Coronavirus in India: Are big cities up to the Covid-19 challenge?

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Updated: May 29, 2020 12:14 AM

Even Mumbai is facing an uphill task & it is not clear others have created even a fraction of the new treatment capacity

And, this assumes that all non-Covid patients are kicked out of hospitals, which is quite unrealistic.And, this assumes that all non-Covid patients are kicked out of hospitals, which is quite unrealistic.

Even a month ago, India had the 16th largest number of Covid-19 cases in the world, it has moved up to 10th place now; in terms of new cases every day, India is ranked 4th and will move up more. It is, of course, true that India has a much lower death rate than many others and its recovery rate is up from 8% on April 1 to 40% today; but others also have high recovery rates, so India is not unique. More worrying, with no sign of the infections dipping, the number of infected persons could soon get unmanageable, especially in the big cities where the bulk of the infections are.

Also, with officials regularly talking of how the ‘doubling rate’ is falling—as the base grows, growth rates falling is pretty normal—it seems the anti-Covid fight is losing some steam. At a time when the state government should only be focussed on creating enough hospital/isolation infrastructure—that includes doctors and nurses, not just equipment— there is news of moves to topple the current regime in Maharashtra; it is possible this will fail, but should it have even been tried? It is not clear if this is a local operation or whether it has the blessings of the BJP’s central command; either scenario is disturbing. And, states continue to be unfairly starved of funds, once again preventing a laser-like focus on the problem; regular sniping with various state governments only adds to the confusion.

Similarly, while most big cities seem to be struggling with getting the requisite number of hospital beds, etc, it is not clear why none are putting out a dashboard of available beds and equipment like PPE, oxygen cylinders, and even the projections for the future.

Some details are out for Pune, though these haven’t been put out in the public domain. Based on cases doubling every 14 days, the local government expects the number of cases to increase around 4.3 times between May 28 and June 30 (bit.ly/2B8wzIr). When the city has 22,940 cases, of which around 40% will be ‘active’ cases, it expects to have a shortage of 216 ICU beds. Put this way, the situation seems under control, but it is not clear whether the estimates are entirely accurate; that is why making estimates public helps. The city has just 1,671 hospital beds dedicated to Covid-19, according to its report, and that is likely to fall short, especially if the hospitalisation needs go up to, say, the 30% levels that they are in Delhi at the moment.

In the case of Mumbai, while the government taking over 80% of the private sector’s hospital bed capacity will help meet a large part of the requirements if the cases jump to New York levels—15,000 active cases per million population at the infection’s peak—even this is quite touch and go. For one, despite the state creating 60,000+ isolation beds, it will still have a shortage of 5,000-10,000 hospital beds (bit.ly/2M4znZ6). And, this assumes that all non-Covid patients are kicked out of hospitals, which is quite unrealistic. Besides, with the government fixing a very low cap on private-hospital tariffs, it is not even clear if they can service the 80% beds—in terms of the requisite number of doctors, nurses, ICU facilities, etc—since the costs of running the hospital is several times more than what they are going to be allowed to charge patients.

In Delhi, similarly, if infection levels keep rising as they are right now—and they should since every 100 new tests throw up 22 new infections—the city will have 2.8 lakh cases by the end of July (see graphic). That is 13,428 infected persons per million population, roughly the average of big cities like New York, London, Singapore and Milan; London has an infection rate of 3,009 and New York 24,418.

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As in the case of Mumbai, the gaps in hospital infrastructure will show up quite quickly. Less than halfway to the 2.8 lakh number, when infections are at 6,000 cases per million, Delhi will need 19,000 hospital beds for the infected (assuming half the cases are ‘active’ and a hospitalisation rate of 30%); assuming all non-Covid patients are thrown out of hospitals, government hospitals have enough beds to meet the rush. At 10,000 cases per million, however, the government beds run out along with the 20% private beds that have been requisitioned so far; the ICU beds fall short at even 6,000 cases per million.

As in Mumbai, taking over all private beds is a solution; like Mumbai, it is once again, touch and go, and the same questions of the viability of the private hospitals comes up if unrealistic price caps are put, and you can be certain they will. Sooner rather than later, the central government will have to play a more central role—while genuinely consulting with states—perhaps while asking the army to quickly set up field hospitals in major areas of infection. And, it cannot be said enough times, there has to be a lot more information—without today’s level of fudging by many state governments—put out in the public domain through public dashboards giving details of all important parameters 24×7.

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