.

Originally Posted by anandmv

The travelogue of our times



https://www.hindustantimes.com/india...xO63cyonM.html

Just incredible. Leaving aside the risks associated with the trip, it's amazing what human will-power is capable of

[Chetan_Rao]

Originally Posted by joslicx

....Suppose the vaccine was invented tomorrow. How soon will the pharma company be able to manufacture 7billion+ doses of it. How soon will it be available to people even in remotest region...

The timeline bit isn't getting enough attention, understandably so as we're still grappling with initial stages of response.

Even assuming we have viable vaccine candidates ready right now, the timeline to actually vaccinate everyone includes human trials + manufacturing + distribution + vaccination + validation, and the challenges each of these steps brings.

Best case scenario - a viable vaccine candidate passing human trials in first attempt and cleared for mass-production - it will still be a few years before everyone is vaccinated. People need to look at the full timeline, and realize some of these cannot be expedited (esp. human trials).

[DigitalOne]

Originally Posted by Chetan_Rao

Best case scenario - a viable vaccine candidate passing human trials in first attempt and cleared for mass-production - it will still be a few years before everyone is vaccinated. People need to look at the full timeline, and realize some of these cannot be expedited (esp. human .

You don't need to vaccinate the entire population to stop the spread. You just need to start with the elderly population of hotzones, then the younger population in hotzones, plus the travellers. That will stop the spread and the death. Others can be vaccinated over a period of time.

[Chetan_Rao]

Originally Posted by DigitalOne

You don't need to vaccinate the entire population to stop the spread. You just need to start with the elderly population of hotzones, then the younger population in hotzones, plus the travellers. That will stop the spread and the death. Others can be vaccinated over a period of time.

There will of course be need for prioritization like you mention, but please account for two things:

1. The end-to-end timeline will still be a few years, even with staggered vaccination.

2. The hot-zones will presumably expand in size and population volume between now and start of vaccination, so the groups within the staggered vaccination approach will become increasingly larger, the longer a vaccine takes to be available.

[meerkat]

Worth a read:

"Don’t bet on vaccine to protect us from Covid-19", says world health expert

Humanity will have to live with the threat of coronavirus “for the foreseeable future” and adapt accordingly because there is no guarantee that a vaccine can be successfully developed, one of the world’s leading experts on the disease has warned.

The stark message was delivered by David Nabarro, professor of global health at Imperial College, London, and an envoy for the World Health Organisation on Covid-19 .....
.
.

In an interview with The Observer Nabarro said the public should not assume that a vaccine would definitely be developed soon – and would have to adapt to the ongoing threat.

“You don’t necessarily develop a vaccine that is safe and effective against every virus. Some viruses are very, very difficult when it comes to vaccine development - so for the foreseeable future, we are going to have to find ways to go about our lives with this virus as a constant threat.

“That means isolating those who show signs of the disease and also their contacts. Older people will have to be protected. In addition hospital capacity for dealing with cases will have to be ensured. That is going to be the new normal for us all.”
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.
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Nabarro’s message is the second grim warning to come from senior ranks of the WHO in the last three days. On Friday, Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, warned that there was no evidence that antibody tests now being developed would show if a person has immunity or is no longer at risk of becoming reinfected by the Covid-19 virus.
.

Link:

https://www.theguardian.com/world/20...-health-expert
.

[Latheesh]

Some good news coming out of this crisis. Kasaragod was at the receiving end few weeks back due to high number of Corona cases in Kerala. Not a single lives lost due to Corona till date but 9 other people died due to lack of timely medical treatment.

Couple of weeks back Tata group agreed to set up a specialty hospital in Kasaragod and Govt. allotted 15 acre land for the project. Work has already been started but there was an issue in site preparation due to rocky terrain. District Collector posted a facebook message asking for help from earth moving equipment owners. Owners association decided to do the site preparation free of cost and sent over 60 equipments to the site. Hospital project completion time is 3 months.

source: twitter user arunmohanother

https://www.youtube.com/watch?v=rTVxbKtg28Y&t=44s

[Miyata]

Originally Posted by meerkat

Worth a read:

"Don’t bet on vaccine to protect us from Covid-19", says world health expert

May not be worth a read (sorry!).

The corona is not a particularly tricky virus like the HIV one is. Corona is fairly stable (as of now) and does not mutate like crazy (unlike HIV). There is good chance we will have some cure for it.

For the moment at least, the article might be more of fear-mongering!

[meerkat]

Originally Posted by Miyata

....

.... the article might be more of fear-mongering!

Being a layman I tend to give credence to what "one of the world’s leading experts on the disease" (according to The Guardian) has to say. I could never have imagined that "an envoy for the World Health Organisation on Covid-19" could have made it his mission to indulge in "fear-mongering" through a prominent newspaper in these dire times! Perhaps Mr. Trump was justified in stopping aid to the WHO after all !
.

[rrsteer]

Originally Posted by meerkat

I could never have imagined that "an envoy for the World Health Organisation on Covid-19" could have made it his mission to indulge in "fear-mongering" through a prominent newspaper in these dire times!

Unfortunately, this could be true. Its out in the open now, how incompetent and naive WHO is, by the way they handled this pandemic. Infact, I wholeheartedly agree with some who are branding it a criminal organization. They are committing a criminal act by discouraging people to wear masks.

https://edition.cnn.com/2020/03/30/w...rnd/index.html

[saket77]

And that is not all. Here’s more:
https://www.livemint.com/news/world/...401652649.html

WHO says that the worst is yet to come. I don’t know how to react to this statement by them.

[JJay]

Lockdown had been proven very effective barring few places before an event in Delhi came out with huge shock. Take my home town Bharuch as an example, which now has 25 cases, including a doctor and 8 medical staff of bharuch civil hospital, almost all the cases can be linked to that event in Delhi.

Here, many people have no idea how much efforts governments (including civic administrations) have been putting in and how pro-actively they are working, but real problem is that WE-the people are not at all co-operating them. I am here not to play blame game but let accept spade as spade. We can criticise govt, authorities, police, our health infrastructures because most of us are sitting at home and are not working in civil administrations/sanitation works/medical personnel/police force.

Try to have some idea about the life of corona warriors, these "warriors" are not coming home for days because they afraid of getting their families infected and still performing their duties, in fact doing duties with utmost responsibility. Irony is that they have to fight not only COVID-19 but also Non-cooperation movements led by some of us, sometimes even criminal disobedience.

I personally know few medical staff and police personnel who have last visited their homes more than a week ago.

It is the irony that ENTIRE WORLD's LEADERS are praising our efforts and showing their support and solidarity in different ways, still few of us want to get to that countries, where probably will take medicines sent by India. for being bit harsh.

Why we always want overnight changes in everything? Why we always expect miracles to happen? Why can't we understand the situation as it is and try to understand all the possible dimensions rationally?

Why it is so hard for us to show faith and solidarity in our corona warriors?

I SALUTE CORONA WARRIORS, who are making variuos sacrifices at various levels just to make us HEALTHY and keep us ALIVE.

why can't we say? WE CAN AND WILL FIGHT IT OUT TOGETHER.

[mvadg]

With ACE2 receptors all over the body, it is only to be expected that the SARS-COV2 would have an effect beyond the respiratory system. Here's an article that explains the ramifications of this:

https://cen.acs.org/biological-chemi...98/web/2020/04




What explains the non-respiratory symptoms seen in some COVID-19 patients?

by Megha Satyanarayana

10-12 minutes

Credit: C&EN/Shutterstock
While COVID-19 is predominantly a lung (4) infection, symptoms have been reported throughout the body, including the central nervous system (1), eyes (2), nose and mouth (3), heart (5), liver (6), and gut (7).



While COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, is generally a respiratory infection with coughing and shortness of breath as key features of the illness, some people have reported other symptoms, including loss of smell, heart trouble, and diarrhea.
These less common symptoms, especially cardiac ones, have caused hospitals to adapt their intake protocols to spot possible COVID-19 patients, says Salim Virani, a cardiologist at Baylor College of Medicine. “Almost all hospitals that I’ve talked to, everybody has a protocol whereby they are testing these patients for COVID-19 as well,” Virani says about people who arrive at the emergency department with heart concerns.
Scientists say that these non-lung symptoms might also be good indicators of SARS-CoV-2. Once inside a person’s body, the novel coronavirus attaches to a protein on human cells called angiotensin-converting enzyme 2 (ACE2). This enzyme, which is normally involved in blood pressure regulation, sits on the surface of different types of cells, including those in the brain, blood vessels, heart, intestines, and kidneys.
It’s plausible that the novel coronavirus causes these other symptoms by directly infecting some of these cells. But this infection also can cause a massive immune response, leading to the overproduction of small immune molecules called cytokines. This cytokine storm triggers inflammation and organ damage. It’s been observed in the lungs of the sickest COVID-19 patients, but it likely happens in other organs as well.
“If you have a severe infection, and there is a systemic response related to that, inflammation can be protective early on,” Virani says. “But then that response itself, when it’s a systemic inflammation all over the body, can become detrimental.”
Here is a look at some of the body parts where the novel coronavirus might cause other symptoms in people, and what scientists think is behind these symptoms. Because researchers are still learning about SARS-CoV-2, a lot of what they hypothesize is based on previous characterizations of the virus’s cousins, the virus that caused the severe acute respiratory syndrome (SARS) outbreak from 2002 to 2004, and the coronavirus that causes Middle East respiratory syndrome (MERS).

Central nervous system

Some COVID-19 patients have shown up at the hospital confused, or with what doctors call an altered mental status. For example, a flight attendant in her fifties from Detroit developed something called acute hemorrhagic necrotizing encephalopathy. This brain condition is characterized by inflammation and tissue damage and is often linked to viral infections. Brent Griffith, a neuroradiologist at Henry Ford Hospital, led the team of health care workers who described the woman’s condition, which they attribute to cytokine storm and a breakdown of the blood-brain barrier. Using magnetic resonance imaging, they showed damage to her brain, and noted that while they were unable to test for the presence of SARS-CoV-2 in fluid from her central nervous system, the presence of virus isn’t always necessary for acute hemorrhagic necrotizing encephalopathy (Radiol. 2020, DOI: 10.1148/radiol.2020201187).
Another research team, led by Yan-Chao Li of Jilin University, thinks that based on what we know about where in the body the virus behind the SARS outbreak attacks, SARS-CoV-2 might be able to infect the central nervous system. Li and the team also propose that when the coronavirus infects the brain, it may damage the nerves that regulate breathing, and that this might be one of the reasons why some people end up in respiratory failure (J. Med. Virol. 2020, DOI: 10.1002/jmv.25728).

Eyes

There have been some reports of eye inflammation, or conjunctivitis, associated with COVID-19, but these symptoms have been rare. Still, some researchers have wondered whether the virus could get into the body through the eyes. In small studies in China, researchers have detected the virus’s RNA in people’s tears (JAMA Ophthalmol. 2020, DOI: 10.1001/jamaophthalmol.2020.1291).
Eye cells do express the ACE2 receptor, but these scientists still think eye-related infection or tear-related spread of the virus would be quite rare. Led by Chuan-bin Sun of the Zhejiang University School of Medicine, this team suggests that tears would wash away the virus, and that immune mechanisms in the eyes, led by antibodies and a molecule called lactoferrin, would prevent widespread infection (J. Med. Virol. 2020, DOI: 10.1002/jmv.25859). The American Academy of Ophthalmology has also weighed in on the issue, saying that, “infectious virus has not yet been cultured from the conjunctiva of any COVID-19 patient.”

Taste and smell

Danielle Reed of the Monell Chemical Senses Center says that viral infections often affect our sense of smell, and thus taste, because the infection blocks airways, preventing odorants from interacting with smell receptors. However, in the case of COVID-19, she says, researchers haven’t ruled out direct infection of smell-sensing cells, or some other mechanism affecting the nerves that conduct smell signals to the brain.
So, Monell, as part of the Global Consortium for Chemosensory Researchers, is gathering data from people who have tested positive for COVID-19, and who are experiencing loss of smell and taste.
While olfactory neurons do not express ACE2, cells that surround those neurons, and provide structural support, do. The virus could infect and kill these sustentacular cells, weakening the scaffolding that holds olfactory neurons up, and perhaps affecting the neurons’ function. “We envision that they’re taking up the virus,” Reed says. “But, how it’s causing problems with people’s ability to smell is not understood.”
There is precedence for these sensory symptoms, Reed points out. People with SARS also reported a loss of smell.

Cardiovascular system

Some people with COVID-19 have had heart attacks, but Baylor’s Virani says that early reports of patients in Seattle and New York indicate that arrhythmia, an irregular heart beat, is the most common cardiovascular symptom. Doctors have also observed inflammation of heart tissue, or myocarditis.
Heart muscle cells express ACE2, Virani says, and it is possible that SARS-CoV-2 is infecting the heart, but he can’t rule out cytokine storm and what’s happening in the lungs as the culprits behind these cardiac symptoms. “The severity of the heart muscle involvement, in most cases, but not in every case, is actually directly related to the severity of the lung involvement,” he says, adding that in some patients, as their lung disease progresses, markers for cardiac damage also increase. Doctors are treating some of the people with these cardiac symptoms with drugs that block some of the perpetrators of cytokine storm, including interleukin-6.

Liver

In one study of 99 people infected with SARS-CoV-2 in Wuhan, 43 had elevated levels of the liver enzymes alanine aminotransferase, aspartate aminotransferase, and lactic dehydrogenase (Lancet 2020, DOI: 10.1016/S0140-6736(20)30211-7). High levels of these enzymes are a sign of liver damage. In another study of nearly 1,100 people who tested positive for the novel coronavirus, between 28% and 40% had elevated liver enzymes, and the more critically ill they were, the more likely they were to have higher levels (N. Eng. J. Med. 2020, DOI: 10.1056/NEJMoa2002032 .
Jie Li, who is an infectious disease scientist at Shandong University, and Jian-Gao Fan of the Shanghai Jiao Tong University School of Medicine, wrote in a recent paper that there aren’t many cells in the liver that express ACE2, so it’s not clear if the virus is causing the damage directly itself (J. Clin. Transl. Hepatol. 2020, DOI: 10.14218/JCTH.2020.00019). They point out that cytokine storm might affect the liver, as could sepsis, which is a large scale bacterial infection that seems to trail coronavirus infection in some people.
Some people who have had SARS or MERS also experienced liver damage, but it’s still too early to say what’s happening with SARS-CoV-2 and the liver.

Gastrointestinal system

As the COVID-2 outbreak spread through Hubei province in China, a team of researchers, led by Lei Tu of Huazhong University of Science and Technology, surveyed about 200 people with COVID-19 to see if they experienced gastrointestinal symptoms and found that 19% reported some combination of diarrhea, vomiting, or abdominal pain. That data makes gastrointestinal distress perhaps the most common non-respiratory symptom of SARS-CoV-2 infection. Their analysis also indicated that some patients went to the hospital complaining about these gastrointestinal issues and no respiratory symptoms, suggesting that some people with COVID-19 could have been missed by doctors. In fact, six of the people they studied never had any respiratory symptoms.
Tu and colleagues found viral RNA in about half of the stool samples they tested in their study. The team speculates that the inflammatory response to infection could explain intestinal symptoms, as the lungs and gut are linked via the body’s mucosal system in what researchers call the gut-lung axis. But scientists also think it’s possible that the novel coronavirus infects intestinal cells carrying the ACE2 receptor. One study of human tissue from COVID-19 patients found evidence of novel coronavirus proteins inside gastrointestinal cells that express ACE2, suggesting that the virus can infect the human gut. That team concluded that these data suggest gastrointestinal symptoms should not be overlooked in the absence of respiratory illness (J. Gastro. 2020, DOI: 10.1053/j.gastro.2020.02.055).
Chemical & Engineering News
ISSN 0009-2347
Copyright © 2020 American Chemical Society

[PGA]

There are some issues about this virus that are confounding me.
Why is it not impacting the entire human race in equal measure. Why countries in South Asia, SE Asia, Eastern Europe have been able avoid the disaster that is being inflicted on western Europe and USA. There are holes in every plausible explanation one might have in the case of Thailand, Malaysia, Pakistan, Sri Lanka, erstwhile Yugoslav region and even Mexico. South Africa and Australia are other examples of having manageable impact besides us.

The way it looks like now is that we may not not have post a Covid world at all. We are going to remain in the Covid world atleast in the near future. While other professions will quickly evolve and manage the change including trade and commerce. The impact on medical profession for the times to come confound me. At the cost of sounding a little exaggerated, if I was a doctor I would aproach each patient the way a bomb disposal guy handles potential explosive. This could result in collapse of our primary health management systems across the world. Maybe time for Google doctors and at home testing is closer than what we envisage.

A peek into the direction some enterprising guys are headed.

https://www.technologyreview.com/202...mpression=true

[V.Narayan]

Originally Posted by meerkat

Worth a read:
"Don’t bet on vaccine to protect us from Covid-19", says world health expert
Link:
https://www.theguardian.com/world/20...-health-expert
.

For the last 35 to 60 years the world of medicine has rapidly, and fortunately for us, moved to a situation where almost all communicable diseases have a cure. Many unfortunate people may not be able to afford the cure but it exists. With Covid-19 needing to be coped with after the lock down we will go back to the world that our parents and grand parents lived in in the 1920s to 1940s where several communicable diseases did not have a clear cure and you relied on what medicine was available, your own immunity, good health, good luck to survive. My parents & in-laws were all born in the 1920s and 30s. Between the 4 of them they survived small pox, diphtheria, typhoid, cholera and chicken pox before vaccines for these illness had been developed {or were not available in small town India} and in an era where these illnesses had a real fatality rate. It was not an ideal situation but it is a part of our living memory. With Covid-19 likely to take much more than a few months to get fully under control we are going back to that earlier era. Wearing masks and washing hands often are here to stay. It will gradually become one more unpredictable risk we live with like cancer, road accidents etc. Some people unfortunately are tying themselves up in knots with panic.

Originally Posted by PGA

There are some issues about this virus that are confounding me.
Why is it not impacting the entire human race in equal measure. Why countries in South Asia, SE Asia, Eastern Europe have been able avoid the disaster that is being inflicted on western Europe and USA. There are holes in every plausible explanation one might have in the case of Thailand, Malaysia, Pakistan, Sri Lanka, erstwhile Yugoslav region and even Mexico. South Africa and Australia are other examples of having manageable impact besides us.

Thank you for this observation. While scientists decry the assumption because tests have not been conducted to explain this but it is likely that there is a difference in the nature of immunity. It could also be that the countries of SE Asia and South Asia have not tested enough. May be the West eats too much of processed foods. We won't know the answers for a while.

[carboy]

Originally Posted by V.Narayan

May be the West eats too much of processed foods.

Weather, I think. Hot weather.