What are the best and worst-case scenarios of COVID-19 in India?
If absolutely no intervention is made i.e. there is no curb on travel, movement and social gatherings, cases could surge to more than 20 lakhs by May 15th.
A collaborative study involving researchers from Johns Hopkins and Delhi University has presented a predictive model of the number of cases that India can see in the coming months. The COV-IND-19 study group used current data of confirmed cases (as of 16th March) and employed epidemiological techniques and statistical modelling data from Italy and the US to arrive at estimations. The data is disaggregated based on best and worst-case scenarios factoring in levels of intervention as well as uncontrollable factors such as climate.
The study states that there is a significant dearth of good data on Indian cases largely because testing remains low. As of Wednesday evening, the ICMR (Indian Council of Medical Research) had conducted just over 25,000 tests, way under the guidelines of the World Health Organization (WHO). Extensive testing, such as the approach in South Korea, is essential to get a handle on the situation and uncover positive cases and isolate them. Given that testing remains low, the group said that their projections may be underestimations.
The best and worst-case scenarios
If absolutely no intervention is made i.e. there is no curb on travel, movement and social gatherings, cases could surge to more than 20 lakhs by May 15th. However, if extremely strict, draconian measures such as lockdown, isolation, and travel bans are executed without a flaw, cases could plummet to as few as 1 per 100,000 or around 13,800 cases by May.
Both of these are extreme situations - and the data is extrapolated from dense, urban populations rather than pan-India estimations - and the actual figure will very likely fall between these two extremes.
What can be learnt from this data?
India officially has 0.7 hospital beds per 1,000 people but even at the best of times, the reality is probably 75% of this figure - not taking into account beds that are already occupied. Only around 5-10% of these are ICU units with ventilator support. Further, India has a substantial number of people considered at risk of COVID-19 making them severely sick; over 300 million suffer from hypertension, over 122 million suffer from diabetes and more than 70 million suffer from asthma and COPD respectively (note that some people will have multiple underlying conditions as well, so there will be significant overlap in these numbers).
Should interventions not be limited, and even a small number of these populations end up being hospitalized, and an even smaller fraction end up in the ICU, the healthcare system will be completely bulldozed. In fact, even the most optimistic figure of 1 per 100,000 being infected will overwhelm the health infrastructure.
This is why there are such draconian measures in place; it is not about individual health per se, but a public health perspective.
What can be done given these projections?
It is important to remember that these figures are estimates and subject to significant limitations. They are not meant to cause alarm but help plan policy in the coming weeks and months.
For starters, the findings justify the interventions being implemented by the national government. The further recommendations of the study include vastly increasing diagnostic testing by including the private sector, persevering with the lockdown, protecting health workers by maintaining a supply of PPE (Personal Protective Equipment) such as hazmat suits, surgical masks and gloves, ensuring a steady supply of essential drugs and reducing non-essential medical care.
There are many economic and social recommendations as well such as providing free care to those who can’t afford it, expanding a social net to those whose livelihood has taken a hit through cash transfers, and giving tax credits to vulnerable companies.
However, these are radical suggestions and the unfortunate fact of the matter is that the country has to balance economic and social factors.
The bottom line for the individual does not change
On a personal level, you need to follow practical and sound medical advice. The single most important thing to do is wash your hands regularly throughout the day for a minimum of 20 seconds each time. Avoid touching your face and maintain a distance of six feet from everyone if you are to venture outside. If you feel unwell, wear a mask (any kind, it doesn’t have to be a surgical mask) since it can protect others from getting sick if you sneeze. Cutting transmission is the best weapon at our disposal currently - and everyone plays a meaningful role in doing so.
For more tips, read our article on Coronavirus.
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