The document discusses several misunderstood determinants of COVID-19 that have been claimed but lack epidemiological evidence. It questions correlations that have been proposed between COVID-19 outcomes and factors like median age, BCG vaccination rates, religion, and disease burdens. While some correlations appear convincing based on statistics alone, the document argues they ignore important context and exceptions. There have been very few rigorous epidemiological studies of COVID-19 to determine true disease modulators and spread, and many studies have misused non-epidemiological data.

1. The Misunderstood Epidemiological
Determinants of COVID-19:
Problems and Solutions
Epidemiology of COVID-19 is illusive.
It is less a disease but more a ‘political
disaster’ or a ‘Disease of Diagnosis’.
BR Singh
Pri. Scientist and Head
Division of Epidemiology, ICAR-IVRI,
Izatnagar-243122
1brs1762@gmail.com

2. Synopsis? Prologue!
COVID-19, a viral disease, fought with political means
for socio-economic gains, will keep on haunting
humanity for long. Without doing any epidemiological
study on COVID-19 we have determined its
modulators and determinants not to win over COVID-
19 but to create misunderstanding to persist for long
in inquisitive minds to blur the vision for novel
inventions. This presentation deals with COVID-19 in
general and misunderstood disease determinants in
particular to suggest possible means to win over the
disease. As the tip of COVID-19 iceberg is illusion and
reality unknown, thus the struggle is endless.
brs1762@gmail.com 2

3. >150000 people dying due to different
disorders daily
Deaths per million of
Indians per year
Food deficiency 21
Fires 22
HIV/AIDS 36
Malaria 40
Drowning 48
Diabetes 104
Suicide 156
Road accidents 171
Tuberculosis 402
Smoking 915
CVD 2820
In India: COVID-
19 Deaths till now
20/ M, Globally 78
Deaths by COVID,
~600 K in 6 months!!
California study
revealed that there is
0.13% case fatality
rate for COVID-19,
a little higher than
0.1% for common
flu
(https://www.vox.com/2020/4/24
/21229415/coronavirus-
antibody-testing-covid-19-
california-survey).
Have you ever
feared so much from
common flu or the
diseases at left and
right???
3brs1762@gmail.com
Worldwide daily deaths by
cause
CVD 48742
Cancer 26181
Respiratory diseases 10724
Lower Respiratory
infections 7010
Dementia 6889
Digestive diseases 6514
Neonatal disorders 4887
Diarrheal diseases 4300
Diabetes 3753
Liver Diseases 3624
https://www.weforum.org/agenda/2020/05/how-many-people-die-each-day-covid-19-coronavirus/

4. COVIDMania
• COVID-19 cases in India till date about a million in last six months may be 10
million by the end of year.
• About 27 000 people in India died due to COVID (?????) in last six month and
many more may, may be 100 K and about 0.6 million died all over the world.
• Have you ever thought: in India 15 million suffer from Malaria per year and 50
million are patients of Filaria (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034168/).
• Every year 100 million poor die due to Dengue globally
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034168/).
• Tuberculosis, a disease of poor, kills 1.5 million people worldwide with 6.4 million
new TB cases per year. (https://www.who.int/gho/tb/epidemic/cases_deaths/en/).
• In India, every year 440,000 (1205 people daily and more than 50 per hour) die
due to TB (https://tbfacts.org/tb-statistics-india/).
• In India, every year more than 230,000 people i.e., 630 daily (more than 26 per
hour) commit suicide due to one or other reason.
(https://economictimes.indiatimes.com/news/politics-and-nation/coronavirus-
india-must-do-more-genomic-sequencing-to-enable-faster-decision-
making/articleshow/74799884.cms), but no one cared!!!!
• Have you or the media or the global leaders ever worried about those poor people
or talked too much? No, because they are already big and
established pharmaceutical markets but to expand that market further. Every
progressive leader wants to have COVID-19. New era of sanitizers, masks, PPE
kits, new diagnostics, old drugs repurposed, new drugs launched, vaccines eagerly
awaited.
4brs1762@gmail.com

5. Global fight with COVID-19
• Fighting COVID-19= Fighting with the unknown
• No lineage
• No address
We have only
Data to create panic
Panic with motive
Motive, economic and political gains (advantage)
Advantage of individuals not of masses.
Masses are fooled as ever before.
5brs1762@gmail.com

6. Overview of Epidemiology of COVID-19
• Ignored since very first day.
• Non-epidemiological data, just numbers.
• R0 values: Fluctuating (1.5-6.7).
• Morbidity: Not yet known, from 0.0003-3.7% (~0.38%)
• Mortality: Skewed, 1- 845/ M (~0.015%).
• CFR: Biased, 0.0 to 36.2% (~6.16%)
• Herd immunity: Illusive (Sweden and California studies, 5-17%).
• Immunity after Infection: Short lived (<3 months in ~80%).
• Treatments: Taali, Thaali, Shankhnaad (शंखनाद), Deepawali, to
hundreds of the known and unknown medicines.
• Protection: Mask, Social distancing, Immune boosters, Tonics
from Dadi Maa and Nani Maa to Yogi and Jogi Babas, dietary
changes and supplements, and Ganda-Tabeej too.
• Vaccine(s): Coming soon.
6brs1762@gmail.com

7. Epidemiological studies on COVID-19
• Hardly few: That too mostly targeted to see the future of vaccine(s)
or clinical trials (in haste) towards repurposing of drugs.
• Most of the studies are either
– Ecological (not fully ecological too) or
– Clinico-pathological (even without proper understanding of
pathology) or
– Clinical trials of already disputed medicines,
– Vaccine trials (in infancy but promising adulthood).
• Some studies claim to determine several Modulators and
Determinants of the disease as an outcome of play with non-
epidemiological data in leisure time under lockdown including
– Median age of population,
– BCG vaccination status,
– Even religion has been linked with morbidity/ mortality and CFR
– Several co-morbidities
– Socioeconomic factors
7brs1762@gmail.com

8. Determinants of the COVID-19
• ‘Politics’ (at all levels starting from non-political WHO to village
level), overruled all real determinants of the COVID-19.
• Panic: From Tabligi to Mass dislocation, Church to Mosque,
Temple to Gurudwara, Sahitan to GOD, Birth to Death, Marriage to
Funerals.
• Game of numbers. Don’t know for what, that is why it is a
political disease or disease of targeted testing.
• Information or misinformation war: On scientific platforms
(>67K publication within less than six months), publishing and
online media, social and anti-social media, socioeconomic and
sociopolitical platforms.
• The most important determinant is the “the market” made
ready to accept just any vaccine, any medicine, either effective
for a month, two months, three months or not at all, just safe as
“normal Saline”.
• Pharmaceuticals: Public and Private, Local-Vocal-Global;
Allo:Homeo:Ayush:Unani:Chinese:African:Yoga, and
Decoctums and Infusions of all.
8brs1762@gmail.com

9. Misunderstood determinants of COVID-19
• Etiology: Controversy over its origin
• Spread & Expansion
• Determinants and factors of
– Morbidity
– Mortality
– CFR
9brs1762@gmail.com

10. Spread of COVID-19
• Communicable through human to human contact, human to animal contact
but we don’t know the exact role of animals, foods, meats, vegetables and
fruits, and environment (air, water, soil, house flies and other flying swabs). We
are fighting with an enemy without knowing even its proper address.
• Faeco-oral transmission of Coronaviruses (epidemics known in pigs and
humans earlier) but no-one is ready to accept that this may also be important
for SARS-CoV-2 also. Probably we have lost the fight in our mind even before
fighting it.
• Survival of the virus for several weeks in ship cabins documented, still claim
that the virus may survive for a few hours or a day or two on common surfaces
and air and not spread through news papers.
• The virus is detected in water and sewage but we are trying to run away from
the facts and happy to live in lockdown, it is like an ostrich keeping its head
hiding in sand to think that there is no danger.
• Several conflicting statements at level of WHO and different disease control
institutions regarding spread of disease my be either due to ill-knowledge
about the disease or intentional with some political motives.
• All good attempts are made by most of the powerful countries to spread the
disease globally through intentional import and export of potential spreaders
of the disease by one or other means, and then politicizing the spread in
different ways, made it as a political disaster rather than a pandemic of a viral
disease.
10brs1762@gmail.com

11. Politics of COVID-19 Transmission
• Disease not spread through human to human contact, WHO.
• Infected people can be contagious well before experiencing
symptoms.
• "Some modeling studies suggest 40-60% of spread is from people
when they didn’t have symptoms”, Ashish Jha, the Brown School of
Public Health.
• Singapore's Corona-virus task force: Released an animation of
demonic spread of COVID-19.
• Maria Van Kerkhove (@mvankerkhove, Infectious Disease
Epidemiologist; COVID-19 Technical Lead, WHO Health
Emergencies Programme tweeted on 8-6-20 “transmission from
asymptomatic individuals are difficult to conduct, but the
available evidence from contact tracing reported by the Member
States suggests that asymptomatically-infected individuals are much
less likely to transmit the virus than those who develop symptoms”.
• It is not Zoonotic, no role of animals in disease spread (though
Cats, dogs, tigers, monkeys suffered and mink transferred
infection to half a dozen people???)
11brs1762@gmail.com

12. Iceberg of COVID-19
• Except a few isolated attempts no country has attempted to determine
the disease iceberg required to estimate the required efforts to contain
the disease.
• To determine the extent of COVID-19 disease iceberg we need to use
antibody tests extensively with well designed sampling plan using one
or more tests with high sensitivity and specificity.
• We are fighting with the tip of the COVID-19 iceberg and destined to
crackdown under lockdowns.
• Direct losses due to COVID-19 in form of sick and dead is only tip of
the iceberg of economic disease probably leading to economic paralysis
after extended lockdowns and partial closures all over the globe which
may be killing billions due to our madness to save a few million people
already approaching towards there end due to several co-morbidities
or have already spent their productive life decades ago.
• There is an urgent need to think scientifically, this disease is here to
teach the lesson again once taught by Darwin, “Survival of the fittest”.
• As the world is ruled mostly by those have enjoyed their productive life
but want to rule till their end or they consider themselves endless
(Rawans). For those inhumane we are posing humane to display
humanity & forget the of the coming generations and poor of this
world constituting more than 90% of the humans of the globe.
12brs1762@gmail.com

13. Determinants????
Correlation of COVID-19 and Median Age of Nations
Cases/ Million 0.153708
Deaths/ Million 0.343575
CFR 0.104797
%Positivity -0.12684
Looks Convincing: 47 countries, median age ≥40 yrs, 13.6% of global
population (GP) but 19.7% global COVID-19 cases and 34.4% deaths,
6.76% CFR,138/Million mortality.
But nine of such countries had 3.7% GP, have less than 5 deaths per million
with 0.7% of cases and 0.25% of deaths.
In 37 countries with median age <20 yrs, with 13.8% GP, mortality is
10/ Million.
https://www.cia.gov/library/publications/the-world-factbook/fields/343rank.html
13brs1762@gmail.com

14. BCG Mandatory Vaccination???
14brs1762@gmail.com

15. BCG facts????
http://www.bcgatlas.org/index.php
• More of Convincing figures: 181 countries with 89.5% GP uses
mandatory childhood BCG vaccination, holds 61.5% COVID-19
cases and 45.7% COVID-19 deaths.
• 29 countries not mandating BCG use holds 10.5% GP but 38.5
% COVID-19 cases and 54.3% of COVID-19 deaths.
• Of the 29 Non-BCG user countries, eight (Australia, Cyprus,
Falkland Islands, Iceland, Israel, Liechtenstein, Luxembourg,
Vatican City) holding 0.5% of GP, 0.5% of cases but 0.1% of
deaths have CFR <2.5.
• Six BCG mandating Nations (Guatemala, 22.4; Honduras, 19.4;
Hungary, 15.6; Mexico, 15.5; Yemen, 38.8) holding 2.5% GP,
2.8% of COVID cases and 6.9% of deaths have CFR >15%.
• 50 BCG user countries having CFR<1%, have hold 7.9% GP,
7% of cases and 7.4% deaths.
15brs1762@gmail.com

16. Other disease vaccinations and
COVID-19 correlations
Use of vaccines
(percent population
vaccinated)*
Cases/M Deaths/M CFR %Positivity
BCG -0.1946 -0.51973 -0.23593 0.021372
DPT 0.177646 0.14664 -0.03692 -0.05969
HiB 0.132929 0.143603 -0.01581 -0.04473
Hep B 0.152188 0.05744 -0.06833 -0.04953
RotaVirus 0.051192 -0.06316 -0.11059 -0.06685
Polio 0.190457 0.166946 -0.09053 -0.0704
MCV1 0.206216 0.159052 -0.10478 -0.08398
MCV2 0.208169 0.115188 -0.17265 -0.15418
*https://apps.who.int/gho/data/node.main.A830?lang=en
16brs1762@gmail.com

17. Religion of COVID-19?????
COVID-
19
Among different nations Correlation of Percent
of population following
Christians Muslims Hindus Buddhist No
Religion
Cases/
Million
0.021435 0.035733 -0.0160 -0.10694 -0.01981
Deaths/
Million
0.220773 -0.21897 -0.0802 -0.10571 0.190216
CFR 0.100398 0.027791 -0.0802 -0.1697 0.066224
% Positivity -0.14913 0.209867 -0.0221 -0.03597 -0.07566
Source of religious structure:
https://www.pewforum.org/2015/04/02/religious-projection-
table/2010/number/all/
https://en.wikipedia.org/wiki/List_of_religious_populations 17brs1762@gmail.com

18. Co-morbidities and COVID-19
Burden of different
diseases in countries
(https://www.who.int/whr/1996/m
edia_centre/press_release/en/)
COVID-19 parameters
Cases/ M Deaths/ M CFR % Positivity
TB* -0.23476 -0.25826 -0.08493 -0.03144
HIV* -0.14436 -0.19381 -0.05991 -0.01834
Malaria* -0.19472 -0.21022 -0.04352 -0.01632
Cardivascular
Diseases
-0.24721 -0.37427 -0.06367 0.183927
Neoplasm 0.163798 0.424877 0.082375 -0.11024
Diabetes 0.185606 -0.06568 -0.08287 0.235771
Smoking -0.16383 -0.09376 -0.06138 -0.10989
18brs1762@gmail.com
*That is why we don’t want to control other infectious disease. Who will
protect us in future from COVID-19 like diseases? Keep on smoking!!!!

19. COVID-19 and Basic amenities and
their indicators in Nations
COVID
Parameters
Correlation of COVID-19 with availability of Basic
amenities and their indicators in Nations
Food
deficiency*
Water and
Sanitation
spending
Healthy life
expectancy
Literacy
rate
#PPP$
Cases/M -0.22351 -0.12252 0.314848 0.22646 0.43915
Deaths/M -0.22378 -0.08841 0.409375 0.256456 0.31057
CFR -0.01284 -0.06721 0.050487 -0.03145 -0.0645
% Positivity -0.02146 -0.05846 -0.15289 -0.16615 -0.1026
19brs1762@gmail.com
*Reduction in prosperity is must to curb the COVID-19, that is why you are
under lockdown. Keep on fasting to be at safe hand from COVID-19!!!!

20. Common Solutions
Cure the panic
• Live and let live, like most of less-severe diseases, COVID-19 has to live on this earth for
long, so we have to accept it as cohabitant on the earth.
• Coronization of the world as soon as possible using some less pathogenic and more
contagious virus, we may wait till the nature invent such or some scientist(s) do it.
• Forgetting at the earliest that some vaccine will come and save the world in real time.
Even if one or many are made available in time to come that is destined to fail in
containing the disease for years to come. Failing vaccination and repeated outbreaks of
age old diseases is lesson to be learned at the earliest.
• Treatments for viral diseases are failing since ages, it may be useful for some
economically able to afford it but at large always failed.
• Respecting the Nature and its forces, and accepting the fact that we are not supreme.
• As it is a political disaster, the best strategy is avoiding the politicizing of the numbers of
targeted diagnostic tests. And their results and boasting the imaginary successes.
• As it is also a disease of diagnosis, another important strategy is either ‘Stop diagnosis’
or ‘Stop public display’ of the numbers now updated in real time.
• Displaying numbers appears to be a political strategy to create panic among masses (for
one or other gain), the importance should be given to ward of panic of numbers.
• As one of the most important determinant of COVID-19 is information or
misinformation war in media, on social media and sociopolitical platforms if we can put
a break on it or stop for some period instead of lockdown the disease will be controlled in
much less time and with less economic implications. 20brs1762@gmail.com

21. Epidemiological solutions
• Through clinical observations we know the most vulnerable population for
COVID-19 morbidity and mortality (aged, people with underlying diseases and
compromised immunity), our target should be to save those vulnerable people.
• In healthy population, young and adults, the disease is either unapparent or
mild, therefore they should be allowed for free movement to work and spend
leisure life so that the herd immunity (???) can be created at the earliest.
• Natural infections are better creators of immunity than any of the best vaccines
thus, we should actively promote that most of the healthy and young population
contract the infection time and again for solid and lasting immunity.
• Even after natural infections immunity is vanishing fast (UK Studies, in 3 months
83% become un-protected) then it is not possible to predict the efficacy of any
vaccine unless repeated frequently, then best is to allow the disease to be
endemic.
• Though contradicted, the disease also spread through asymptomatically infected
people (young and adults) thus their contact with vulnerable be stopped to the
maximum.
• Educating the people with reality (still unknown) may be other best tool to
control the disease because disease is more a created panic than the virus itself.
21brs1762@gmail.com

22. https://innovationorigins.com/how-
colossal-is-the-corona-iceberg-in-the-
netherlands/
https://www.researchgate.net/publication/340183646_COVI
D-19_MORTALITY_ICEBERG
22brs1762@gmail.com
As the tip is illusion, reality
unknown, thus the struggle is
endless