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From best to worst scenario, India will need thousands of ventilators, upgraded health infra to tackle virus: ICMR

Maitri Porecha New Delhi | Updated on March 24, 2020

‘Lockdowns give time to understand if virus can be contained through self-isolation’

Novel coronavirus has brought human life almost to a standstill in 32 States across India. The Indian Council of Medical Research (ICMR), in its latest study, has implied that India needs to brace itself for the long haul lockdown and self-isolation as cases may increase over the next two years.

Tarun Bhatnagar, co-author of the study published in Indian Journal of Medical Research on Monday and a member of the National Task Force for tackling Covid-19, told BusinessLine:“In the event that Covid-19 started spreading in India, we developed a mathematical model to simulate the transmission dynamics in the four most-populated metropolitan areas (Delhi, Mumbai, Kolkata and Bengaluru metropolitan areas) in India, as well as their population connectivity.”

In an optimistic scenario with intervention from the government, Delhi could see two-lakh Covid-19 symptomatic cases over 600 days. “Only 5 per cent of these will require ICU admission, which is 10,000 cases over two years in Delhi,” Bhatnagar said. In a pessimistic scenario, even with intervention, the paper states that Delhi may witness as many as 90-lakh symptomatic cases, of which 4.5 lakh may require ICU admission in 45 days. Mumbai, Bengaluru, and Kolkata show similar trends in terms of numbers that vary slightly depending on the populations. Rural populations have not even been accounted for as of now, Bhatnagar added.

“These are mathematical modellings of hypothetical projections and will change dynamically, and ICMR is right now studying what effect quarantining and lockdown had on containment. We will release these figures in the coming days,” said Bhatnagar.

ICMR Head Balram Bhargav explained the logic behind lockdowns. “This gives us sufficient time to understand if India is being able to contain the virus through self-isolation. We will study the situation till March 31 to take further decisions,” he said.

Do we have enough beds?

 

Confirmed cases of Covid-19, as on March 24, stood at 538, of which 37 have been cured and nine (1.67 per cent) have died till date. While February 29 had four cases, since March 15 — which recorded 112 cases — the number has surged to over five times to 538 in nine days alone. According to MoHFW internal data, India has capacity of 37,618 isolation beds, 9,512 ICU beds and 8,432 ventilators as on March 24. “We will rapidly need to upgrade its health infrastructure if the situation worsens as cases surge in a short time,” Bhatnagar said.

By intervention, the study means that half of all symptomatic patients would have been screened at airports and quarantined at home or government facilities. “Any containment strategy focussed on symptomatic infections, no matter how comprehensively, tends to be negated by the asymptomatic infections that escape detection and can go on to cause onward transmission in the community,” Bhatnagar explained.

The biggest worry

The paper states 46 per cent may not be detected at the airport due to incubation period, and travel screening would miss more than half the infected travellers on account of not showing symptoms and being unaware of exposure, thus emphasising the need for tracking post-travel symptoms among them.

The biggest worry here is passengers slipping through the cracks since January, who may not have symptoms but are still unknowingly spreading the virus. The paper states that, according to the data shared by the Delhi Health Department, till February 13, 17 of 5,700 (0.3 per cent) passengers, who had arrived from China and other Covid-19-affected countries prior to the beginning of airport screening from January 15, were found symptomatic and hospitalised, while the rest were advised home isolation. The status of another 885 passengers is unknown. Similarly in Punjab, officials are scampering to find up to 40,000 missing passengers.

As on date, the Central and State governments collectively do not have more than 60,000 quarantine beds, but this number may change dynamically as more quarantine facilities are added.

“At the moment we do not have adequate quarantine set-ups so only travellers over 60 years are being kept in government quarantines, while those who are young are being asked to be on home quarantine after travel,” said Dammu Ravi, Additional Secretary, Ministry of External Affairs. Bhargav agreed with Ravi and said that inability to quarantine so many passengers has led to lightening of quarantine norms as of now.

The paper also states that to avoid these huge numbers, the only way out would be to diagnose up to 90 per cent diagnosis among asymptomatic arrivals, perhaps through isolation and quarantine of all arrivals from specified origin airports back in February.

As on March 24, the MoHFW data show that the total number of passengers under community surveillance found in airports since March are 1,00,993, of which 3,723 (3.68 per cent) were found to be symptomatic. Of these 2,480 were hospitalised.

According to time-line of events accessed from the MoHFW, India’s response has been slowly graded up in terms of airport screening.

While China informed the World Health Organization on December 31 that cases of mysterious pneumonia were breaking out in Wuhan and identified it as Covid-19 on January 7, India started surveillance of China and Hong Kong passengers in Mumbai, Delhi and Kolkata. On February 2, it was expanded to 21 airports for four countries in which Thailand and Singapore were added. Only by March 4, did India start screening all international passengers and has eventually imposed ban on any international travel.

“As the introduction of cases may take anywhere from a minimum of 20 days to a few months to be visible, we need to enhance surveillance and prepare the community in a proportionate way that is neither alarmist nor complacent,” said Bhatnagar.

Why lockdown is essential?

The less number of people you meet, the better, as Covid-19 can spread unknowingly even through persons who do not display symptoms like cough, cold, breathlessness or respiratory distress. The Centre has, therefore, advised people to self-isolate themselves at home. Senior citizens and those with lung ailments are more prone to catch the virus and suffer from its complications. Those with mild symptoms are advised by experts to stay at home to let the virus wean away in a few days.

However, the local doctor must be informed in case further guidance is needed. In case of severe symptoms, one can call the national helpline - 011-23978046 or 1075 or the respective State helplines.

Published on March 24, 2020

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