New rules on testing, quarantining, etc. all suggest ad-hoc level of planning; will fall apart when COVID-19 cases go into millions.
Apart from the back and forth on migrant labours and the shameful way they were treated—versus those flown back on special planes — the spate of orders on testing (mild cases to be discharged without a confirmatory test!) and on hospitalisation (mild cases to be treated at home) suggest India’s anti-Covid strategy is quite ad-hoc. Some of this was to be expected, given how fast the virus is spreading, how little we know of its behaviour, and the near-broken state of our healthcare. But, if we don’t course-correct quickly — as in, have a 3-month projection of disease and what we need—in a few months, lakhs of Covid-struck Indians will have no hospital beds, ICU facilities etc.
Test kits are a good place to start. At the beginning of April, around 50,000 tests were done and around 2,000 infections were found. As the demand for more testing rose—especially since 70-80% of those infected are asymptomatic — India ramped up quickly and by the end of April, 8.3 lakh tests were done, and it has doubled since. While there are many who argue this is still inadequate—India does 1,189 tests per million people versus 26,310 in the US—Indian experts cite the low number of deaths and the number of people who test positive (4%) to say testing is adequate; even the current level of testing, however, requires a huge increase in test kits.
If the virus-spread doubles every 10 days—this is optimistic, given cases doubled every 12 days during the lockdown—we will have 2.2 million affected by the end of June and 1.8 crore by the end of July. Given we get around 4% positive cases, to detect so many people means India will need 5.5 crore test kits by the end of June and 47.4 crore by the end of July! Given the huge shortage even right now—it takes 9-10 days between the time a test is recommended and the results coming out—and the fact that most of the equipment needs to be imported which takes several weeks, have these orders been placed? Using rapid anti-body tests will reduce the need for RT-PCR kits/machines, but has the government figured out which suppliers are kosher and which aren’t; you don’t want to, like the last time around, wait for weeks to get Chinese antibody kits and then announce that they are duds and need to be returned?
There is, believe it or not, no dashboard where anyone, including researchers and planners, can see just how many hospital beds, isolation wards, ventilators, PPE, etc, are available or needed. No state government provides this either, though a colleague, Ishaan Gera, managed to source one detailed report that the Maharashtra government had put on its website (bit.ly/2SUJGTA); many calculations in this column are based on that report. Around a fifth of those infected needed to be hospitalised in Maharashtra, for instance. While some of this will now be done at home—assuming the cases are ‘mild’— by the end of July, India will need 42 lakh isolation beds (we have just19 lakh of all type of hospital beds). The Maharashtra example, sadly, showed that while the state had 177,129 isolation beds—just 8.2% of them were occupied—just 3,422 were in Mumbai which already had 7,792 infected people who needed to be hospitalised by then; in some hospitals, the number needing beds were 5-6 times the capacity.
It is not clear how PPE requirements are to be estimated, but the Maharashtra report documents a huge shortage in some individual hospitals; this will go up around 300 times by the end of July given the likely growth in the number of infected. So what is the plan to order the PPE and, as in the case of kits, several Chinese suppliers have been found to be supplying useless masks here as well (https://nyti.ms/35PZj3V on the US FDA action on this).
Using the Maharashtra number for ventilators— 0.4% of the infected patients need ventilators —India will need 77,000 by the end of July. All of this rises manifold if the infection levels double faster; if infections double every eight days, the demand for isolation beds will rise to 1.7 crore by the end of July versus 4.2 million in the scenario where infections double every 10 days. The first step to addressing this yawning gap in infrastructure is to make the projections public, and not just at the all-India level, but for big cities where the most infections are taking place; when the gap is obvious, citizens will put enough pressure on the government to ensure solutions are put in place. The alternative is lakhs of Indians dying on the streets with no facilities to treat them; it will be too late by then.