This document summarizes Covid-19 data in India as of June 7, 2021 and projects potential scenarios for a third wave. Key points include:
- Testing rates have declined while positivity rates remain above 5%, and cumulative CFR has risen indicating the second wave was more lethal.
- Cases peaked in early May but are declining, though the rate of decline is slowing. Active cases and deaths are also declining.
- States peaked within 3-4 weeks of each other, suggesting the dominant Delta variant spreads rapidly. Declines are also consistent across states.
- The consistency of rises and falls implies human interventions have low impact once a wave starts, and virus/variant traits may drive peaks and trough
Deaths/Day have been fluctuating between 1000 – 1200 since 13th August
The highest point for Deaths/Day was 1283 on 15th September. This peak has held till now (20 days)
Almost all states are showing stable/declining trends in Deaths/Day
New/Active cases have also peaked and are 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
• 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 followed by a plateau and a slow decline post the Diwali spike
• 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/declining now
• Likely trend in Deaths/Day for the next 30 days is a plateau/slow decline
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. Decline commenced on 15.09.20
The decline has been faster than anticipated. After a plateau in November and early December a declining trend is visible currently
North India’s spike after Diwali has come under control. As of now all states are stable/declining
In the next 30 days we may expect Deaths/Day to slowly decline further
71 cases of the new UK variant have been observed in India – no indications of local spread as of now. Genome has been mapped in UK and India. Implications for vaccine effectiveness awaited.
Vaccination logistics and process seem comprehensive and well thought through
Vaccination should start within a week or ten days
Criteria to begin relaxing social distancing revision AJames Orr
Latest weekly update (on weekend) of my projection of the number of Coronavirus case per day by state. Prior predictions modeled following three weeks. Mode VII two weeks ago and Model IX on week ago appear as accurate as randomness in data allows, or new pockets of outbreaks. This version looks at where states are at plateauing or being pose peak new cases per day. Also looks at criteria to begin to relax social distancing guidelines. Revision A corrects Alaska (missing a 0) and Nevada population (one extra 0).
A Fundação Fernando Henrique Cardoso (FFHC) e o Centro Brasileiro de Relações Internacionais (CEBRI) convidam para o webinar:
China and the New Coronavirus: challenges of an interconnected world
Neste evento, o economista Arthur Kroeber, diretor da Gavegal Dragonomics, empresa de consultoria global com foco na economia chinesa, apresentará sua visão sobre o impacto da pandemia do Covid - 19 na China e na economia mundial. Apoiado em ampla base de dados e reconhecida capacidade analítica, traçará cenários para o futuro imediato e de médio prazo, considerando as dimensões do desafio e as respostas dadas até aqui pelo governo da China, dos Estados Unidos e da Europa.
PALESTRANTE
ARTHUR KROEBER
Sócio Fundador e Chefe de Pesquisa da Gavekal, foi co-fundador do serviço de pesquisa Dragonomics, com foco na China, em 2002, em Pequim, e é o editor-chefe do China Economic Quarterly. Desde a fusão da Dragonomics em 2011 com a Gavekal Research, ele foi chefe de pesquisa da operação combinada. Antes de fundar a Dragonomics, ele foi de 1987 a 2002 um jornalista especializado em assuntos econômicos asiáticos, e reportou da China, Índia, Paquistão e outros países asiáticos. Ele publicou amplamente em jornais, revistas e periódicos acadêmicos e é membro do Brookings-Tsinghua Center em Pequim.
Deaths/Day have been fluctuating between 1000 – 1200 since 13th August
The highest point for Deaths/Day was 1283 on 15th September. This peak has held till now (20 days)
Almost all states are showing stable/declining trends in Deaths/Day
New/Active cases have also peaked and are 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
• 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 followed by a plateau and a slow decline post the Diwali spike
• 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/declining now
• Likely trend in Deaths/Day for the next 30 days is a plateau/slow decline
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. Decline commenced on 15.09.20
The decline has been faster than anticipated. After a plateau in November and early December a declining trend is visible currently
North India’s spike after Diwali has come under control. As of now all states are stable/declining
In the next 30 days we may expect Deaths/Day to slowly decline further
71 cases of the new UK variant have been observed in India – no indications of local spread as of now. Genome has been mapped in UK and India. Implications for vaccine effectiveness awaited.
Vaccination logistics and process seem comprehensive and well thought through
Vaccination should start within a week or ten days
Criteria to begin relaxing social distancing revision AJames Orr
Latest weekly update (on weekend) of my projection of the number of Coronavirus case per day by state. Prior predictions modeled following three weeks. Mode VII two weeks ago and Model IX on week ago appear as accurate as randomness in data allows, or new pockets of outbreaks. This version looks at where states are at plateauing or being pose peak new cases per day. Also looks at criteria to begin to relax social distancing guidelines. Revision A corrects Alaska (missing a 0) and Nevada population (one extra 0).
A Fundação Fernando Henrique Cardoso (FFHC) e o Centro Brasileiro de Relações Internacionais (CEBRI) convidam para o webinar:
China and the New Coronavirus: challenges of an interconnected world
Neste evento, o economista Arthur Kroeber, diretor da Gavegal Dragonomics, empresa de consultoria global com foco na economia chinesa, apresentará sua visão sobre o impacto da pandemia do Covid - 19 na China e na economia mundial. Apoiado em ampla base de dados e reconhecida capacidade analítica, traçará cenários para o futuro imediato e de médio prazo, considerando as dimensões do desafio e as respostas dadas até aqui pelo governo da China, dos Estados Unidos e da Europa.
PALESTRANTE
ARTHUR KROEBER
Sócio Fundador e Chefe de Pesquisa da Gavekal, foi co-fundador do serviço de pesquisa Dragonomics, com foco na China, em 2002, em Pequim, e é o editor-chefe do China Economic Quarterly. Desde a fusão da Dragonomics em 2011 com a Gavekal Research, ele foi chefe de pesquisa da operação combinada. Antes de fundar a Dragonomics, ele foi de 1987 a 2002 um jornalista especializado em assuntos econômicos asiáticos, e reportou da China, Índia, Paquistão e outros países asiáticos. Ele publicou amplamente em jornais, revistas e periódicos acadêmicos e é membro do Brookings-Tsinghua Center em Pequim.
The 2nd wave is retreating. However, Kerala and to some Maharashtra are growing again as are the North East States. Meanwhile vaccination is averaging only 4 Mn doses/day. What are the possibilities for a 3rd wave? Read the presentation to see the latest position.
The 11th Update of Covid Stats in India was presented by Debu Bhatnagar on 3.11.20. Neeraj Chandra presented a model that seeks to understand the shapes of the Covid curves for different countries.
The last week has seen a spurt in deaths/day. This has been led by Maharashtra (minus Mumbai), Karnataka and other Southern States. UP, Bihar and West Bengal are growing fairly fast on a small base.
Delhi/Haryana/Gujarat are coming under control.
Mathematical projections have been impacted by the spurt in deaths. At the moment, we appear to be still growing. No clear decline is visible as yet.
Deaths/day reached 1013 on 9th August and started declining. There was another peak on 18th August of 1099 which has held till now.
Plateauing is established. Sharp declines are yet to be seen.
Assuming the 18th August peak holds, the following predictions may follow:
A decline in the 7 DMA in the next 2 weeks by 10 – 30 deaths/day
Decline in daily deaths to 50% of peak level in November
There has been a huge change between my last presentation on 14.02.21 and now. The second wave has India (and especially Maharashtra) suddenly and hard.
What are the contours of the second wave? How bad will it be and when will it start abating?
This presentation seeks to explore the above areas.
This presentation focuses on the 2nd wave in India. What may have caused it and by when will it abate. There are no definite answers at this stage but directions are laid out.
Key Highlights:
1. India Deaths/Day continue to decline. 7 DMA now stands at 343.
2. New mutant discovered in UK is an imponderable. There is considerable movement between the 2 countries.
3. Vaccine status in India is unchanged. No EUA has been given yet.
Predictions of decline made on 1.09.20 have not held.
There has been a spurt in deaths in the key states of Maharashtra, Karnataka and Delhi that is still continuing.
Punjab and UP are especially worrying
Very recent trends are again showing stability/decline in deaths
Deaths/day reached 1013 on 9th August and have declined thereafter with some fluctuations.
Infections/day reached 67,066 on 12th August and have declined thereafter with some fluctuations.
Active Infections reached 677,059 on 15th August and have declined thereafter.
On 9th August, cumulative deaths were 44,466 (32 deaths/Mn)
There are several caveats and possibilities still left as we will discuss further.
The highest point for Deaths/Day was 1283 on 15th September. This peak has held till now (35 days)
Deaths/Day have crossed 1000 on only 1 day after 3rd October. Distinct declining trend has set in.
Almost all states are showing stable/declining trends in Deaths/Day
New/Active cases have also peaked and are 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
R0 value has dropped to 0.93 on 25th September
North India’s spike after Diwali has come under control. As of now all states are declining
In the next 30 days we may expect Deaths/Day to slowly decline further
150 cases of the new UK variant have been observed in India – no indications of local spread as of now. Genome has been mapped in UK and India. Implications for vaccine effectiveness awaited
Sero positive study in Delhi has come up with 50% positive in Delhi. Significant jump in a few months. This may hasten the progress to herd immunity. Results awaited
Vaccination has got off to a slow start with numbers picking up gradually. India cumulative upto 24.01.21 is 1,615,504 jabs in 9 days. Average of 179,500 per day. USA 20.54 Mn from 14th Dec (42 days) = 489,047 per day
Key risk is of a second wave (possible but unlikely) caused either by a the existing variant or possibly a new one. Vaccination is too slow to provide herd immunity in the near future. India will have to rely on social distancing, masking etc for the foreseeable future
Deaths/day are slowing down gradually. The trend is visible in most hotspots and at the All India level.
On June 16th, there was a massive spike in deaths (2004) caused by backlog data that was added for Maharashtra and Delhi. This distorted the trend, but subsequent days have shown a decline
Researchers at the Network Dynamics and Simulation Science Laboratory have been using a combination of modeling techniques to predict the spread of the Ebola outbreak.
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.
Highlights
Cases and deaths continue to slowly decline. However there are some signs that cases are picking up again in some geographies
In the next 30 days we may expect Deaths/Day to slowly decline further
Key risk is of a second wave (possible but unlikely) caused either by a the existing variant or possibly a new one. Vaccination is too slow to provide herd immunity in the near future. India will have to rely on social distancing, masking etc for the foreseeable future
Researchers at the Network Dynamics and Simulation Science Laboratory have been using a combination of modeling techniques to predict the spread of the Ebola outbreak.
Learn about YFactor's Advisory Services and Team Members. We are over 8 years old and comprise of 12 Directors and Senior Advisors. We are based in India and are focused on Consumer Facing Businesses. Our range of Advisory Services include India Entry, Strategy, Supply Chain, Branding, Human Resources and Distribution. Mail us at contact@yfactor.in
More Related Content
Similar to Covid 19 stats in india update 22 8.06.21
The 2nd wave is retreating. However, Kerala and to some Maharashtra are growing again as are the North East States. Meanwhile vaccination is averaging only 4 Mn doses/day. What are the possibilities for a 3rd wave? Read the presentation to see the latest position.
The 11th Update of Covid Stats in India was presented by Debu Bhatnagar on 3.11.20. Neeraj Chandra presented a model that seeks to understand the shapes of the Covid curves for different countries.
The last week has seen a spurt in deaths/day. This has been led by Maharashtra (minus Mumbai), Karnataka and other Southern States. UP, Bihar and West Bengal are growing fairly fast on a small base.
Delhi/Haryana/Gujarat are coming under control.
Mathematical projections have been impacted by the spurt in deaths. At the moment, we appear to be still growing. No clear decline is visible as yet.
Deaths/day reached 1013 on 9th August and started declining. There was another peak on 18th August of 1099 which has held till now.
Plateauing is established. Sharp declines are yet to be seen.
Assuming the 18th August peak holds, the following predictions may follow:
A decline in the 7 DMA in the next 2 weeks by 10 – 30 deaths/day
Decline in daily deaths to 50% of peak level in November
There has been a huge change between my last presentation on 14.02.21 and now. The second wave has India (and especially Maharashtra) suddenly and hard.
What are the contours of the second wave? How bad will it be and when will it start abating?
This presentation seeks to explore the above areas.
This presentation focuses on the 2nd wave in India. What may have caused it and by when will it abate. There are no definite answers at this stage but directions are laid out.
Key Highlights:
1. India Deaths/Day continue to decline. 7 DMA now stands at 343.
2. New mutant discovered in UK is an imponderable. There is considerable movement between the 2 countries.
3. Vaccine status in India is unchanged. No EUA has been given yet.
Predictions of decline made on 1.09.20 have not held.
There has been a spurt in deaths in the key states of Maharashtra, Karnataka and Delhi that is still continuing.
Punjab and UP are especially worrying
Very recent trends are again showing stability/decline in deaths
Deaths/day reached 1013 on 9th August and have declined thereafter with some fluctuations.
Infections/day reached 67,066 on 12th August and have declined thereafter with some fluctuations.
Active Infections reached 677,059 on 15th August and have declined thereafter.
On 9th August, cumulative deaths were 44,466 (32 deaths/Mn)
There are several caveats and possibilities still left as we will discuss further.
The highest point for Deaths/Day was 1283 on 15th September. This peak has held till now (35 days)
Deaths/Day have crossed 1000 on only 1 day after 3rd October. Distinct declining trend has set in.
Almost all states are showing stable/declining trends in Deaths/Day
New/Active cases have also peaked and are 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
R0 value has dropped to 0.93 on 25th September
North India’s spike after Diwali has come under control. As of now all states are declining
In the next 30 days we may expect Deaths/Day to slowly decline further
150 cases of the new UK variant have been observed in India – no indications of local spread as of now. Genome has been mapped in UK and India. Implications for vaccine effectiveness awaited
Sero positive study in Delhi has come up with 50% positive in Delhi. Significant jump in a few months. This may hasten the progress to herd immunity. Results awaited
Vaccination has got off to a slow start with numbers picking up gradually. India cumulative upto 24.01.21 is 1,615,504 jabs in 9 days. Average of 179,500 per day. USA 20.54 Mn from 14th Dec (42 days) = 489,047 per day
Key risk is of a second wave (possible but unlikely) caused either by a the existing variant or possibly a new one. Vaccination is too slow to provide herd immunity in the near future. India will have to rely on social distancing, masking etc for the foreseeable future
Deaths/day are slowing down gradually. The trend is visible in most hotspots and at the All India level.
On June 16th, there was a massive spike in deaths (2004) caused by backlog data that was added for Maharashtra and Delhi. This distorted the trend, but subsequent days have shown a decline
Researchers at the Network Dynamics and Simulation Science Laboratory have been using a combination of modeling techniques to predict the spread of the Ebola outbreak.
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.
Highlights
Cases and deaths continue to slowly decline. However there are some signs that cases are picking up again in some geographies
In the next 30 days we may expect Deaths/Day to slowly decline further
Key risk is of a second wave (possible but unlikely) caused either by a the existing variant or possibly a new one. Vaccination is too slow to provide herd immunity in the near future. India will have to rely on social distancing, masking etc for the foreseeable future
Researchers at the Network Dynamics and Simulation Science Laboratory have been using a combination of modeling techniques to predict the spread of the Ebola outbreak.
Similar to Covid 19 stats in india update 22 8.06.21 (20)
Learn about YFactor's Advisory Services and Team Members. We are over 8 years old and comprise of 12 Directors and Senior Advisors. We are based in India and are focused on Consumer Facing Businesses. Our range of Advisory Services include India Entry, Strategy, Supply Chain, Branding, Human Resources and Distribution. Mail us at contact@yfactor.in
Fact, fiction and speculation have a habit of blending together when one looks at ancient India. In this article I have put forward my point of view – it is not accepted historical dogma and neither is it original. It is speculative and interesting as it has many facets. Enjoy the read!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Covid 19 Stats in India –
Update 22
Review of key data and presentation of a projection model
Data updated till 7.06.21
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&areasRegional=usfl&area
sRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=deaths
https://ourworldindata.org/covid-vaccinations
https://www.mygov.in/aarogya-Setu-app/
2. Agenda
• Presentation of key data for All India
• Review of cases and deaths in states
• Analysis of 2nd wave
• Vaccination
• 3rd wave possible scenarios
• Discussion
3. Data Integrity
• India data on deaths is being strongly questioned by researchers both in
India and abroad. Anywhere between 2 – 4 times the official death rate is
being talked about as the real figure
• Cases are anyway ‘discovered cases’ and it is well known that the real
figure is multiple times
• Approach
• We will look at surrogate variables to get a directional indication (TPR and Daily
Growth in Active Cases are two such)
• We will also use the official numbers for modelling and look for correlation with the
surrogate variables
5. • Testing has not been able to keep pace with the
pandemic after the second wave has started
• Positivity rates have crossed 20% (the peak in
September was 15%). However, recently, testing has
been ramped up and TPR is now around 5%
• TPR is coming down from a peak of 24.85% on 9th May.
The rate of decline is steeper than the ascent. Testing
has come down in the last couple of days. Hope it is a
temporary blip
6. • Cumulative CFR is trending upwards. This is a
disturbing trend indicating that fatalities in the 2nd
wave are higher
• This is clearly visible when you see the 7DMA CFR.
It is now at 2.4%. In the 1st wave the maximum
level was 1.4%. Clearly the second wave is more
lethal than the 1st wave. The extent of
underreporting is also higher
7. • New infections reached their lowest point on 11.02.21 at
10,983 7DMA
• Cases have galloped after that and the previous peak was
surpassed on 4.04.21
• The highest number has been 414,280 on 6 May. The highest
level on a 7DMA basis was 392,330 on 8th May. The declining
trend in cases is now well established. When coupled with a
decreasing TPR this is a more robust figure. Daily cases have
dipped below 100,000 on 7.06.21 for the first time after the
decline commenced
• The pace of decline is now slowing down. This may lead to a
plateauing as the polynomial curve is projecting
8. • Active Infections have peaked. From 22nd April, the rate
of growth has been slowing.
• On 10th May for the first time in the second wave, Active
Infections declined by 30,499. Thereafter, the declining
trend has got established
• Daily Growth in Active Infections is a reasonable lead
indicator of what direction the wave is taking
• The load on the healthcare system is also coming down
• However, the rate of decline in Active Infections is
slowing down. This is another indicator of a plateau
approaching
9. • Deaths had reached a plateau from around the
10th of May. However, the numbers have been
distorted by Previous Period Adjustments carried
out by Maharashtra on several days.
• For this presentation I have shown the raw
numbers without adjustment
• The 7DMA is showing a peaking on 23rd May. The
30 DMA has peaked on 27th May
• The salient point is that deaths have continued to
grow after cases peaked on 8th May on a 7DMA
basis. This may indicate that serious cases are
taking more time to resolve. Complications such
as mucomycorsis are also gaining ground
• The declining trend is now clearly established
15. 10 Feb Level 10 Times Days
Punjab 229 18-Mar 35
Haryana 77 19-Mar 36
MP 141 23-Mar 40
Chattisgarh 222 24-Mar 41
AP 50 24-Mar 41
Maharashtra 3451 31-Mar 48
Delhi 127 31-Mar 48
Rajasthan 107 31-Mar 48
UP 121 31-Mar 48
Uttarakhand 35 31-Mar 48
Jharkhand 45 31-Mar 48
Karnataka 415 31-Mar 48
Bihar 64 02-Apr 50
West Bengal 179 04-Apr 52
Telengana 157 06-Apr 54
Tamil Nadu 479 09-Apr 57
Odisha 92 09-Apr 57
HP 83 12-Apr 60
All India 12539 07-Apr 55
• An interesting feature of India’s second wave is how
consistently and swiftly the cases have ramped up
• The chart shows how long various states took to reach a level
of 10 times the daily cases that they had registered on 10th
Feb (lowest level). It is remarkable how consistent this data is
• Some speculations:
• Punjab and Haryana had been hit the earliest probably
by the Alpha (UK Variant)
• The Delta Variant (popularly known as the double
mutant) emerged in Vidarbha and rapidly spread to some
of the adjoining states of MP, Chhattisgarh and AP
• Delta then rapidly overpowered all other strains and
spread all over the country like wildfire. This is the
possible explanation for the consistency of the spread –
that it is caused by the same variant. Genome
sequencing is in progress
• It is becoming increasingly possible that massive second
waves in most countries are due to the emergence of variants.
These, in turn, are nurtured in areas where the infection is
widespread
These speculations
made 4 weeks ago
have been largely
proved correct
16. • Phase 1 states (green) are showing a remarkable consistency in the decline curve EXCEPT for Maharashtra.
• Phase 2 states (yellow) seem to decline faster than Phase 1
• States marked in Brown – picture is not clear yet
• Need to carefully watch at district level for outbreaks in these states that could also signal a new variant
Population
Date No Per Mn CFR Date No Per Mn CFR 90% Days 75% Days 50% Days 25% Days
Delhi 1,67,87,941 23.04.21 25294 1,507 1.00% 3.05.21 398 23.71 1.70% 5.05.21 12 9.05.21 16 14.05.21 21 20.05.21 27
Maharashtra 11,23,74,333 24.04.21 65447 582 0.90% 23.05.21 1019 9.07 3.50% 5.05.21 11 13.05.21 19 20.05.21 26 4.06.21 41
UP 19,98,12,341 27.04.21 34813 174 0.60% 7.05.21 329 1.65 1.10% 4.05.21 7 10.05.21 13 16.05.21 19 22.05.21 25
Chattisgarh 2,55,45,198 28.04.21 15583 610 1.50% 3.05.21 248 9.71 1.70% 8.05.21 10 12.05.21 14 18.05.21 20 27.05.21 29
MP 7,26,26,809 29.04.21 13105 180 0.70% 3.05.21 98 1.35 0.80% 10.05.21 11 14.05.21 15 20.05.21 21 27.05.21 28
Gujarat 6,04,39,692 30.04.21 14305 237 1.20% 1.05.21 169 2.80 1.20% 8.05.21 8 15.05.21 15 21.05.21 21 27.05.21 27
Telengana 3,50,03,674 1.05.21 8036 230 0.60% 7.05.21 58 1.66 0.80% 5.05.21 4 12.05.21 11 20.05.21 19
Bihar 10,40,99,452 6.05.21 14191 136 0.60% 23.05.21 102 0.98 1.90% 11.05.21 5 14.05.21 8 19.05.21 13 28.05.21 22
Rajasthan 6,85,48,437 8.05.21 17590 257 0.90% 12.05.21 162 2.36 0.90% 15.05.21 7 18.05.21 10 22.05.21 14 28.05.21 20
Haryana 2,53,51,462 9.05.21 14430 569 1.10% 10.05.21 163 6.43 1.10% 14.05.21 5 17.05.21 8 22.05.21 13 28.05.21 19
Karnataka 6,10,95,297 9.05.21 47502 778 1.00% 13.05.21 500 8.18 1.00% 13.05.21 4 20.05.21 10 30.05.21 21
Uttarakhand 1,00,86,292 11.05.21 7555 749 1.90% 20.05.21 177 17.55 3.90% 14.05.21 3 18.05.21 7 23.05.21 12 1.06.21 21
Kerala 3,34,06,061 12.05.21 38153 1,142 0.20% 2.06.21 191 5.72 0.90% 17.05.21 5 23.05.21 11 4.06.21 23
Punjab 2,77,43,338 12.05.21 8576 309 2.10% 20.05.21 203 7.32 3.00% 17.05.21 5 21.05.21 9 29.05.21 17
West Bengal 9,12,76,115 15.05.21 20085 220 0.70% 25.05.21 157 1.72 0.80% 27.05.21 10 30.05.21 15 4.06.21 20
AP 4,95,77,103 20.05.21 22051 445 0.50% 23.05.21 108 2.18 0.50% 25.05.21 5 29.05.21 9 6.06.21 17
Tamil Nadu 7,21,47,030 25.05.21 35307 489 1.20% 2.06.21 484 6.71 1.70% 31.05.21 6 5.06.21 11
Odisha 4,19,74,219 26.05.21 11657 278 0.30% 28.05.21 2 1.06.21 6
All India 1,21,05,69,573 8.05.21 392331 324.0879 1.00% 23.05.21 4191 3.46 1.60% 15.05.21 7 20.05.21 12 29.05.21 19
Peak Cases Peak Deaths Decline in Cases
17. • Difficult to find a pattern in cases/Mn. States with
higher testing appear to have higher peaks.
• Maharashtra is an outlier in terms of the shape of the
curve. The build up and the decline are both slower.
Need to keep a very close watch for further outbreaks
and possible new variants
• Kerala, Karnataka declines are also slower and TN has
peaked later
18. Discussion – 2 weeks ago
• The spread of the 2nd wave has been swift. Most of the country has peaked
within 3 – 4 weeks of each other. This implies that the dominant variant Delta
spreads extremely rapidly
• After the peak, the decline is also quite consistent. There are 2 points here:
• States that peaked close to each other follow a similar decline curve
• The decline curve is steeper for those states that reached peak later (not fully observed) –
does this indicate a weakening in the virus strain with time?
• What triggers a decline? We are nowhere near herd immunity or saturation
vaccination. Especially since the peak cases/mn are very different across states.
• Anecdotally, having watched several programs coming in from rural UP, even the
rural, uncounted cases and deaths have declined in the last 2 weeks.
19. Discussion – 2 weeks ago
• The consistency of the rise and fall across states, urban and rural implies that human
intervention – lockdowns, social behaviour etc have relatively low impact on the progress
of the virus once a wave is triggered. This time around the states were implementing
their own policies and it is hard to imagine that poor, rural oriented states like UP or
Bihar could implement anything as effectively as Delhi or Mumbai. Is there something
inbuilt in the virus that causes these peaks and troughs?
• Speculatively, are virus mutation cycles and the life cycle of new variants becoming
shorter? Both UK with Alpha and India with Delta have experienced short, intense peaks
• Clearly, new variants are a big danger. Genome sequencing and big data to throw up
abnormal trends are the way forward to identify these as they emerge.
• The states to watch out for are Maharashtra and South India and maybe Punjab and
West Bengal
21. Waves vs Wavelets
• Speculation:
• Are wavelets of the type that Delhi
exhibited prior to the wave in
April/May 2021 the same as the
latter?
• Wavelets appear to be caused by
relaxation in Covid appropriate
behaviour such as what happened in
Delhi and North India around Diwali.
They tend to recede when behaviour
is tightened.
• Wavelets appear to be caused by the
same strain as the original. A true
wave is caused by a new strain (in
India – Delta) and in UK – Alpha
• India’s second wave has been
remarkably consistent across states
and geographies – pointing to the
relative ineffectiveness of normal
covid control measures in stopping
the wave cased by the Delta variant
22. 3rd Wave www.nature.com Multiwave pandemic dynamics explained: how to tame the next wave of infectious diseases
Giacomo Cacciapaglia 1,2,5*, Corentin Cot1,2,5 & Francesco Sannino3,4,5
• “The key to control the arrival of the
next wave of a pandemic is in the
strolling period in between waves, i.e.
when the number of infections grows
linearly. Thus, limiting the virus
diffusion in this period is the most
effective way to prevent or delay the
arrival of the next wave”
• UK 3rd wave is predicted to peak on
24.07.21 with 75% cases of the 2nd
wave
23. 3rd Wave UK – Manindra Agrawal
• Predicts a mild wave (around 25% of wave 2 peak) due to high
vaccination (60% at least 1 dose and 40% fully vaccinated)
• Also peaking around July 2021
24. India 3rd Wave
• Influencing Variables
• Strolling period
• New Variant
• Speculation
• The gap between Wave 2 and 3 in UK is projected to be around 6 months.
Assuming a similar situation for India it would indicate a peak for Wave 3
around Nov 2021
• Strolling period behaviour unlikely to be Covid appropriate. Vaccination drive
will remain slow at least for June and probably July
• If there is no variant we may get away with a mild wave. If there is a new
variant it could be worse than Wave 2
26. • Govt had committed a target of 85 Mn doses in May. Actual jabs were 58 Mn
• Progressive Average is 1.65 Mn doses/day. 7 DMA is 2.88Mn doses/day. June has improved over May
• There is an uphill task ahead in June where the target is on the lower side (120Mn) vs the rest of the
year. However, good to see that the trend has been rising in June
• For this year the Govt has committed to vaccinating all Indians by End Dec 2021. I have taken that to
mean at least 1 jab for all adults by year end
India Vaccination Progress
Day Jun-21 FY 21
Target 12,00,00,000 1,35,49,50,000
Avg/Day 40,00,000 63,31,542
Achievement
01-Jun 1 25,00,029
02-Jun 2 24,97,026
03-Jun 3 30,65,755
04-Jun 4 37,50,869
05-Jun 5 34,62,100
06-Jun 6 14,64,065
07-Jun 7 34,12,244
Cum 2,01,52,088 23,27,86,482
Avg/Day 28,78,870 16,27,877
Bal 9,98,47,912 1,35,33,22,123
Bal Avg/Day 43,41,214 65,37,788
Acceleration 150.8% 401.6%
27. Vaccination – New Strategy on 7.06.21
• Welcome steps:
• Central Govt to procure vaccines for Govt hospitals and vaccination centres (Central and
State). All adults to be administered vaccine free.
• Private sector can buy directly from manufacturers (up to 25% of the output of local
manufacturers - presumably). Service charge limited to Rs 150/jab above the cost of the
vaccine.
• What we would like to see:
• Empowered Committee (Covid Ministry? Headed by a top professional)
• Clarity and time table on procurement. Procurement data to be shared in real time
• Forecasting, Logistics and MIS need to be streamlined
• Process simplification required (registration on Co Win, requirements of smartphone)
• Marketing Plan and Implementation including integration with States – Budgets?
• Carrot and stick approach
• Delivery touch points increase
29. 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.