A Novel Near Real-time System to Estimate Impact of Sudden Economic Shocks (Such as COVID-19) on the Economy (preprint)

As the novel coronavirus progressed from Wuhan to various parts of the globe, governments were faced with a tradeoff: to go into lockdown to save lives but hurt the economy, or stay open to save the economy but lose lives. At the time, those in favour of the lockdown had empirical data to show the lethality of the virus and the need to go into lockdown. Whereas those against lockdowns didn’t have data to show the severe reduction in economic activity that would follow the lockdown. Hence, numerous governments enforced lockdowns and realized the need to re-open much after the damage had already been done. This delayed realization was purely due to the lack of a real-time system to quantitatively gauge the economic impact of various policies. In this paper, we develop a near real-time framework to estimate the economic impact of such sudden shocks at any geographical level (city, state or country). We use novel data sources, specifically satellite recorded Night Light and Electricity Consumption data. Such alternate sources are advantageous as they can answer economic questions related to isolated locations and the informal economy (a sizable constituent of developing economies). We demonstrate the applicability of our framework across a variety of cities across countries (both developing and developed) and present our results specifically for the COVID-19 pandemic. We quantitatively estimate the economic decline in various cities, how government policies affected this decline, and the impact on intercity transport. Using Night Light, we estimated a GDP decline of 12.3% for New York and Miami (Apr - June quarter), and the U.S. government reported 7.2% at the country level. This difference is expected since these would have had a higher decline than the overall country. Moreover, our framework could make these predictions one month before the official numbers were released, reflecting the framework’s accuracy and real-time nature. This framework could revolutionize the way governments, policymakers and stakeholders receive economic data, leading to more rational and proactive decision making.

Clinico-pathological features in fatal Covid-19 Infection: A Preliminary Experience of a Tertiary Care Centre in North India using Post-Mortem Minimally Invasive Tissue Biopsies (preprint)

Background: The Covid-19 pandemic began in China in December 2019. India is the second most affected country, as of November 2020 with more than a 8.5million cases. Covid-19 infection primarily involves the lung with the severity of illness varying from influenza-like illness to acute respiratory distress syndrome. Other organs have also found to be variably affected. Studies evaluating the histopathological changes of Covid-19 are critical in providing a better understanding of the disease pathophysiology and guiding treatment. Minimally invasive biopsy techniques (MITS/B) provide an easy and suitable alternative to complete autopsies. In this prospective single-center study we present the histopathological examination of 37 patients who died with complications of Covid-19. Methods: This was an observational study conducted in the Intensive Care Unit of JPN Trauma Centre AIIMS. A total of 37 patients who died of Covid-19 were enrolled in the study. Post-mortem percutaneous biopsies were taken with the help of surface landmarking/ultrasonography guidance from lung, heart, liver, and kidneys; after obtaining ethical consent. The biopsy samples were then stained with haematoxylin and eosin stain. Immunohistochemistry (IHC) was performed using CD61 and CD163 in all lung cores. SARS-CoV-2 virus was detected using IHC with primary antibodies in selected samples. Details regarding demographics, clinical parameters, hospital course, treatment details, and laboratory investigations were also collected for clinical correlation. Results: A total of 37 patients underwent post-mortem minimally invasive tissue sampling. Mean age of the patients was 48.7years and 59.5% of them were males. Respiratory failure was the most common complication seen in 97.3%. Lung histopathology showed acute lung injury and diffuse alveolar damage in 78% of patients. Associated bronchopneumonia was seen in 37.5% of patients and scattered microthrombi were visualized in 21% of patients. Immunostaining with CD61 and CD163 highlighted megakaryocytes and increased macrophages in all samples. Immunopositivity for SARS-CoV-2 was observed in Type II pneumocytes. Acute tubular injury with epithelial vacuolization was seen in 46% of the renal biopsies but none of them showed evidence of microvascular thrombosis. 71% of the liver tissue cores showed evidence of Kupfer cell hyperplasia. 27.5% had evidence of submassive hepatic necrosis and 14% had features of acute on chronic liver failure. All the heart biopsies showed non-specific features such as hypertrophy with nucleomegaly with no evidence of myocardial necrosis in any of the samples. Conclusions The most common finding in this cohort is the diffuse alveolar damage with demonstration of SARS-CoV-2 protein in the acute phase of DAD. Microvascular thrombi were rarely identified in the lung, liver and kidney. Substantial hepatocyte necrosis, hepatocyte degeneration, Kupffer cell hypertrophy, micro, and macrovesicular steatosis unrelated to microvascular thrombi suggests that liver might be a primary target of Covid-19. This study highlights the importance of MITS/B in better understanding the pathological changes associated with Covid-19.