About 5% of Confirmed COVID19 Cases Currently Hospitalized in Pakistan

Pakistan has so far had just over 100,000 confirmed cases of COVID19. About 5,000 are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to the World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available. Meanwhile, antibodies testing in Karachi indicates millions in Pakistan may have already been infected with COVID19 without any symptoms or sickness. More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.

Pakistan Hospitalization Data. Source: WHO
Hospitalizations in Pakistan:

About 5,000 Pakistanis are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available.

Nearly 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a period three times longer than at the start of the pandemic.


COVID19 Testing and Cases:

Media headlines tend to highlight record single day spikes in confirmed cases. What they don't tell you is the record spike in tests almost every single day in Pakistan. It is very simple: The more you test the more cases you will confirm as long as the virus is in the community.  More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.


COVID19 Tests and Cases. Source: Pakistan Ministry of Health

Antibodies testing in Pakistan's largest city Karachi has revealed that 15% of the citizens are asymptomatic carriers of the coronavirus, a figure close to WHO's estimate of 16% for the global population.

Coronavirus Antibodies
Serological Testing:

Antibodies testing of 7,000 adults in Karachi reveals that as many as 15% of them have already been exposed to COVID19 without experiencing symptoms, according to a study by Dr. Wajiha Javed, an epidemiologist and head of public health and research at Getz Pharma in Pakistan. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus. It takes at least 40% of the population to be exposed to build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

Human Immune Response:

Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.


Getz Study:

Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.

Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.

Pakistan COVID19 Death Rate Among The World's Lowest. Source: Our World in Data 

Asymptomatic Carriers: 

Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper.  But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.

Summary:

About 5% of the 100,000 confirmed COVID19 in Pakistan are currently hospitalized. About 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a much longer period than at the start of the pandemic.  As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. This is close to WHO's 16% of the global asymptomatic carrier population. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus.  Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

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Comments

Riaz Haq said…
Wall Street Journal on COVID19 New York City: ”You can magically make an ICU appear, but you can’t make staff appear immediately.”

https://www.wsj.com/articles/how-new-yorks-coronavirus-response-made-the-pandemic-worse-11591908426

How New York’s Coronavirus Response Made the Pandemic Worse
The hasty expansion of medical facilities by state, city and hospital leaders led to grave mistakes, a Wall Street Journal investigation found; ‘wartime conditions’
Elmhurst Hospital in Queens, N.Y., in April. NATALIE KEYSSAR FOR THE WALL STREET JOURNAL
By Shalini Ramachandran, Laura Kusisto and Katie Honan
June 11, 2020 4:47 pm ET

New York leaders faced an unanticipated crisis as the new coronavirus overwhelmed the nation’s largest city. Their response was marred by missed warning signs and policies that many health-care workers say put residents at greater risk and led to unnecessary deaths.

In the first few days of March, Gov. Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mr. de Blasio tweeted that people should go see a movie.
Riaz Haq said…
#Pakistan #lockdown in 20 cities as #coronavirus ‘hotspots’: #Karachi, #Lahore, #Quetta, #Peshawar, Rawalpindi, #Islamabad, #Faisalabad, Multan, Gujranawala, Swat, Hyderabad, Sukkar, Sialkot, Gujarat, Ghotki, Larakana, Khairpur, DGKhan, Malakand & Mardan. https://tribune.com.pk/story/2242926/1-live-pakistan-start-commercial-manufacturing-covid-19-diagnostic-kits-national-tally-hits-144478/


The novel coronavirus emerged in the central China city of Wuhan towards the end of last year and proliferated to almost the whole world within a couple of months. It’s not the virulence or fatality, but the infectivity of the new virus – also known as SARS-CoV-2 – that has set off a global frenzy.

The Covid-19 respiratory illness caused by this mysterious contagion has so far infected more than 7.7 million people in 202 countries and territories of the world – and over 428,000 of them have died and counting.

Pakistan, despite its close proximity with China, remained coronavirus-free until February 26 when a young man from Karachi tested positive after returning from Iran – one of the worst-hit countries. After a brief hiatus following the first case, Covid-19 cases spiked as more pilgrims returning from Iran tested positive for the virus.

Nearly one-and-a-half months after imposing the lockdown across the country, Prime Minister Imran Khan announced to ease the lockdown in phases.

The nationwide tally of Covid-19 patients stands at 146,879 with 54,138 cases in Punjab, 55,581 in Sindh, 18,472 in Khyber-Pakhtunkhwa, 8,327 in Balochistan, 1,143 in Gilgit-Baltistan, 8,569 in Islamabad and 663 in Azad Jammu and Kashmir.

The virus has claimed at least 2,784 lives while around 53,721 coronavirus patients have recovered.

The situation remains fluid and we’re updating stats as soon as new figures are officially released.

Riaz Haq said…
COVID19 drug Dexamathsone has been found to be effective. It is widely available under various brandnames in Pakistan at very low cost.


http://www.druginfosys.com/AvailableBrands.aspx?query=4%20mg/ml&form=Inj&drugCode=222&drugName=Dexamethasone&Ing==1


Single Ingredient
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Multi Ingredient
Drops:0.1 %w/v
Eye Drops:0.1 %w/v0.2 %w/v
Ear Drops :0.1 %w/v
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E and E Drops:0.1 %w/v
Oint:0.1 gm
Cream:0.1 gm0.1 %w/w0.4 %w/w0.04 %w/w3500 IU/g
Dexamethasone [Inj 4 mg/ml]
Brand Name Manufacturer/Mnf. Representative Trade Price Retail Price
ADRENAAL CIRIN PHARMACEUTICALS (PVT) LTD. 0.00 250.00
ALDRON HARMANN PHARMACEUTICAL LABORATORIES (PVT) LTD. 132.60 156.00
ATNESON ENGLISH PHARMACEUTICALS INDUSTRIES 212.50 250.00
CECIDRON CEICIL LABORATORIES LTD. 221.00 260.00
D CORT BROOKES PHARMACEUTICAL LABORATORIES (PAK.) LTD. 203.23 239.09
D SONE MEDIATE PHARMACEUTICALS (PVT) LTD 250.00 250.00
D.DRON EPHARM LABORATORIES 107.95 127.00
DANADEX DANAS PHARMACEUTICALS (PVT) LTD 0.00 250.00
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DECADRON OBS 349.35 411.00
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DEXADRIN STAR LABORATORIES (PVT) LTD. 154.70 182.00
DEXADRIN STAR LABORATORIES (PVT) LTD. 24.43 28.75
DEXAMED MUNAWAR PHARMA (PVT) LTD. 82.02 96.50
DEXAMEDRON GEOFMAN PHARMACEUTICALS 48.06 56.54
DEXAMEDRON GEOFMAN PHARMACEUTICALS 212.91 250.48
DEXAMEK KARACHI PHARMACEUTICAL LABORATORY 79.56 93.60
DEXAMETHASONE VENUS PHARMA 59.65 70.18
DEXAMETHASONE AMROS PHARMACEUTICALS. 82.28 96.80
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DEXAROID MEDICAIDS PAKISTAN (PVT) LTD. 199.38 234.57
MERRYSONE HYGEIA PHARMACEUTICALS 40.80 48.00
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NEUDEX NEUTRO PHARMA (PVT) LTD. 212.50 250.00
ORADEXON OBS 252.70 297.29
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Z-DEX Z-JANS PHARMACEUTICAL (PVT) LTD. 0.00 160.00
Riaz Haq said…
Has #Coronavirus peaked in #Pakistan? Cases fall for 5th straight day from peak of 6,895 last week to 3,892 in last 24 hours. Fatalities have also decreased significantly over recent days, falling to 60 on Wednesday from the record high of 153 on June 19. http://v.aa.com.tr/1888337

New coronavirus cases in Pakistan continued to decline for a fifth consecutive day on Wednesday, official data showed.

According to the Health Ministry, 3,892 cases were confirmed across the country over the past 24 hours, raising the overall count to 188,926.

The figure marked a fall of almost 3,000 from the record high of 6,895 reached slightly over a week ago on June 13.

It was also the fifth day of declining cases -- 6,604 on June 19, 4,951 on June 20, 4,471 on June 21, and 3,946 on June 22.

Fatalities have also decreased significantly over recent days, falling to 60 on Wednesday from the record high of 153 on June 19.

The death toll in the country now stands at 3,755, while recoveries increased by 4,283 to 77,75, raising the overall recovery ratio from 37% to 41.2%, according to the ministry's data.

Health experts also confirmed the improving numbers in the South Asian country of over 220 million, which has conducted over 1.15 million tests so far.

"Despite increased testing capacity, the numbers are slowly reducing and we at Khyber Medical University have also observed the declining trend," Arshad Javaid, the university's vice chancellor, told Anadolu Agency.

Asad Umar, a federal minister leading Pakistan's COVID-19 response, last week warned that infections could exceed one million by the end of July, if daily numbers continued to rise at the same rate.

However, on June 15, authorities identified hotspots in 20 big cities and enforced locality-based lockdowns -- which the government has dubbed "smart lockdowns" -- in the high-risk areas.

"The smart lockdown, apparently, has helped stem the spread of the virus to other areas," Dr. Mohammad Akram, a pulmonologist based in the capital Islamabad, said.

Earlier this month, the World Health Organization advised Pakistan to impose a two-week strict lockdown, declaring the country the second-most vulnerable to the pandemic after neighboring Afghanistan.

The recommendation came as infections skyrocketed when the government lifted its lockdown restrictions of varying strictness in late May, ahead of the Muslim festival of Eid al-Fitr.

Prime Minister Imran Khan, however, rejected the UN body's suggestion, saying "smart lockdowns" were the only possible option for Pakistan because it "is a poor country … [with] no choice but to reopen."
Riaz Haq said…
One More Reason to Wear a Mask: You’ll Get Less Sick From COVID-19

https://www.ucsf.edu/news/2020/07/418181/one-more-reason-wear-mask-youll-get-less-sick-covid-19

As more and more states promote face masks as a way to control the spread of COVID-19, the top-line message has been: wear a mask to protect others. While it’s true that most face masks are more effective in preventing you from launching droplets into the air than breathing in already dispersed droplets – that doesn’t mean masks offer no protection to the wearer.

It’s likely that face masks, by blocking even some of the virus-carrying droplets you inhale, can reduce your risk of falling seriously ill from COVID-19, according to Monica Gandhi, MD, an infectious disease specialist at UC San Francisco.

“The more virus you get into your body, the more sick you are likely to get,” she said.

In the latest wave of infections in the U.S., the wider use of masks may be one factor for the lower death rates – along with more testing, younger patients and better treatments – said Gandhi. A greater proportion of these new cases have been mild or asymptomatic, though more data is needed to see if they track geographically with higher rates of mask-wearing.

Worldwide, epidemiological patterns seem to provide a clue. In countries where mask wearing was already commonplace, such as Japan, Taiwan, Thailand, South Korea, and Singapore, and in countries where mask wearing was quickly embraced, such as the Czech Republic, rates of severe illness and death have remained comparatively low.

These epidemiological observations are among the evidence that Gandhi and colleagues cite in a paper in the Journal of General Internal Medicine, in which they propose that masks can lead to milder or asymptomatic infections by cutting down on the dose of virus people take in.

“Masks can prevent many infections altogether, as was seen in health care workers when we moved to universal masking. We’re also saying that masks, which filter out a majority of viral particles, can lead to a less severe infection if you do get one,” said Gandhi. “If you get infected, but have no symptoms – that’s the best way you can ever get a virus.”

The idea that viral dose, also known as viral inoculum, determines the degree of illness is not new, said Gandhi. Descriptions of a dose-mortality curve – how much of a virus is needed to cause death in an animal – were first published in 1938. And after all, the earliest vaccines, which were documented in 16th century China, involved exposing someone to a small amount of smallpox virus to induce mild illness and subsequent immunity.

A small number viral particles is more likely to be quelled by the immune system before they can proliferate, said Gandhi.

Researchers have studied dose dependency experimentally with other viral infections, like the flu. In a study with healthy volunteers, those who received a higher dose of the influenza A virus developed more severe symptoms.

Because the new coronavirus, SARS-CoV-2, is potentially lethal, experiments on masking and disease severity have been necessarily limited to animals. In a hamster study, a surgical mask partition between the cages of infected and uninfected hamsters significantly cut COVID-19 transmission. Fewer hamsters caught the virus and those that did showed milder symptoms.

Tale of Two Cruise Ships
Gandhi believes the viral inoculum theory helps explain an unusual feature of the new coronavirus – what Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease, has called its “protean” manifestations.

Early in the year, as COVID-19 spread around the world, infectious disease experts began to notice this strange aspect of the new virus – the extreme variation in its symptoms and severity. Some who tested positive didn’t seem sick at all, some had symptoms of a cold, others lost their sense of taste or developed delirium, and still others suffered severe pneumonia that led to death.
Riaz Haq said…
Immune system is like a muscle... you lose it you don’t use it

Vaccines for everything from influenza to measles provide partial protection against COVID-19, according to new Mayo Clinic research, suggesting that parents should get children up to date on shots before school this fall, and senior citizens should schedule their vaccinations before the winter flu season.

People showed a 28% reduction in COVID-19 risk if they received the PCV13 pneumonia vaccine in the past year compared with those who didn’t, and a 43% reduction if they received the polio vaccine before travels to at-risk locations, the study showed.


While the population-based study has limitations and was posted online Tuesday without peer review, Mayo officials said there is little harm in using the results to encourage people to seek shots that are recommended anyway.

“Make sure you get your scheduled vaccines,” said Dr. Andrew Badley, an author of the study and a leader of Mayo’s COVID research task force. “Not doing so is not doing everything you can to reduce your risks.”


The recommendation comes as Minnesota leaders wrestle with the dilemma of wanting to reopen K-12 schools this fall while facing a rising rate of COVID-19 cases and hospitalizations.

Gov. Tim Walz will unveil his school reopening plan Thursday, but he made reference during a press briefing Wednesday to a “decision matrix” that will guide districts on whether to reopen with live classrooms, online sessions or a mix. The guidance is expected to give schools discretion, depending on COVID-19 levels in their communities.

“Our guiding principles are to keep our children and our staff in the buildings safe,” Walz said. “Our second goal right behind that is to get our children back in the schools, especially our littlest learners, if at all possible.”

The governor on Wednesday highlighted 4 million protective masks that are being distributed to help people comply with Minnesota’s new indoor mask mandate.

The Minnesota Department of Health on Wednesday reported nine COVID-19 deaths and 681 infections with the SARS-CoV-2 coronavirus that causes the infectious disease. That brings the state’s totals to 1,589 deaths and 52,947 known infections.

The state reported 310 people hospitalized with COVID-19, and 143 of them needing intensive care. Those are both highs for the month of July.

Cases have been increasing for weeks, initially among teenagers and young adults but now among older, higher-risk individuals who are more likely to need hospital care, said Kris Ehresmann, state infectious disease director.


https://m.startribune.com/non-covid-vaccines-offer-some-covid-protection-mayo-reports/571949932/

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