Responding to Covid-19: A mobility-based surge capacity framework
Between April 1 and May 23, 2021, the situation in the city of Delhi changed from a significant shortages of hospital beds, critical care equipment, oxygen, medicines and doctors to vacant beds and excess capacity as the surge abated. Figure 1 (from Sheikh 2021) shows just how rapidly demand declined; for large private hospitals, utilisation went down from close to 100% to below 60% in an 18-day period; the decline from 90% to 30% for Delhi government hospitals over the same period was even more dramatic. As Delhi limps back to normalcy, the city will have an abundance of resources, at least until the next surge. Meanwhile infections are beginning to spread in newer states and rural areas, and some will face the very same crisis Delhi confronted, with far less resources.
Delhi’s experience, if repeated, illustrates that capacity will have to increase three to four-fold to meet Covid-19 demand in a very short period. But if this capacity is used only at and by one area, much of it will remain unused once the immediate surge has died away. Managing that short-term increase in demand successfully requires that all those who need appropriate care receive it within the time necessary to minimise the possibility of adverse outcomes. This brings together two critical and interrelated challenges that we call the ‘surge elasticity’ and the ‘mobility premium’.
We think of surge elasticity within the health system as its ability to increase the availability of resources within a given area. This can be by increasing production, drawing on reserves, or importing from other locations, foreign or domestic. We think of the mobility premium as the ability of the health system to meet a spatially varying demand for health resources, as the virus travels through the country. If cities, districts and states surge at different points in time, health capacity at a location need not be fixed- it can also vary over time across geography. This note discusses each of these two aspects of our health system.
We highlight that the issues in this note only address the supply response, taking the number of cases as a given. As is well known, managing the pandemic requires both supply response to tackle surges and demand management responses, such masking, physical distancing and containment measures that dampen the surge. In the early days of the second surge, there was limited reliance on demand management, which may have exacerbated the problem. We do not address this issue here but recognise its very essential role in pandemic management.
(The study has been authored by Yamini Aiyar, Jishnu Das, Partha Mukhopadhyay and Shamindra Nath Roy)