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.

1. Covid 19 Stats in India –
Update 12
Review of key data and presentation of a projection model
Data updated till 22.11.20
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&area
sRegional=usfl&areasRegional=ustx&byDate=0&cumulative=0&logScale=1&perMillion=0&values=dea
ths

2. Key Highlights
• 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.

3. Projection Model for India

4. Basis for Projection
• Most countries have seen a fall in new infections and deaths per day
after some time. Some countries like India have yet to experience
this.
• The response of various counties is different in terms of when this
decline started.
• Our model will use per capita deaths and infections on the day the
decline started in each country to model a possible scenario for India.
As stated earlier, deaths are a more reliable indicator than infections
for projection.

5. Herd Immunity and R0
• There is some speculation on why the virus has declined in so many countries.
• ‘Herd Immunity’ comes when approximately 60% of the population is immune
either by a vaccine or because they have had the disease already. This has not
happened anywhere in the world. However there is new thinking on this that we
will discuss later.
• Social distancing, hand washing, and masking can help to reduce the R0 value
even if Herd Immunity has not been achieved. Perhaps this is the reason why
infections and deaths have declined.
• This presentation and projection model does not seek to answer this question. It
is merely based on the empirical evidence of declines having taken place in most
countries.

6. Infections Deaths Infections Deaths
Malaysia 3.04.20 29.03.20 103 1
Thailand 29.04.20 NA 42 -
Indonesia 13.05.20 NA 57 -
Bangladesh NA NA - -
Pakistan NA NA - -
Turkey 11.04.20 19.04.20 619 24
Iran 30.03.20 4.04.20 495 41
Italy 26.03.20 27.03.20 1,333 151
Spain 1.04.20 2.04.20 2,227 221
France 3.04.20 15.04.20 1,171 263
Germany 2.04.20 15.04.20 1,012 45
Russia 11.05.20 NA 1,517 -
UK 6.05.20 21.04.20 2,962 298
USA 24.04.20 21.04.20 2,797 138
Brazil NA NA - -
Date of Decline Start Per Million on that date

7. Country Wise Variations
• The disease has impacted various countries differently. Broadly, the following clusters emerge:
• UK/USA are the worst hit. While deaths/day have started declining in both countries they will have a slow recovery.
• Spain/France/Italy have had a very sharp increase followed by a steep fall.
• Germany is the outlier in Europe as they have managed to contain the infection better than other neighbouring countries.
• Turkey and Iran in West Asia have fared better than their European counterparts. There is a ‘second wave’ of infections
happening in Iran.
• South East Asia, Africa and ANZ have largely escaped the brunt of the disease.
• It is outside the scope of this discussion to assign reasons for this differential behaviour.
Speculation about natural immunity, BCG vaccination, endemic malaria, hot weather etc are
continuing.
• Based on the differential response, India looks set to behave more like its West Asian
counterparts. The rest of South Asia may also follow suit.

8. Projection Update
Population Per Mn Deaths on Day Decline Starts Projected Deaths on Day Decline Starts
Low Medium High Low Medium High
India 1,37,843,247 25 40 50 34,461 55,137 68,922
• May 24th Presentation – Projected date for decline in deaths/day was in July 2020 based on a doubling rate
of deaths per day of 13 days.
• Actual decline (this has held for 47 days now) has commenced from 15th September when the cumulative
deaths were 82,091 corresponding to 75 Deaths/Mn

9. Agenda
• Presentation of key data for All India
• Statewise data
• Covid vaccine update
• Discussion

10. All India Data

11. • Testing was slowing down
but has picked up again.
• The % positive rate is stable
at 4%. Overall figures for All
India are OK but Delhi
positivity has gone up
sharply
• The Antigen test now
accounts for close to 60%
of total tests being
conducted. Since there
could a need for multiple
tests on the same patient,
a direct correlation
between tests and persons
infected is weak. Recently,
tests in Delhi have shifted
back to RT PCR
We will continue to use Deaths, not Cases as the main parameter for analysis and
forecasting

12. • New Infections/Day have plateaued and are beginning to
rise again driven by Delhi. Highest point was on 16th
September at 97,856
• Active Infections are showing a similar trend. Highest point
was on 17th September at 10,17,718 active infections

13. • A crest has formed in Deaths/Day. As mentioned
earlier, the peak of 1281 Deaths on 15.09.20 is
still holding (67 days)
• A plateau had formed at around 500 deaths/day
and the numbers are inching up again

14. Key States

15. • Delhi cases and deaths have been rising rapidly from 9th
October. Cases are showing a slight decline in the last few
days. Cumulative deaths stand at 651/Mn for Delhi. It has
gone ahead of Mumbai which is at 649/Mn
• The spike coincides with the festive season

16. • North India is showing clear signs of a second wave with the epicentre at Delhi
• Some likely reasons are: socialising, shopping at high levels during the festive season, Covid fatigue, Covid indifference,
Colder weather than usual, Pollution

17. • Four of the
worst hit
states have
shown
steeply
declining
trends.
• The decline
is now
beginning to
slow down
and there
are signs of
plateauing

18. • Bihar had a spike soon after the election. However
this has been controlled.
• Jharkhand has been less impacted though recent
trends are upwards.
• Odisha trends are not looking good

19. • West Bengal is beginning to
slowly decline
• Kerala is finally beginning to
plateau

20. Directions
• 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
• The decline was faster than anticipated initially. However, a plateau began to
form at around 500 deaths/day and the trend is moving slowly upwards now
• North India is clearly undergoing a 2nd wave now with the epicentre at Delhi
• The hitherto intractable states of West Bengal and Kerala are now showing signs
of plateauing and a mild declining trend
• Some likely reasons for the 2nd wave are: socialising, shopping at high levels
during the festive season, Covid fatigue, Covid indifference, Colder weather than
usual, Pollution

21. Covid Vaccine

22. Types of Vaccines https://graphics.reuters.com/HEALTH-CORONAVIRUS/VACCINE/yzdpxqxnwvx/
• Live attenuated virus
• A live attenuated virus is constructed by mutating the
original virus
• The mutation creates a weaker virus that cannot cause
significant harm to the body
• Inactivated virus
• An inactivated vaccine is produced by disabling a virus
through radiation, chemicals or heat
• The inactive virus cannot cause disease because it is
not trying to enter cells and replicate.
• Protein subunit
• A protein subunit vaccine contains a piece – or subunit
– of a coronavirus antigen
• It contains no other part of the coronavirus, so it can’t
replicate and cause harm
• Virus like particles
• Virus-like particle vaccines closely resemble the
coronavirus in structure but contain none of its genetic
material
• It’s like an empty shell that looks like the coronavirus
but isn’t capable of doing damage to the body
• DNA and RNA
• DNA and RNA vaccines consist of Messenger RNA
(mRNA) or DNA code for making a version of a
coronavirus protein
• The code is inserted into a human cell which then uses
the genetic instructions to make this antigen. The
immune system can then produce antibodies that will
recognize that antigen and fight off the virus
• Viral vector
• Like DNA and RNA vaccines, viral vector vaccines
contain instructions for making a coronavirus antigen
• The instructions are carried into a human cell by a
harmless virus like the adenovirus which causes the
common cold
These six vaccine types vary in method, but they all introduce an antigen into the body that the
immune system can use to build antibodies against the real coronavirus.

23. Vaccine Status https://www.raps.org/news-and-articles/news-articles/2020/3/covid-19-vaccine-tracker
• Sputnik V and EpiVacCorona have been approved by the Ministry of Health
in Russia without entering Stage 3 clinical trials
• Operation Warp Speed in the USA has selected three vaccine candidates to
fund for Phase 3 trials: Moderna’s mRNA-1273, University of Oxford and
AstraZeneca’s AZD1222, and Pfizer and BioNTech's BNT162
• The COVAX initiative’s goal is to work with vaccine manufacturers to offer
low-cost COVID-19 vaccines to countries. Currently, candidates from
companies Inovio, Moderna, CureVac, Institut Pasteur/Merck/Themis,
AstraZeneca/University of Oxford, Novavax, University of Hong Kong,
Clover Biopharmaceuticals, and University of Queensland/CSL are part of
the COVAX initiative

24. Vaccines in Phase 3 Clinical Trialshttps://www.raps.org/news-and-articles/news-
articles/2020/3/covid-19-vaccine-tracker
• 13 Vaccines are in Phase 3 clinical trials
• MRNA/DNA – Pfizer, Moderna, Invovio (3)
• Viral vector – Astra Zeneca/Oxford University/SIL, Can Sino Biologics, J&J, Sputnik
V (4)
• Inactivated vaccine – Sinovac, Bharat Biotech, Wuhan Institute (3)
• Nanoparticle, Plant based adjuvant – Novavax ,Medicago/GSK (2)
• Live attenuated vaccine (BCG Vaccine) – University of Melbourne (1)

26. Covid Vaccine in India

28. Vaccine Data
• Pfizer vaccine requires -70 C cold chain. Moderna -20 C and can be held at fridge
temperatures for 30 days.
• Unclear about India availability.
• These vaccines are also highly priced
• Effectiveness is high in early trials 90 – 95%
• Applications have been moved for EUA
• Sputnik Russian trials claim 90% efficacy
• Astra Zeneca trials just announced say effectiveness is 90% in one regimen (half
dose followed by full dose) and 62% in another (2 full doses). Application for EUA
to be moved shortly

29. India Scenario
Manufacturer Capacity/Annum
(Mn Doses)
Preliminary Results
Expected by
Approx Cost
Vaccines in Phase 3
Astra Zeneca Covishield SII 1000 Nov 2020 Rs 1000 with a
substantial discount
for Govt purchases
Novavax SII 500 Jan 2021
J&J Biological E 400 Jan 2021
Bharat Biotech - Covaxin Bharat Biotech 150 Feb 2021
Sputnik V Dr Reddy’s 100 Mar 2021
Vaccines in Phase 2
Cadila Cadila 100 Mid 2021

30. India Distribution
The central government has already started the
process of identifying around 30 crore priority
beneficiaries. It has demarcated four categories of
people for vaccination in the initial phase — around
one crore healthcare professionals including doctors,
MBBS students, nurses and ASHA workers, etc.;
around two crore frontline workers including
municipal corporation workers, personnel of the
police and armed forces; about 26 crore people aged
above 50; and a special group of those below 50 years
of age with co-morbidities and requiring specialised
care….
Centre is planning to procure COVID-19 vaccines
directly from the drugmakers and distribute them
among priority group
https://www.livemint.com/science/health/covid-vaccine-distribution-in-india-
who-will-get-it-first-frontline-workers-to-get-priority-11603968400105.html

31. Speed is of the Essence https://theprint.in/opinion/covid-vaccine-distribution-can-take-tips-from-how-
india-conducts-general-elections/534841/
• As vaccinated people spread through the population, the virus will respond
by mutating. So far close to 300 mutations have been observed but they
are still not radical enough that the vaccine cannot work on them
• “Cluster Bomb” approach for India. In a geography quickly vaccinate 65% of
the people so as to reach herd immunity and move to the next. This is
different from the top down approach shown in the last slide
• Strategy derived from the elections. Set up multiple booths for vaccination
– Bihar elections were conducted in 3 working days

32. Discussion

33. 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.