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Covid 19 stats in India update 12 23.11.20

Divyaroop Bhatnagar
Divyaroop Bhatnagar
Divyaroop BhatnagarManaging Director at YFactor Marketing Pvt Ltd

The highest point for Deaths/Day was 1281 on 15th September. This peak has held till now (67 days) Deaths/Day have crossed 1000 on only 1 day after 3rd October. Declining trend had set in but is now plateauing/trending upwards due to a spike in Delhi and North India. New/Active cases have also peaked and were declining. The highest no of cases was on 16th September at 97,856. That peak has held till now. Active Cases peaked at 10,17,718 on 17th September Both New and Active cases are plateauing/trending upwards now Vaccine developments hold promise for India via Astra Zeneca and Novavax tie up with Serum Institute of India, Sputnik with Dr Reddy’s, J&J with Biological E and Bharat Biotech. All these vaccines are in Phase 3. Cadila in Phase 2 is also promising.

Covid 19 stats in India update 12 23.11.20

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Covid 19 Stats in India –
Update 12
Review of key data and presentation of a projection model
Data updated till 22.11.20
Data Sources: https://www.covid19india.org/; https://www.worldometers.info/;
https://censusindia.gov.in/2011-prov-results/paper2/data_files/india/paper2_1.pdf
https://ig.ft.com/coronavirus-
chart/?areas=eur&areas=usa&areas=bra&areas=gbr&areasRegional=usny&areasRegional=usca&area
sRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=dea
ths
Key Highlights
• The highest point for Deaths/Day was 1281 on 15th September. This peak has held till now (67
days)
• Deaths/Day have crossed 1000 on only 1 day after 3rd October. Declining trend had set in but is
now plateauing/trending upwards due to a spike in Delhi and North India.
• New/Active cases have also peaked and were declining.
• The highest no of cases was on 16th September at 97,856. That peak has held till now.
• Active Cases peaked at 10,17,718 on 17th September
• Both New and Active cases are plateauing/trending upwards now
• Vaccine developments hold promise for India via Astra Zeneca and Novavax tie up with Serum
Institute of India, Sputnik with Dr Reddy’s, J&J with Biological E and Bharat Biotech. All these
vaccines are in Phase 3. Cadila in Phase 2 is also promising.
Projection Model for India
Basis for Projection
• Most countries have seen a fall in new infections and deaths per day
after some time. Some countries like India have yet to experience
this.
• The response of various counties is different in terms of when this
decline started.
• Our model will use per capita deaths and infections on the day the
decline started in each country to model a possible scenario for India.
As stated earlier, deaths are a more reliable indicator than infections
for projection.
Herd Immunity and R0
• There is some speculation on why the virus has declined in so many countries.
• ‘Herd Immunity’ comes when approximately 60% of the population is immune
either by a vaccine or because they have had the disease already. This has not
happened anywhere in the world. However there is new thinking on this that we
will discuss later.
• Social distancing, hand washing, and masking can help to reduce the R0 value
even if Herd Immunity has not been achieved. Perhaps this is the reason why
infections and deaths have declined.
• This presentation and projection model does not seek to answer this question. It
is merely based on the empirical evidence of declines having taken place in most
countries.
Infections Deaths Infections Deaths
Malaysia 3.04.20 29.03.20 103 1
Thailand 29.04.20 NA 42 -
Indonesia 13.05.20 NA 57 -
Bangladesh NA NA - -
Pakistan NA NA - -
Turkey 11.04.20 19.04.20 619 24
Iran 30.03.20 4.04.20 495 41
Italy 26.03.20 27.03.20 1,333 151
Spain 1.04.20 2.04.20 2,227 221
France 3.04.20 15.04.20 1,171 263
Germany 2.04.20 15.04.20 1,012 45
Russia 11.05.20 NA 1,517 -
UK 6.05.20 21.04.20 2,962 298
USA 24.04.20 21.04.20 2,797 138
Brazil NA NA - -
Date of Decline Start Per Million on that date
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Covid 19 stats in India update 12 23.11.20

  • 1. Covid 19 Stats in India – Update 12 Review of key data and presentation of a projection model Data updated till 22.11.20 Data Sources: https://www.covid19india.org/; https://www.worldometers.info/; https://censusindia.gov.in/2011-prov-results/paper2/data_files/india/paper2_1.pdf https://ig.ft.com/coronavirus- chart/?areas=eur&areas=usa&areas=bra&areas=gbr&areasRegional=usny&areasRegional=usca&area sRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=dea ths
  • 2. Key Highlights • The highest point for Deaths/Day was 1281 on 15th September. This peak has held till now (67 days) • Deaths/Day have crossed 1000 on only 1 day after 3rd October. Declining trend had set in but is now plateauing/trending upwards due to a spike in Delhi and North India. • New/Active cases have also peaked and were declining. • The highest no of cases was on 16th September at 97,856. That peak has held till now. • Active Cases peaked at 10,17,718 on 17th September • Both New and Active cases are plateauing/trending upwards now • Vaccine developments hold promise for India via Astra Zeneca and Novavax tie up with Serum Institute of India, Sputnik with Dr Reddy’s, J&J with Biological E and Bharat Biotech. All these vaccines are in Phase 3. Cadila in Phase 2 is also promising.
  • 4. Basis for Projection • Most countries have seen a fall in new infections and deaths per day after some time. Some countries like India have yet to experience this. • The response of various counties is different in terms of when this decline started. • Our model will use per capita deaths and infections on the day the decline started in each country to model a possible scenario for India. As stated earlier, deaths are a more reliable indicator than infections for projection.
  • 5. Herd Immunity and R0 • There is some speculation on why the virus has declined in so many countries. • ‘Herd Immunity’ comes when approximately 60% of the population is immune either by a vaccine or because they have had the disease already. This has not happened anywhere in the world. However there is new thinking on this that we will discuss later. • Social distancing, hand washing, and masking can help to reduce the R0 value even if Herd Immunity has not been achieved. Perhaps this is the reason why infections and deaths have declined. • This presentation and projection model does not seek to answer this question. It is merely based on the empirical evidence of declines having taken place in most countries.
  • 6. Infections Deaths Infections Deaths Malaysia 3.04.20 29.03.20 103 1 Thailand 29.04.20 NA 42 - Indonesia 13.05.20 NA 57 - Bangladesh NA NA - - Pakistan NA NA - - Turkey 11.04.20 19.04.20 619 24 Iran 30.03.20 4.04.20 495 41 Italy 26.03.20 27.03.20 1,333 151 Spain 1.04.20 2.04.20 2,227 221 France 3.04.20 15.04.20 1,171 263 Germany 2.04.20 15.04.20 1,012 45 Russia 11.05.20 NA 1,517 - UK 6.05.20 21.04.20 2,962 298 USA 24.04.20 21.04.20 2,797 138 Brazil NA NA - - Date of Decline Start Per Million on that date
  • 7. Country Wise Variations • The disease has impacted various countries differently. Broadly, the following clusters emerge: • UK/USA are the worst hit. While deaths/day have started declining in both countries they will have a slow recovery. • Spain/France/Italy have had a very sharp increase followed by a steep fall. • Germany is the outlier in Europe as they have managed to contain the infection better than other neighbouring countries. • Turkey and Iran in West Asia have fared better than their European counterparts. There is a ‘second wave’ of infections happening in Iran. • South East Asia, Africa and ANZ have largely escaped the brunt of the disease. • It is outside the scope of this discussion to assign reasons for this differential behaviour. Speculation about natural immunity, BCG vaccination, endemic malaria, hot weather etc are continuing. • Based on the differential response, India looks set to behave more like its West Asian counterparts. The rest of South Asia may also follow suit.
  • 8. Projection Update Population Per Mn Deaths on Day Decline Starts Projected Deaths on Day Decline Starts Low Medium High Low Medium High India 1,37,843,247 25 40 50 34,461 55,137 68,922 • May 24th Presentation – Projected date for decline in deaths/day was in July 2020 based on a doubling rate of deaths per day of 13 days. • Actual decline (this has held for 47 days now) has commenced from 15th September when the cumulative deaths were 82,091 corresponding to 75 Deaths/Mn
  • 9. Agenda • Presentation of key data for All India • Statewise data • Covid vaccine update • Discussion
  • 11. • Testing was slowing down but has picked up again. • The % positive rate is stable at 4%. Overall figures for All India are OK but Delhi positivity has gone up sharply • The Antigen test now accounts for close to 60% of total tests being conducted. Since there could a need for multiple tests on the same patient, a direct correlation between tests and persons infected is weak. Recently, tests in Delhi have shifted back to RT PCR We will continue to use Deaths, not Cases as the main parameter for analysis and forecasting
  • 12. • New Infections/Day have plateaued and are beginning to rise again driven by Delhi. Highest point was on 16th September at 97,856 • Active Infections are showing a similar trend. Highest point was on 17th September at 10,17,718 active infections
  • 13. • A crest has formed in Deaths/Day. As mentioned earlier, the peak of 1281 Deaths on 15.09.20 is still holding (67 days) • A plateau had formed at around 500 deaths/day and the numbers are inching up again
  • 15. • Delhi cases and deaths have been rising rapidly from 9th October. Cases are showing a slight decline in the last few days. Cumulative deaths stand at 651/Mn for Delhi. It has gone ahead of Mumbai which is at 649/Mn • The spike coincides with the festive season
  • 16. • North India is showing clear signs of a second wave with the epicentre at Delhi • Some likely reasons are: socialising, shopping at high levels during the festive season, Covid fatigue, Covid indifference, Colder weather than usual, Pollution
  • 17. • Four of the worst hit states have shown steeply declining trends. • The decline is now beginning to slow down and there are signs of plateauing
  • 18. • Bihar had a spike soon after the election. However this has been controlled. • Jharkhand has been less impacted though recent trends are upwards. • Odisha trends are not looking good
  • 19. • West Bengal is beginning to slowly decline • Kerala is finally beginning to plateau
  • 20. Directions • The co-relative model presented on 24.05.20 has been reasonably successful in predicting the date for first decline in deaths/day to start • The decline was faster than anticipated initially. However, a plateau began to form at around 500 deaths/day and the trend is moving slowly upwards now • North India is clearly undergoing a 2nd wave now with the epicentre at Delhi • The hitherto intractable states of West Bengal and Kerala are now showing signs of plateauing and a mild declining trend • Some likely reasons for the 2nd wave are: socialising, shopping at high levels during the festive season, Covid fatigue, Covid indifference, Colder weather than usual, Pollution
  • 22. Types of Vaccines https://graphics.reuters.com/HEALTH-CORONAVIRUS/VACCINE/yzdpxqxnwvx/ • Live attenuated virus • A live attenuated virus is constructed by mutating the original virus • The mutation creates a weaker virus that cannot cause significant harm to the body • Inactivated virus • An inactivated vaccine is produced by disabling a virus through radiation, chemicals or heat • The inactive virus cannot cause disease because it is not trying to enter cells and replicate. • Protein subunit • A protein subunit vaccine contains a piece – or subunit – of a coronavirus antigen • It contains no other part of the coronavirus, so it can’t replicate and cause harm • Virus like particles • Virus-like particle vaccines closely resemble the coronavirus in structure but contain none of its genetic material • It’s like an empty shell that looks like the coronavirus but isn’t capable of doing damage to the body • DNA and RNA • DNA and RNA vaccines consist of Messenger RNA (mRNA) or DNA code for making a version of a coronavirus protein • The code is inserted into a human cell which then uses the genetic instructions to make this antigen. The immune system can then produce antibodies that will recognize that antigen and fight off the virus • Viral vector • Like DNA and RNA vaccines, viral vector vaccines contain instructions for making a coronavirus antigen • The instructions are carried into a human cell by a harmless virus like the adenovirus which causes the common cold These six vaccine types vary in method, but they all introduce an antigen into the body that the immune system can use to build antibodies against the real coronavirus.
  • 23. Vaccine Status https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker • Sputnik V and EpiVacCorona have been approved by the Ministry of Health in Russia without entering Stage 3 clinical trials • Operation Warp Speed in the USA has selected three vaccine candidates to fund for Phase 3 trials: Moderna’s mRNA-1273, University of Oxford and AstraZeneca’s AZD1222, and Pfizer and BioNTech's BNT162 • The COVAX initiative’s goal is to work with vaccine manufacturers to offer low-cost COVID-19 vaccines to countries. Currently, candidates from companies Inovio, Moderna, CureVac, Institut Pasteur/Merck/Themis, AstraZeneca/University of Oxford, Novavax, University of Hong Kong, Clover Biopharmaceuticals, and University of Queensland/CSL are part of the COVAX initiative
  • 24. Vaccines in Phase 3 Clinical Trialshttps://www.raps.org/news-and-articles/news- articles/2020/3/covid-19-vaccine-tracker • 13 Vaccines are in Phase 3 clinical trials • MRNA/DNA – Pfizer, Moderna, Invovio (3) • Viral vector – Astra Zeneca/Oxford University/SIL, Can Sino Biologics, J&J, Sputnik V (4) • Inactivated vaccine – Sinovac, Bharat Biotech, Wuhan Institute (3) • Nanoparticle, Plant based adjuvant – Novavax ,Medicago/GSK (2) • Live attenuated vaccine (BCG Vaccine) – University of Melbourne (1)
  • 28. Vaccine Data • Pfizer vaccine requires -70 C cold chain. Moderna -20 C and can be held at fridge temperatures for 30 days. • Unclear about India availability. • These vaccines are also highly priced • Effectiveness is high in early trials 90 – 95% • Applications have been moved for EUA • Sputnik Russian trials claim 90% efficacy • Astra Zeneca trials just announced say effectiveness is 90% in one regimen (half dose followed by full dose) and 62% in another (2 full doses). Application for EUA to be moved shortly
  • 29. India Scenario Manufacturer Capacity/Annum (Mn Doses) Preliminary Results Expected by Approx Cost Vaccines in Phase 3 Astra Zeneca Covishield SII 1000 Nov 2020 Rs 1000 with a substantial discount for Govt purchases Novavax SII 500 Jan 2021 J&J Biological E 400 Jan 2021 Bharat Biotech - Covaxin Bharat Biotech 150 Feb 2021 Sputnik V Dr Reddy’s 100 Mar 2021 Vaccines in Phase 2 Cadila Cadila 100 Mid 2021
  • 30. India Distribution The central government has already started the process of identifying around 30 crore priority beneficiaries. It has demarcated four categories of people for vaccination in the initial phase — around one crore healthcare professionals including doctors, MBBS students, nurses and ASHA workers, etc.; around two crore frontline workers including municipal corporation workers, personnel of the police and armed forces; about 26 crore people aged above 50; and a special group of those below 50 years of age with co-morbidities and requiring specialised care…. Centre is planning to procure COVID-19 vaccines directly from the drugmakers and distribute them among priority group https://www.livemint.com/science/health/covid-vaccine-distribution-in-india- who-will-get-it-first-frontline-workers-to-get-priority-11603968400105.html
  • 31. Speed is of the Essence https://theprint.in/opinion/covid-vaccine-distribution-can-take-tips-from-how- india-conducts-general-elections/534841/ • As vaccinated people spread through the population, the virus will respond by mutating. So far close to 300 mutations have been observed but they are still not radical enough that the vaccine cannot work on them • “Cluster Bomb” approach for India. In a geography quickly vaccinate 65% of the people so as to reach herd immunity and move to the next. This is different from the top down approach shown in the last slide • Strategy derived from the elections. Set up multiple booths for vaccination – Bihar elections were conducted in 3 working days
  • 33. Thank You! Please mail me at debubhatnagar@gmail.com with any comments. Disclaimer: These projections and analysis are not official and are the work of an amateur. They should not be the basis of any decision making.