India has reported over 840 cases of novel coronavirus and 20 fatalities according to the latest data available.
New Delhi| After the largest single-day increase in the number of novel coronavirus cases in India (26th March), it has never been clearer that the pandemic is upon us and the next few weeks are going to throw up a scenario that many still find hard to imagine.
India’s death toll from the coronavirus rose by six to 17 in just 24 hours, as the government sought on Thursday to improve basic services to 1.3 billion people locked indoors to slow the spread of the disease.
(Data collected by 4 PM, 27 March 2020)
It took India forty days to reach the first 50 cases, five more days to reach 100 cases, three more days to reach 150 cases and then just two more days to reach 200 cases. From here on, cases are spiking rapidly.
The number of confirmed cases in India is now doubling in three days or less, down from six days earlier this month. This puts India in line with trajectories of countries across the world — in the United States, cases are now doubling every two days.
Italy discovered its first case 10 days after South Korea. For another 20 days, it had less than 10 cases, even as South Korea’s case count began to rise steadily. But then in a span of one frightening week, Italy’s case count multiplied a hundredfold. Within the next week, South Korea began to flatten the curve, while Italy’s case count continues to skyrocket, completely overwhelming its health system. India needs to try to move its own growth curve away from the Italy trajectory, and fast, with strict implementation of the social distancing measures it has already announced, if not even stricter lockdowns.
Moreover, these are only confirmed cases; to ascertain the true number of cases, India will need to ramp up it’s conservative testing. On Friday, the Modi government took one small step closer to that by expanding testing to those hospitalised with respiratory distress who did not have known contact with a person with foreign travel history.
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At this rate of growth, and assuming the 3.4 per cent fatality rate relative to confirmed cases calculated by the World Health Organization, India is headed for nearly a million confirmed cases by the end of May and over 30,000 deaths. These are conservative estimates. A team of bio-statisticians used predictive modelling and estimated that the number could be even higher, reaching nearly a million cases by 15 May instead.
Sudden single-day spikes, or a higher ratio of estimated to confirmed cases — nearly impossible to put a number to in the absence of more widespread testing — could tip these numbers higher, faster. By assuming that there are eight times as many undiscovered as confirmed cases, Indian software entrepreneur Mayank Chhabra estimated over five million cases and over 1.7 lakh deaths by the end of May.
With a ratio of just 0.5 beds per 1,000 people as of 2017, India’s existing healthcare infrastructure will be swamped in the coming months. At the current rate of growth of confirmed cases, by early June, India will be out of hospital beds. Factoring in usual bed availability and a faster doubling rate, Chhabra estimates India will be out of hospital beds by the end of April.
The number of critical care beds and ventilators in India is not officially known but is believed to be sharply lacking. With ICU beds estimated at 70,000 nationally, if even one out of every 10 cases was to require an ICU bed by the end of May, India would be running at full capacity, if not earlier.
On what could spell real trouble for the country in the next three months, a new report from prestigious Johns Hopkins University and the Centre for Disease Dynamics, Economics & Policy (CDDEP) has predicted that 21-day lockdown may be ineffective to stop the COVID-19 peak arriving in April-May-June — infecting over 12 crore Indians in an optimistic (low) scenario.
In a High scenario (trajectory with current lockdowns but insufficient physical distancing or compliance), the total number of cases (asymptomatic, hospitalized and symptomatic) can even touch a massive figure of 25 crores.
In the most likely (Medium) scenario with moderate to full compliance but no change in virulence or temperature/humidity sensitivity, the numbers of total cases can swell up to 18 crores.
The optimistic (low) scenario constitutes decreased virulence and temperature/humidity sensitivity.
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To reach these numbers, Johns Hopkins and CDDEP — a public health research organisation — used IndiaSIM, a well-validated agent-based model of the Indian population which has been published widely over many years and has been used for government decision-making.
According to the report, hospitalised cases can reach up to 25 lakh people in the High scenario, 17-18 lakh people in Medium scenario and 13 lakh people in Low scenario.
“Ventilator demand will be 1 million. Current availability in India is estimated to be between 30,000 and 50,000 ventilators,” said the joint report.
“Mortality in healthcare workers could further increase deaths in the general population. Healthcare workers need personal protective equipment (masks and gowns) to protect themselves. Without them they get sick further straining the capacity of the healthcare system to respond,” the report warned.
The number of coronavirus cases climbed to 649 in India on Thursday and the death toll hit 13, with one death reported each from Gujarat, Tamil Nadu and Madhya Pradesh, according to the Health Ministry.
But March is the month when the peak is yet to even begin, according to the report.
According to the report, delays in testing are seriously reducing the ability of the population to protect itself.
“This is the most important way in which we can contain the epidemic. An increase in the official number of detected cases in the short term could encourage the population to take distancing more seriously and will reduce panic compared to a big spike later,” the findings showed.
“Border closures at this stage have little to no impact and add further economic disruption and panic. While the international transmission was important in the first stage, the domestic transmission is now far more relevant,” it warned.
A national lockdown, said the report, is not productive and could cause serious economic damage, increase hunger and reduce the population resilience for handling the infection peak.
“Some states may see transmission increase only after another 2 weeks and lockdowns should be optimized for when they could maximize the effect on the epidemic but minimize economic damage,” said Johns Hopkins-CDDEP report.
State-level lockdowns in the most affected states could change the trajectory of the epidemic and should commence immediately. Any delay allows for more secondary cases to emerge.
Lockdowns should be guided by testing and serological survey data and should be planned on a rolling basis, the report mentioned, adding that preparedness for caseload should be the highest priority at this time.
(Input from Agencies)
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