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| Image Source: Google COVID19 Map |
"Viruses aren't considered alive -- in class, I call them pseudo-alive," “They require a host to even begin to function. A virus usually enters the cell through a protein our cells have on their surface. COVID-19 -- and SARS [severe acute respiratory syndrome] before that -- use a protein called ACE2, which is on the surface of the cells in our lung, throat and intestinal tract."
"If you don't pass it on, then that virus hits a dead end in its pseudo-life," said Eric Mendenhall, an associate professor of biological sciences at the University of Alabama in Huntsville.
Doctors believe that the COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, thus releasing them in the air. Most people infected with the COVID-19 virus experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. Death rate by Corona virus globally is 13.9/ 1 million population where as it is 0.3 for India which is very less.
WHO recommends two most important preventive actions are: (1) that Viruses can't spread unless people help them i.e. social distancing or self-quarantine; and (2) people can stop the spread by washing hands frequently for 20 seconds and maintain social distancing of at least 1 metre.
Objectives of the Study:
1. To understand the pattern of spread and countries severely impacted by the Corona Virus (COVID19)2. To study the effect of temperature on the spread and incidence in countries affected by Corona Virus
3. To analyse the Impact of complete lock=down in India on Deaths other than COVID-19.
Methodology:
For the purpose of this study, we have sourced the data from tracker https://www.worldometers.info/coronavirus/. as of 12th of April.Death rate is calculated on the basis of Total confirmed case/ Total death. Where as probability of death per hundred COVID-19 positive case are calculated on the basis of total death+ Seriously Critical out of total confirmed cases. We know that some critical patient may be cured with time. Probability of death will always show upper side. It is difficult to calculate current mortality rate because different countries are at different stages of the COVID-19 outbreak and deaths per million population will change with every single deaths.
We have considered multiple variables, causes and factors influencing the spread of the disease and have attempted to understand and arrive at a pattern. We have analysed the data continent wise to see the pattern of incidence in different continent.
To analyze the impact of lock down on other than COVID-19 deaths , only those Diseases have been considered which will increase death due to Corona lock-down.
We have also taken other data from each of the countries who have been largely affected by the Corona Virus, wherever available.
OBJECTIVE-1 : To understand the pattern of spread and countries severely impacted by the Corona Virus (COVID19)
The Corona virus disease has spread in 210 countries and territories. Out of 210 countries 51 countries have no deaths while 55 countries have been reported with deaths (127) within 1-5 range. It means that the pattern of disease spread is very different from other previous virus epidemics. There are 197 countries that fall under the 0-1000 range with a total deaths of 8541 as on 12thApril. On the other hand, there are only 13 countries within the range of 1001 and above and have huge number of deaths with 99793, almost 1 lakh. Most of the deaths have occurred in very developed countries who have high per capita income with better and most advance health facilities. Most of the under developed and developing countries have low incidence of COVID-19 disease. It clearly reflects that some other factors are responsible and playing big role in it.
As far as total deaths is concerned, Africa has the lowest date ratio at 0.328 per million population, followed by Oceania at 1.148 deaths per million population. Asia which includes China at 1.1884 and 2.451 deaths per million population are in the mid-range. North American Countries are at the second highest 21.984 deaths per million population and the highest number of deaths has been recorded in Europe at 77.285 and this includes the most affected countries like Italy, Spain, France, UK and Belgium.
Probability of deaths
Data indicates that the probability of death of affected people does not exceed 17%. The highest rate recorded is in Italy (15.01%), Spain (14.74%), France (15.98%), UK (14.48%), Netherland (16.50%) has been in European Union.USA with 5.96 is leading in the deaths per identified cases, followed by Mexico at 8.38% and Canada at 5.20% among the North American Countries.
Comparatively, the rate for Asian Countries is Turkey (5.23%) China (4.25%), Iran (11.92%), India (3.41%), Pakistan (2.71%), Sri Lanka (4.04%), Malaysia (3.20%), Philippines (5.60%), Indonesia (8.51%), Saudi Arabia (2.95%), UAE (0.56%), Bangladesh (6.43%), Nepal (0.00), Afghanistan (3.245%).
Similarly, the probability of deaths of affected people in the African countries is also low with Algeria leading at 17.59% followed by Marrakesh (7.29%), Kenya (4.71%), Nigeria (3.77%), Jordan (3.15%), Ghana (2.45%), Niger (2.24%). Other countries have recorded higher death ratio because the number of cases identified is comparatively small.
Amongst the South American Countries, Argentina (10.03) is leading the probability of deaths followed by Brazil (6.85%), Chile (6.58%) and Peru (4.72%).
Two leading countries in Oceania which highest death rate is Australia (2.16%) and New Zealand (0.69%).
From the above, it can be safely concluded that Continents with higher incidence and probability of death are those with lower temperatures, viz. Europe and North America whereas Asian, South America, Africa and Ocenia continents where temperatures are warm to hot have recorded lower rate of spread of virus and all other related indicators.
In most African countries have low number of incidence of affected people and therefore the number is low but reflects a higher percentage, which can be misleading and incorrect to be able to arrive at some sort of conclusion as to the impact.
INDIA: The first case of COVID-19 was reported in India on 29th January, 2020 whereas Janata Curfew was implemented on 22nd March, 2020, which was after a wide gap of 54 days. Thereafter, the Government of India announced a 21-day compulsory lock-down to restrict the movement of people and asked people to maintain a social distancing. If the international flights would have been canceled just after the first reported case then there would not be any need of complete lock-down and cancellation of transportation system.By 22nd of March, 2020, there was a delay of 54 days and things had seemingly gone out of control. Seeing our fragmented public health system where infrastructure in the Public Hospitals including the number of beds, non-availability of testing kits, laboratories not equipped to conduct such tests, non-availability of medical professionals trained to handle such a situation, the complete lock-down for 21 days was only effective option before the government.
This 21 days lock-down was necessary because every epidemic has its peak and a subside period. COVID-19 virus is known to have an incubation period of 14 days and one extra week is required to know its pattern.
As far as spread of COVID -19 in India is concerned, it can be considered a mild attack. Out of total global deaths, 97% deaths have occurred in countries that lie between 30 degree to 50 degree Latitude in Northern hemisphere within temperature range of 5-10 degree C with dry air. The Incidence and Intensity of COVID-19 is very low in most of African, Asian, South American and Oceania countries. The number of Deaths in India due to COVID-19 is dismally low at 0.3 per million population which is considered very low in comparison to the deaths in other countries globally.
Of the 28 states, the top Seven States which have recorded the highest number of cases are Maharashtra (127), Madhya Pradesh (36), Gujarat (22), Delhi (19) and Tamil Nadu (10) covering almost 74% of the recorded deaths.
OBJECTIVE-2 : To study the effect of temperature on the spread and incidence in countries affected by Corona Virus.
Prominent Scientists and virologists affiliated with the Global Virus Network (GVN), have determined that temperature and latitude may have a direct link to the spread and seasonality of COVID-19.
“The statistics all show that they breed and survive longer when it’s cold and dry,” Myers said. “So, when it’s warmer and more humid and there’s a lot of sunshine, the statistics on all of the others show a virus is less lethal, it spreads less efficiently and less effectively among humans.” Dr. Joseph Fair, a virologist, epidemiologist and infectious disease specialist, suggested sunshine is a critical factor in subduing the virus.
“Notably, during the same time, COVID-19 failed to spread significantly to countries immediately south of China,” the paper notes. “The number of patients and reported deaths in Southeast Asia is much less when compared to more temperate regions noted ... The association between temperature in the cities affected with COVID-19 deserves special attention.”
Some have suggested the possibility that weather factors might affect the virus – particularly the intensity and amount of hours of sunshine as well as heat and humidity. “Obviously, the virus is something we’ve never dealt with before, but if we look at other viruses … they all had their peak during the cold season,” said AccuWeather Founder and CEO Dr. Joel N. Myers.
“It really doesn’t have anything to do with the warmth, but it has to do with the length of the day and the exposure to sunlight, which inactivates the virus through UV light,
Research from a laboratory-grown copy of the corona virus (SARS-CoV-2) that causes the COVID-19 illness shows that heat affects the virus and impacts its behavior, a top pathologist said new research has shown. “In cold environments, there is longer virus survival than warm ones,” Hong Kong University pathology professor John Nicholls told AccuWeather exclusively.
New study says 'high temperature and high relative humidity significantly reduce' spread of COVID-19. Increased UV exposure may limit spread of new corona virus.
The following world temperature map clearly indicates the spread of the virus is restricted to only a limited handful of few countries located between 30-50 degree North Latitude and these are countries which have cold temperatures (5 to 10 degrees) with dry climate. These countries include USA, Spain, Italy, France, Germany, China, Iran, UK, Belgium, Netherlands.
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| Image provided by John Nicholls |
“Temperature could significantly change COVID-19 transmission,” the authors note in the study. They also pointed out that the “virus is highly sensitive to high temperature.” “Most corona viruses become weak in high temperature and high humidity” - By SHOBHA WARRIER, March 28, 2020 09:00 IST
INDIA: A study conducted at MIT found that the spread of corona virus is much less in high temperatures and high humidity conditions.
Dr. Himanshu Reddy Dandu of the King George's Medical University in Lucknow has been leading his team in fighting the corona virus said “most of the corona viruses become weak in high temperatures and high humidity. That way, it will be helpful for India because by April, temperatures will be in the late 30s and early 40s (degrees centigrade). Therefore, if we are able to sustain these 21 days, and go to that temperature zone, it will be a way of nature protecting us.
OBJECTIVE-3 : To analyse the Impact of complete Lock-down in India on Deaths other than COVID-19.
A lot has been said about mortality rates in the context of the COVID-19 virus outbreak. We know that most of the cases of COVID-19 that resulted in fatalities belong to the older age group. The young generation are far more likely to be infected (as the carrier) but old people are more likely to die. But in case of lock-down due to Corona virus, many younger population are also losing their lives, not due to the virus but due to other factors.
Many people are dying due to non availability of food. According to the World Bank's 2015 estimates, India has 176 million people living in extreme poverty. The economists Sandhya Krishnan and Neeraj Hatekar conclude that 600 million people, or more than half of India's population, belong to the middle class. According to Oxfam, India's top 1% of the population now holds 73% of the wealth while 670 million citizens, comprising the country's poorest half, saw their wealth rise by just 1%. In 2019 India has been ranked at 102nd place among 117 economies in the Global Hunger Index. India ranked below Pakistan (94), Bangladesh (88), Nepal (73) and Sri Lanka (66) among other South Asian countries. The “hunger” kills 821 people every day in our country. Government strong determination could save their lives but does not do so, because “hunger” does not kill the rich.
“What the people of the world want most and have always wanted is bread and peace." - Patricia Young, UN General Assembly.
“When India achieved independence, more than 50 years ago, the people of the country were much afflicted by endemic hunger. They still are." - - Amartya Sen, Nobel Prize Winner.
The Director-General of the World Health Organization (WHO) said the lock-down to limit the COVID-19 transmission had "unintended consequences for the poorest" and "most vulnerable". It is necessary for government to ensure food, life essentials and medical facilities for rural population which is 66% of the total population. Rural India does not have good quality health infrastructure, medical services and is poorly staffed.
The Mortality rate of India at 7.3 per thousand population is already considered to be high and a cause of concern. As per mortality rate 27,536 people are dying per day in India. Major causes of deaths are many but for the purpose of this study, only those Diseases have been considered which will increase death due to Corona lock-down.
People might be dying in their locked-down homes due to Hunger, heart failure who might be unable to make it to a hospital, they might be escalating domestic violence cases, or people might be committing suicide in seclusion. The outcomes from cancelled surgeries, suspended clinical trials, disrupted maternity and neo-natal services, unfilled prescriptions and delayed chemotherapies, to name a few, are difficult to imagine.
Deaths due to Heart attack and stroke combined cover 26.6 percent of total deaths in India. In the cases of Heart attack and stroke, if not treated immediately and quickly, the heart muscle fails to pump and begins to die. Due to lock-down many of them would not be able to act quickly enough to make it to the hospital on time for help. When a heart attack happens, delay in treatment can be very deadly. Delay in Heart attack, stroke, maternal delivery, chronic kidney diseases will increase by at least 20% whereas infant mortality, deaths due to malaria, suicide, COPD, Tuberculosis, malignant and other tumors will increase by a minimum 10% while deaths by Hunger will increase at least 25%.
The table below is indicative of the additional deaths that may occur due to lack of access to medical care or non-medical causes. This is increasing the burden of death due to the COVID19 pandemic.
Findings and Conclusions:
1. COVID19 has so far spread in 210 countries and territories.
2. Till 12th April, 2020, 51 countries have recorded no deaths whereas 55 countries have reported a total of 127 deaths not exceeding 5 in number.
3. Between 197 countries, the total number of deaths in the range of 0 to 1000 deaths is 8541.
4. Alarmingly, a total of 13 countries combined have recorded total 99173 deaths (91.54%)
5. Around 97% of the total deaths lie between 30o to 50o Latitude in the Northern Hemisphere.
6. Most of the African, South American, Asian or Occenia Continents have mild or less lethal spread of the COVID19 mainly because the warm climate.
7. Data of deaths in different countries clearly shows that there is a very strong relation between the temperature and total deaths occurring in specific countries.
8. The probability of deaths occurring all over the world is 9 persons per 100 patients with COVID19 positive cases whereas it is around 15 person in Italy, Spain, UK, Belgium, Netherland.
9. In India, the probability of deaths per 100 confirmed patients however, is merely 3.41%. Similarly, neighbouring Pakistan is also in close range with 2.71 deaths per 100 patients. China with highest number of deaths recorded in Asia at 3339 also has a lower death probability at 4.25%.
10. It is observed that the pattern of spread of COVID19 in different continents is not uniform as also the rate of incidence and mortality.
11. There appears to be a strong affect on the survival of the corona virus, given that it is spread rapidly in countries and cities which have seen harsh winter with low temperatures starting from November 2019 till March 31, 2020.
12. In comparison to the deaths recorded in India so far, there are additional 3116.6 deaths per day due various other causes (Refer to Table No.4) which is an additional burden not considered but is much higher than deaths due to COVID19 recorded so far. If this is extrapolated to include the 41 days of lock-down, then the total number of deaths due to causes other than COVID19 will be a whopping 127780.6 deaths. Of this, Ischemic Heart Disease and deaths due to stroke alone will account for 58592 deaths, followed by Hunger which will account for 8210 deaths. Maternal deaths by itself will be 808 which will not include the unborn child.
13. It is estimated that more than 1 Lakh citizens will be injured or succumb to injuries due to police lathi-charge or mobbing during the lock-down enforcement because they will venture out in search of food supplies, for work, to beg or violating the lock-down laws.
14. There are many other countries where the incidence of COVID19 is high but despite which a complete lock-down has not been imposed. There are countries with same socio- economic and climate condition have not much incidence as well as deaths without locked down.
Recommendations:
1. The states and their districts where the COVID19 numbers are significantly lower, the lock-down should be relaxed in a phased manner after as soon as possible to minimize the casualties on account of other health reasons and inaccessibility to medical facilities.2. After the withdrawal of the lock-down, the fear amongst people about catching COVID19 will reduce and people will start moving out of their homes to re-start their business, agricultural activity and people in rural areas will should start getting employment opportunities under various government schemes like MNREGA. Projects under MNREGA should be expanded. Payments to those covered under this scheme should be prompt so that there is no financial distress.
3. People will be able to go in search of food and other commodities as soon as the opening of highways and movement of people and goods is eased and it will lead to ease in supply of various items of consumption. This has to be monitored so that there are no delays and should be managed well.
4. The Indian Railways and State Transport Corporations should operate non-air conditioned trains within such states where incidence is low to enable labourer’s and workforce to travel in search of work or go to their factories and office. Fresh tickets shoul be issue and all other existing travel passes should be suspended. Issual of new tickets should be limited so that there is no crowding which can lead to community spread of the virus. Movement of such trains should be restricted within 50 kms. of the state border if incidence of disease is high in that state. This will also enable them to start the wheel of economy. International Flights from airports in states where lock-down has been lifted, may be restricted to countries with very minimal casualties.
5. Provision of Compensation to deceased due to COVID19 and other causes on account of lock-down. It is recommended that a dedicated helpline be started at each state to enable people needing help for getting transportation to the nearest and best medical facilities so that avoidable deaths can be minimised.
6. People who have lost or will lose lives during the lock-down process must receive adequate compensation so that families do not fall apart and they can rebuild their lives to overcome their sorrow and do not have to be dependent on others or sink under the burden of impoverishment and deprivation. The reimbursement has to be quick and free from bureaucratic red-tape.
About the Authors:
Dr. Abu Altamash Faizi holds a Ph.D. in Population Sciences from the International Institute of Population Sciences, Deonar, Mumbai and is an alumni of Aligarh Muslim University. He has been associated with UNICEF and Internationally acclaimed Non-Government Organisations. He has held the position of the State Head for Jammu & Kashmir of National Rural Heath Mission (NRHM) of the Government of India. He has earlier worked extensively on community based health projects with Aga Khan Health Service, India, a part of an International group of non-denominational organisations, i.e. the Aga Khan Development Network, specialising in Maternal & Child Health, HIV/AIDS, Mental Health. He was also a member the Scientific Advisory Committee of Prince Aly Khan Hospital.Mr. Sarfaraz Lakhani has a Post-Graduate Masters Degree in Human Resources Management with Interest in Community Based Health Care Management, Community Based Health and Education Management, and Community Based Disaster Risk Management, Disaster Intervention. He has also been associated with one of the largest International Non-Government Organisation and is actively involved in social development through social-change initiatives with special focus on the elderly. He has gained deep insights in primary, secondary and tertiary healthcare during his work related to Quality Accreditation of healthcare providers. As a trainer, he has trained thousands of students and professionals and given motivational lectures. He has worked at the International level and brings that sense of professionalism, planning and execution to the projects he is involved with. He has been a management consultant to many new start-ups and a Mentor to many a students.
Sources and References:
1. https://www.worldometers.info/coronavirus/2. https://www.statista.com/chart/21240/enforced-covid-19-lockdowns-by-people-affected-per-country/
3. https://www.asirt.org/safe-travel/road-safety-facts/
4. https://en.wikipedia.org/wiki/Gun_violence_in_the_United_States#/media/File:1999-_Gun-related_deaths_USA.png
5. https://injuryfacts.nsc.org/home-and-community/safety-topics/guns/data-details/
6. https://www.accuweather.com/en/weather-blogs/realimpactofweatherwithdrjoelnmyers/if-weather-is-a-factor-vs-the-coronavirus-heres-why-and-when-we-can-expect-to-see-results/692326
7. https://www.accuweather.com/en/health-wellness/experts-skeptical-that-warm-weather-will-slow-covid-19-outbreak/699704
8. https://www.accuweather.com/en/health-wellness/whats-the-latest-on-coronavirus/691967
9. https://www.accuweather.com/en/health-wellness/new-study-says-high-temperature-and-high-relative-humidity-significantly-reduce-spread-of-covid-19/703418
10. https://www.accuweather.com/en/health-wellness/increased-uv-exposure-may-limit-spread-of-new-coronavirus/703393
11. https://www.accuweather.com/en/cn/guangzhou/102255/weather-forecast/102255
12. https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-lesson-from-the-1918-influenza-pandemic-509151dc8065
13. https://www.nbcdfw.com/news/coronavirus/virus-hunter-epidemiologist-talks-science-of-covid-19/2328913/
14. https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-own-in-warmer-weather/
15. https://www.scmp.com/news/china/science/article/3074131/coronavirus-highly-sensitive-high-temperatures-dont-bank-summer
Excellently written
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