Presentation holistically and briefly covers the technical aspects of global pandemic. To put things in perspective a comparison woth recent pandemics is also included. I have tried to make the presentation as rational and unbiased. Though with the ever coming developments daily some things might become redundant even in 10 days only. would love to get suggestions for improvement.

1. COVID-19 Outbreak: A Brief Review
Date: 25th May 2020
Presentation by
Akhtar Hussain – 2016CH10120

2. History of Outbreaks
Disease Timeline Death Toll Cause Status / Remarks
Malaria 400
Millions+
(Estimated)
Protozoa Annual death toll: 0.5
Million. Both vaccines and
Treatment available
Black Death 1347-1351 200 Million Bacteria
AIDS 1981-PRESENT 25-35
Million
HIV (Virus) No vaccine available till
now
Small Pox 16th Century Virus 300 Million people alone
in last century. Vaccine
available since 1796!
Influenza 1918-19 50 Million H1N1
Virus
More Recent Outbreaks
SARS 2003 774 SARS-COV
Ebola 2014-2016 11000 Virus
MERS 2015-Present 850 MERS-COV
COVID-19 2019-Present 0.33
Million
Virus
0.8
1.5
2
2.5
3.5
4.5
6
6
16
0 5 10 15
MERS
Influenza
Ebola
COVID-19
SARS
Mumps
Rubella
Smallpox
Measles
Disease
REPRODUCTION NUMBER FOR VARIOUS
OUTBREAKS
Reproduction Number: No. of susceptible
people, a sick person will infect (On an
average).
Data Source: World Economic Forum

3. What’s so special about COVID-19
Coronaviruses: Group of related RNA viruses. lethal
varieties can cause SARS, MERS, and COVID-19.
Virus Causing COVID-19: Severe acute respiratory
syndrome coronavirus 2
Fact Source: Lindsay B. April 2020. “Coronavirus – a brief history”. The Conversation.
1. More contagious, Higher Mortality rate (10 times) that of flu.
2. Difference from SARS-MERS: Much greater chance of dying in
case of SARS. Symptoms of SARS more severe.
1. Novel
2. Asymptomatic People. (Incubation time 5-14 days)
Not deadly as SARS or MERS but it can spread undetected.
3. No vaccine. No treatment. No Herd immunity.
Specialities of SARS-CoV-X
1. RNA Virus; High mutation rate: Lacking proofreading ability.
2. Positive Sense – Can directly translate into viral proteins.
Specialities of SARS-CoV-2
10%
1.50%
34%
0.20%
45%
0% 10% 20% 30% 40% 50%
SARS-CoV-1
SARS-CoV-2
MERS-CoV
Seasonal Flu
Ebola
MORTALITY RATE OF OUTBREAKS

4. COVID-19: Spread, Symptom, Mechanism
Spread:
1. Respiratory, Mother to child, Faeces, Saliva,
2. No evidence of spread by blood transfusion
3. Tears, Semen, Other body fluids: No evidence of spread.
Only 20% of infected people need to be
hospitalized, 80% get what feels like bad cold
or flu and recover in one week.
Entry of Virus in
Body
How Virus Affects the Body
Incubation in throat in
mucous membrane (2 to 10
days)
Spread of
virus in
whole body
Mild disease
(80%)
Damaging
cells
Over-reaction of
Overreaction of
immune system.
Cytokine Storm
.
1. Too much inflammation in
lungs: Pneumonia
2. Sacs starting to fill up with
water; Shortness of breath;
Need of ventilator Severe (14%)
Critical (6%)
1. Immune system out of
control and damanging
body severely
2. Septic Shock
3. ARDS. Kidney fail.
Simultaneous
response of
immune system.
If disease continues
80% people gets
cured with bed
rest, fluid, drugs
Information Sources: Wuhan Lab, BBC, WebMD, ICMR

5. Mortality Risk of COVID-19
Data Source: John Hopkins University & Medicine
6.50% 6%
14.20%
12.10%
14.20%
0.90%
6.37%
5.50%
3.02%
4.73%
1.40%
2.10%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
MORTALITY RATE ACROSS WORLD
Measuring parameters for death rate:
C(t): Number of Cases; D(t): Number of people died
R(t): Number of People recovered;
1. Time taken for D to double. India :9 days: New York: 3 days.
2. Case fatality Rate
3. Crude Mortality Rate: Probability that an individual in the
whole population will die from the disease.
4. Infection Fatality Rate
Shortcomings of CFR
1. In case of undiagnosed people. Overestimation of risk.
2. No account of currently sick. Underestimation of risk.
14.5
24.2
16
19.26
3.15
1.73
5.6
6.8
5.7
6.8 6.2
0
5
10
15
20
25
30
Case fatality Rates: Not single steady number. Severity
of disease in a particular context, at a particular time in
a particular population
D(t) / C(t) D(t) / [D(t) + R(t)] D(t) / C(t+7)
D / C
D / D+R

6. India in COVID-19: Why low mortality
Potential Reasons Suggested for low Mortality Scepticism
1. Not enough tastings.
2. Missing COVID-19 Deaths.
Lockdown
Young population of India.
Presence of less virulent strain of virus in India.
Hot weather, Climate, Demography
Exposure to Malaria
High TB vaccination rate (BCG)
Country Tests/Population
India 420
Pakistan 654
Bangladesh 262
Country Tests/Population
US 15000
Spain 19000
Italy 28000
Data is Indicative. 26th April 2020. Our World in Data.
National Centre for BTI, US

7. India’s Role in the Pandemic
1. Lockdown
2. Contact Tracing
3. Community Mobilization
4. Arogya Setu
5. Strong leadership: Active and Timely Decisions
6. International Relations
o Doing right things & Doing things rightly: Holistic Policy
Measures should have been taken. Considering diversity
among population in India. Health inequalities, widened
economic and social disperities, distinct cultural values
and unique challenges.
o Testings: More testing should be done. Rates of testing is
very low. Capacity issues, absence of political will and
operational feasibilities are to blame.
o Non-COVID19 health services have been disturbed.
o Spread of misinformation driven by fear, stigma and
blame.
What did we do best What could we have done better
1. Samples Tested till 25/5: 2943421
2. Current capacity: 1 lacs test per day
3. Strict guidelines for testing
“Future of this pandemic will depend on how India handles it.
India eliminated smallpox & polio and gave a gift to the world.
India has tremendous capacities. India should lead the way and
show the world again.”
--WHO Press Conference (23 March 2020)
“India is the key as the world works to
minimize social & economic impact and pave
the way to vaccine, testing and treatment
access for all..”
--Bill Gates (14 May 2020)

8. COVID-19: Way forward in Diagnosis
Potential Methods
Biomarker: antibodies
 Not good for detecting illness when
you are sick; can be reliable only
after recovery.
 False positives.
Methods in Pipeline / Recent Research
Direct Testing Serology Tests
Biomarker: actual pieces of virus
 Less reliable for asymptomatic
people.
 False negatives.
Sample: Saliva or Swab
Methods
1. RT-PCR; Time dependent
2. Isothermal Amplification Assays
1. IITD Probe-Free Assay
1. Real Time; PCR Based
2. Swab Testing
2. DiAGSure (Bengal) nCoV-19:
1. INR 500; 160 patients
2. 100% accuracy
3. 90 minutes detection time
3. At home antibody tests:
1. Massachusetts Gastropub
tried for same but got shut
down by FDA.
2. Coplicacy of tests (False
positives)
3. Less knowledge of virus.
Data Source: ICMR, NIH, Quartz

9. COVID-19: Therapy
Mild disease to 80%. Among 20% few require critical care & ventilators. No specific treatment method is there yet for COVID-19.
Convalescent Plasma Transfusions
Patients who recover from infection make IgG. These
are transfused into sick patients.
• Ebola Drug.
• Knocks out
RNA
Polymerases.
Restricting
replication.
Status
No approval yet.
Drug under trial.
Potential Drugs Therapy
• Influenza Drug
• Disrupts
pathway which
helps virus in
replication in
cells.
• Less effective.
Status
Rejected in few
research. Still under
trial.
• Malaria Drug
• Blocks viruses from
binding to human cells
& prevents them from
getting inside.
• Having side effects
• Heart Problems1
• Increased risk of
death.
Status
Optimal dose under
question. Use sceptical.

10. COVID-19: Vaccination
Potential Issues with Vaccine Development:
1. Process of approval (3 Phase trials) Animal
studies.
2. Novelty of Virus: We don’t know for how
many days antibodies will last.
Most Common: Recombinant type. Having
genetic code of S protein as antigen.
 Moderna: Genetic code of s protein fused
with fatty nanoparticles. No animal trials.
 Imperial College London: Corona Virus
RNA as antigen.
 Sanofi: Subunit. Mixing virus DNA with
genetic material of other harmless virus.
 J&J: Deactivating Corona.
 University of Cambridge: Computer
modelling of virus structure to determine
weak spots in DNA..
Sources; Institutions Working
on Vaccine
1. Moderna (US)
2. Imperial College London
3. Pennsylvania Biotech
Company
4. Johnson & Johnson
5. Sanofi (France)
6. Serum Institute.
7. Oxford University
Finding viable antigen which will simulate immune system into defending against infection; Key for vaccine: Crownlike
projections on surface. Can be potential antigen for vaccine. S proteins. Also present in other corona viruses as well.
Research Under Pipeline

11. COVID-19: Vaccination – A Case Study
Vaccine Name: Adenovirus Type 5 Vectored Vaccine.
Type: Recombinant vaccine. Uses weakened adenovirus (Common Cold). Cells will produce spike proteins.
Which will serve as antigen to produce immune response.
Phase 1 Trial
1. Defining of dose groups and infusing the vaccine.
2. Antibody Measurement through ELISA after certain periods.
3. Neutralising antibody response by SARS-CoV2 Neutralization.
4. Assessment of T-Cell response by enzyme linked immunospot and flow cytometry assays.
Observation and Findings
Adverse reaction was reported in 7 days among around 80% people. No serious effect after 28 days. ELISA
antibodies and Neutralising antibodies increased significantly. T-cell response peaked at day 14. warrants
further investigation.
Reference Research: Feng-Cai Zhu et al. The Lancet.
Vaccine
Development
Animal
Testing
Phase 1
Trial
Phase 2
Trial
Phase 3
Trial
Regulatory
Approval
Regulatory
Approval
Vaccine in
Market

12. Lessons Learnt
1. Stability of Asian economies.
2. Need of better, more cooperative global political order.
3. Approval process for drugs. Can tech and combined innovation in BT & IT solve the issue?
4. Social disparities and inequalities makes us less resilient in times of crisis.
5. Poor and Migrants can’t be invisible. Crisis is a mirror of society in highlighting these issues.
6. Change is the only thing constant.
7. Unorganised labour and Migrant Issues.
Every crisis brings number of opportunities with itself and with a promise for better future. And it reflects limitation of existing
systems forcing us to do better to improve us and build a better future. Hoping for better us who will build better future at end.

13. Some Resources I believe everyone should have a look
1. Emily London. May 2020. “What we know so far about 2019 novel coronavirus”. Uchicago Medicine.
2. Soutik Biswas. April 2020. “India Coronavirus: The mystery of low Covid-19 death rates”. BBC.
3. Ana Sandoiu. March 2020. “Why are COVID-19 death rates so hard to calculate”. Medical News Today
4. Max Roser. May 2020. “Mortality Risk of COVID-19”. Our World in Data.
5. James Gallagher. March 2020. “Corona Virus: What it does to the body”. BBC.
6. Hansa Bhargava. March 2020. “Corona Virus: What happens once you get infected”. WebMD.
7. Jackson Ryan. May 2020. “Coronavirus treatments Remdesivir, hydroxychloroquine and vaccines for COVID-19”. CNET.
8. Prof. Rajendra Pratap Gupta. March 2020. “What India could have done to better handle the deadly Coronavirus”. Outlook