Pan-India Covid-19 numbers gloss over local risks & distress.
If just 6.4% of those affected by Covid-19 need to be hospitalised, as the health ministry’s joint secretary Lav Agarwal asserts—plus 3% need hospitalisation and 0.45% ventilator support—then India can weather the corona crisis quite comfortably. If doubling of infections is taking place every 12 days, that means India will have 225,000 cases by June 2 and 7.2 million by the end of July; we will need 4.6 lakh hospital beds, 2.2 lakh ICU beds and 32,000 ventilators, taking into account the total infections, and not the active cases. India already has 19 lakh hospital beds, a lakh ICU beds and 50,000 ventilators; so other than ICU beds, India has no capacity problem and it has two months to ramp up capacity there.
But, just as crossing the river depends on whether you can deal with it where the depth is the greatest—and not the average depth—the virus is not spread evenly across the country; 21% of cases are in Mumbai, 10% in Delhi, and 51% is in just five cities including Chennai and Pune. Indeed, the hospitalisation rate is also very different for these areas. In Delhi, the latest data puts this at 30% and it is an even higher 37% for Ahmedabad, a city that accounts for 8.2% of the total infected in India. And in cities like Mumbai, we have already witnessed a shortage of beds and there have been stories of patients—just a few so far, fortunately—being turned away from hospitals for want of beds.
Even these numbers, it must be kept in mind, are a big understatement; India’s testing protocol remains woefully inadequate even though it has been changed to accommodate a few more categories of people.
Till now, India consistently showed an infection rate—those testing positive as a proportion of those being tested—of around 4%. While that was enough reason for more testing, this infection-level rose to 5.6 in the first four days of Lockdown 4; for Maharashtra, the infection levels were 9.6 in Lockdown 2 and this rose sharply to 13.3 in Lockdown 3, and then to 19.3 in the first four days of Lockdown 4.
Worse, with very large infections being seen in migrant populations, even rural India could witness a big shortfall in hospital beds/ICUs/ventilators/PPE etc. Bihar, for instance, saw an 8% infection level among the 8,337 migrants tested till May 17, and it was 26% for those coming from Delhi; the state has just seen 5 lakh migrants coming back so far, and is expecting many times this number given that, as per the 2011 Census, there were 80 lakh migrants from the state. If even half of them were to return and a tenth tested positive, the state would need 12,000 ICU beds and 1,800 ventilators going by the health ministry’s numbers; the state has only 1,543 ICU beds and 771 ventilators. India has a serious health crisis on its hands, trying to suggest it is manageable by focusing on the averages serves no purpose.