If the current coronavirus trajectory continues, the worst-affected states in the country would face massive shortages in isolation beds, ICU beds, and ventilators in the second half of May.
As the country draws close to the final phase of lockdown 2.0, the preparedness of its healthcare infrastructure to combat COVID-19 will come into increasing focus. Five weeks of lockdown have managed to slow the rate of growth of the infection, with cases doubling in roughly 10 days. However, the battle against the virus is far from over. As the lockdown is relaxed in a phased manner, and with expatriate Indians set to return, there could be a surge in cases.
What is the readiness of the healthcare infrastructure of individual states? If infections continue to rise at the same rate in May as they have done so far in April, India could be facing a deficit in isolation beds by the end of May, and in intensive care unit (ICU) beds and ventilators by the first week of June, a new analysis suggests.
The infrastructure stress will be especially acute in eight high-burden states, led by Gujarat, Maharashtra, and Delhi. In April, cases in all these eight states grew at a compounded daily rate of above 10% — or, a doubling in about seven days or even less. At the other end are states whose case growth is slower and which have greater reserves of COVID-critical infrastructure relative to their case count.
Healthcare capacity is also a moving target. Till the April 27 night, the policy directive was to mandatorily isolate everyone who tested corona-positive in a standalone facility. This facility could be an entire hospital or a separate block where other patients are not allowed. This necessitated the establishment of isolation wards.
However, considering the scenario that these facilities might be overwhelmed, the Union health ministry issued a directive April 27 allowing “very mild” and pre-symptomatic patients to isolate at home, provided they fulfil eight-point eligibility criteria. The key requirement was space for separate quarantining of family members, a challenge for most Indian households.
As of April 4, there were 152,403 isolation beds in India. Rajasthan had the most (20,835), followed by Tamil Nadu (19,860) and Kerala (13,028). Maharashtra, which had the maximum number of coronavirus cases (8,100) as of April 26, had 11,861 isolation beds. The document of the Health Ministry projected a compounded daily growth rate (CDGR) of 2% in isolation beds. We have taken a 4% CDGR to factor in the intensification of efforts.
Finally, to account for further augmentation by the private sector, a multiplier of 0.5 of the share of the private sector in hospital beds in the state is applied to the count of isolation beds available.
For ICU beds and ventilators, India possibly has a 2% CDGR since these facilities are more expensive and time-consuming to provide. In line with projections from various global studies, we have assumed that 5% of cases require ICU care and 3% of cases would be on the ventilator. Finally, the projected cases in each state increasing at the CDGR recorded by it between April 1 and April 26. This ranges from around 14% in West Bengal to 1.5% in Goa. At their respective rates, Maharashtra and Gujarat will be the worst-affected states, with over 700,000 and 530,000 cases, respectively, by 31 May.
This would put immense strain on the healthcare infrastructure, with both states running a deficit in isolation beds by May 17. Going by numbers provided by the ministry, Delhi is already running a deficit in isolation beds. By May 31, India will fall short of isolation beds at an aggregate level, with West Bengal, Madhya Pradesh, Jharkhand, and Uttar Pradesh joining them.
In terms of ICU beds and ventilators, India will show a shortage at an aggregate level by June 7, with Delhi, Gujarat, and Maharashtra again the worst-affected.
In spite of the apparent slowing down of growth in coronavirus cases, there is no scope for complacency.
Unless the trajectory slows down further, the country’s medical capacity will be overwhelmed soon.
Agencies
