[mvadg]

Even Seoul! I doubt this social distancing strategy will really work. Many countries that we regard as having disciplined citizens seem to be flouting social distancing rules.

[vivek95]

Originally Posted by Behemoth

One question to the doctors and epidemiologists (if any on the forum).
If you see the current closed cases data (from worldometer) it is as below:
Attachment 1993956

Out of all the current infected cases, so far only 610,242 have been closed and out of that 79% have recovered and been discharged while around 21% have died - does this mean that the mortality rate is much higher than expected?

(request to Mods , in case my post is too gloomy, please do delete.)

I will attempt to answer this in simple terms and avoid the use of epidemiology jargon ( I am not an epidemiology expert but I am a physician ).

First thing to carefully note here is that Mortality rate is very different from Case Fatality rate. Mortality rate is calculated with respect to the entire population ( age specified or otherwise and whether infected or not) in that region. Simply put, how many people died due to a certain disease out of an entire population gives us the Mortality rates. Hence, for Covid-19 it is currently hovering around 6 to 7%.


The 21% figure in the snapshot that you have shared is a close reflection of Case Fatality rate and this takes into account the percentage of deaths from the number of total or closed Covid-19 cases. However, as the cases continue to get added every other moment, CFR calculated from only the closed cases suffers bias and inaccurate estimations according to epidemiologists.

For all practical purposes and for the general understanding of a layman, the Case Fatality rate can be considered as 21% from your report. Also, there is absolutely nothing gloomy in your post. Nowhere else in this world on any forum, the discussions on covid-19 might be as closely scrutinized and moderated as much as on Team-BHP. Thanks to our awesome admin and moderators. They are constantly ensuring to approve only reliable posts on this thread. Deletion of all the posts on Covid-19 conspiracy theories is itself an evidence to their commitment. I love this forum

Cheers
--Dr. Vivek

[Sankar]

Originally Posted by The Rationalist

There have been 3 deaths due to Covid-19 in India which has not been accounted in any states statistics. One Keralite (resident of Palakkad) died in Tamilnadu (Coimbatore) not included in Kerala deaths, Puducherry (resident of Mahe) who died in Kerala not included in Puducherry deaths, person from outside Haryana who died in PGI, Chandigarh. All three had gone to neighbouring states for treatment and died.

I’m ashamed to see Kerala resorting to such acts to keep it’s death tally low, it should be 3 deaths instead of 2. These persons were once productive citizens, the least the states could do is to show some respect! Are we going to put these deaths under ‘OTHER’ column? If Kerala, one of the most transparent of all states has resorted to such methods, I’m really afraid of the rest of the places.

In one of the regional TV channel debates where one of the members was a minister (though not health) this question was raised; but the reply was not convincing. Imho by the same logic the British and Italian nationals cured in Kerala should go under UK's and Italian register and not Kerala's. This should really be kept simple; if a death has happened in a particular state it should be entered in the respective state's register. It really should not matter if the person was transferred into a state while in treatment.

[LobsterB]

Originally Posted by skdking

Dear Mayank, Good point raised by you.

However one correction. Just because BBC is hiring Indians for reporting on India does not make it kosher. We all know the type of reporters engaged by any organisation is as per that organisation's line of thought and policy.

The condescending tone and the racist vibes do not necessarily have to come from a white BBC reporter. A well chosen brown person will the job better.

And one request to all. Please do not raise the bogey of shoddy reporting by Indian news channels. All our news channels have been re-designated as Entertainment channels.

I am a bit confused here, so how do you get your news? Only newspapers? I am of the opinion that there should be 'independent' media available in addition to government sources. Everyone will have their biases (including the government/bureaucracy). It is up to every individual to collate the information from disparate (biased) sources and construct the three-dimensional picture. So the government point-of-view, national left-centre-right point-of-view and the international media point-of-views are all important and together they provide the complete picture.

N.B: Even pure propaganda circulating in social media conveys something (many a times diametrically opposite of what they say and show)!

[vibbs]

Originally Posted by vivek95

...

Originally Posted by The Rationalist

...

Docs, quoting you only to get your attention.

Originally Posted by Slick

Attached is the official report from Government of Maharashtra,

We saw in the pdf shared by Slick yesterday of the official report from government of Maharashtra (page 14) that 65% of the cases are asymptomatic! (I hope I read the report correctly)

I was a bit by this.

This means 65% of people who were positive did not develop any symptoms at all. Is this not a dire situation? How do we know how many such people roam around unknowingly spreading the infection to others?

If my understanding is correct, it means these people have strong immunity which is why although they were infected by the virus, it has not affected them?

How long does such a person stay infectious?
Is it possible that they were tested while they were still within the incubation period and that is why they were asymptomatic?

Or is it possible that some people do get infected by virus and recover as well all the while not getting any symptoms?

[LobsterB]

Originally Posted by Safety is Param

^^ I believe Mysore / Nanjangud theory was debunked last week by authorities.

https://www.newindianexpress.com/sta...e-2128129.html

As far I could make out from both the reports it is still not ruled out. P52 did handle the chinese consignment. Swabs from packaging were negative when tested, the test results of the contents is still awaited. Not clear if the earlier chinese visitors came in contact with P52. It not being from any these source is perhaps even more scary.
I would still quarantine any (local/foreign) consignment to my home or office for a week or so to be on the safe side.

[Slick]

Originally Posted by vibbs

Docs, quoting you only to get your attention.

This means 65% of people who were positive did not develop any symptoms at all. Is this not a dire situation? How do we know how many such people roam around unknowingly spreading the infection to others?

If my understanding is correct, it means these people have strong immunity which is why although they were infected by the virus, it has not affected them?

While right now the numbers show that Maharashtra has the most cases and growing in numbers as well, I think it has something to do with the testing carried out in Maharashtra.
As per the CM's address, GOVT. has done 20K tests in Mumbai alone.

I am afraid as other states might have asymptomatic patients that must already be slowly spreading the virus.

I might be wrong, as this is an educated guess based on the general number of tests being done. (I read somewhere Maharashtra has done 20% of total tests in India)

-Slick

PS - bhpians, do correct if these figures are wrong.

[DCEite]

Coming back to the topic of Hydroxychloroqine (HCQ)

Found an interesting video by Dr Eric Berg DC:

https://www.youtube.com/watch?v=Eha_XjGNKj4

[The Rationalist]

Originally Posted by vibbs

Docs, quoting you only to get your attention.
people who were positive did not develop any symptoms at all. Is this not a dire situation? How do we know how many such people roam around unknowingly spreading the infection to others?
If my understanding is correct, it means these people have strong immunity which is why although they were infected by the virus, it has not affected them?
How long does such a person stay infectious?
Is it possible that they were tested while they were still within the incubation period and that is why they were asymptomatic?
Or is it possible that some people do get infected by virus and recover as well all the while not getting any symptoms?

As per latest analysis the virus may only be infective for a week or so. The virus can be detected in the blood by RT-PCR test for upto a month, so being positive may not mean that the patient is infective!

I’m not sure about the correct percentage of asymptomatic patients, but yep asymptomatic patients will be there and they can very well spread the infection. You are very right about the thing that there are people who get infected and won’t show any symptoms and recover.

Any illness caused by an organism, let it be bacteria, virus, parasite will not cause symptoms in everyone. We would have come across food poisoning happening to only few of a family while we eat out. So the risk of infection depends on not only your immunity but also varies depending on your genetic makeup, your gut biome ( make up of your natural bacteria in your gut ), that’s the next frontier of medicine called personalised medicine. You may have also noticed some drugs while very effective for one person may not cause any effect on the other person.

[vb-saan]

Originally Posted by The Rationalist

There have been 3 deaths due to Covid-19 in India which has not been accounted in any states statistics. One Keralite (resident of Palakkad) died in Tamilnadu (Coimbatore) not included in Kerala deaths, Puducherry (resident of Mahe) who died in Kerala not included in Puducherry deaths, person from outside Haryana who died in PGI, Chandigarh. All three had gone to neighbouring states for treatment and died.

I’m ashamed to see Kerala resorting to such acts to keep it’s death tally low, it should be 3 deaths instead of 2. These persons were once productive citizens, the least the states could do is to show some respect! Are we going to put these deaths under ‘OTHER’ column? If Kerala, one of the most transparent of all states has resorted to such methods, I’m really afraid of the rest of the places.

In my opinion, the count (whether it is of tested positive, cleared, or fatalities) should refer to the cases happened in that state, irrespective of which state or country that person is from. For e.g.; the British national who got treated and recovered in Kerala must be showing up in the no. of cured and tested negative cases. There are around 8 Malayalis who did not make it in the US; they will reported under fatalities in the US.

From your example, the Mahe case should be reported under Kerala, and the Coimbatore one under Tamil Nadu.

[The Rationalist]

If we don’t include the Mahe person in our list, then we have no reason not to include the Palakkad person in our list. We can’t say two opposite reasons. Whichever way it is , we have 3 deaths. If the states play this game, we will end with fudged mortality figures which is not good for analysis later and corrective measure.

[laluks]

Originally Posted by The Rationalist

If we don’t include the Mahe person in our list, then we have no reason not to include the Palakkad person in our list. We can’t say two opposite reasons. Whichever way it is , we have 3 deaths. If the states play this game, we will end with fudged mortality figures which is not good for analysis later and corrective measure.

Thanks for the clarification

[vivek95]

Originally Posted by vibbs

Docs, quoting you only to get your attention.




We saw in the pdf shared by Slick yesterday of the official report from government of Maharashtra (page 14) that 65% of the cases are asymptomatic! (I hope I read the report correctly)

I was a bit by this.

This means 65% of people who were positive did not develop any symptoms at all. Is this not a dire situation? How do we know how many such people roam around unknowingly spreading the infection to others?

If my understanding is correct, it means these people have strong immunity which is why although they were infected by the virus, it has not affected them?

How long does such a person stay infectious?
Is it possible that they were tested while they were still within the incubation period and that is why they were asymptomatic?

Or is it possible that some people do get infected by virus and recover as well all the while not getting any symptoms?

Hello @vibbs. Thanks for really good questions.

1.Asymptomatic very much means the virus enters the body but does not affect them in a way to cause any discernible symptoms. This can be attributed to very good immunity. Your routine Dengue also has about 10-20% people who remain asymptomatic. This is a well established phenomenon in the microbiology world.

2. Incubation period refers to only symptomatic individuals eventually. By definition, it is the period between acquiring an infection/virus and the onset of first symptom. So for someone who is asymptomatic, incubation period does not apply. That person will anyhow never exhibit any symptoms. Point no. 3 will give more clarification on this one.


3. Presymptomatic individuals -- This is a very important category. Now it can be possible that, what Maharashtra has reported is this "Presymptomatic category". In the sense, these could be the contacts of confirmed COVID-19 patients, who in turn tested positive but did not exhibit symptoms at the time of turning positive. It's possible that these individuals can develop symptoms at a later time and that requires follow up. Now, this is what you are actually referring to - someone without symptoms
tested positive during incubation period.

To simplify things for you, if these positive patients develop symptoms later, label them as "Presymptomatic". If they do not develop symptoms whatsoever until tests become negative - label them as "Asymptomatic". Let me go through the Maharashtra report and check what they are pointing at.

4. Time to introduce you to Latent period as this is more important. Latent period is interval between acquiring infection/virus and being infectious. This holds good for both symptomatic and asymptomatic individuals. Droplets are shed by both of those. During the period of infectivity ( infectiousness ), transmission is higher. Latent period can be longer or shorter than incubation period. Symptomatic person is more infectious than asymptomatic.

5. It is not that individuals were tested negative during the incubation period that is why they were labelled as "asymptomatic". They are asymptomatic because they will not exhibit symptoms from being "positive" to eventually turning "negative". Go back to point no. 3 to understand more.


6. Contact tracing of the already positive patients is one way how these asymptomatic/presymptomatic individuals can be identified. This is exactly what is widely done across the globe at present.


7. Mass community testing as is happening in South Korea, Germany. Just catch hold of everyone and test irrespective of symptoms or not. The most effective means of identifying asymptomatic carriers and isolating them . This is mostly feasible only in highly developed countries like Germany.

8. I handle and examine suspected/ confirmed Covid-19 positive patients regularly, collect throat swabs etc with adequate PPE. I don't have any symptoms so far by God's grace. As per the ICMR guideline, I do not have to get tested. If I still go ahead and get myself tested out of curiosity and then turn positive, I will now come into the picture/identified as case no. "x" in the regsitry. At some centres in Mumbai, my friends who attended Covid-19 patients in ICU for over a week got themselves tested on day 5 irrespective of any guideline. Idea was to isolate the asymptomatic/Presymptomatic positive Doctors and get the others ( negatives ) back on duty. Wise move.

9. Little is known on how long does the person stay infectious. In other terms, period of infectivity is yet to be ascertained. Patients can remain infectious even after testing negative and discharge from hospital. Please note, this is not yet well understood for Sars-Cov2.

Regards,
Dr. Vivek

[ckranjan]

Guys there is a bad news. The funding for our beloved WHO has been blocked by America.

How dare they said the Chinese.

https://www.republicworld.com/world-...-covid-19.html

The global beacon of hope in fight against C Virus is being handicapped by Trump.

Didn't we (WHO) chose to ban Taiwan, the country which doesn't understand how to fight the virus and refused to import the virus from China for experimentation but they are importing it from America.

https://focustaiwan.tw/society/202004150013

Damm the Taiwanese too.

Guys our hope for win against C virus has been severely dented. Its a crime against humanity say experts.

https://www.theguardian.com/world/20...funding-freeze


Now don't dare ever to blame China or WHO.

Blame America or better the American Army.

Serve (Kill) the People.

[The Rationalist]

I don’t know what’s wrong with this guy Donald Trump, he says the Chinese didn’t contain the virus early. In retrospect we can say anything, but in the initial stages of any epidemic it’s difficult to predict whether we are dealing with a epidemic. Trump wanted China to inform in November!

There is a story that mocks doctors. A person was brought dead to the hospital and the doctor told “ I could have saved him if he was brought half an hour earlier”. To which the bystander told “ What to do doctor, we wanted to bring him earlier, but he fell from the coconut tree 10 minutes back only “.

PS: The story is not an exaggeration as many doctors talk irresponsibly and claim they could have saved if the person reached half an hour earlier and the relatives think the first hospital intentionally killed the patient.