Covid-19: What you need to know today
On Wednesday, 43% of the world’s new coronavirus disease cases came from India. Rising positivity rates — weekly average positivity rates are up in 31 of the 34 states and Union territories (UTs) that publish testing data regularly — indicate that, one, the surge in India’s numbers will continue (although states and UTs can always change their approach to testing to hide the real numbers, or, worse still, show a dip in positivity rates; this is beginning to happen) and two, that many states and UTs are definitely not testing enough.
This is really the only positivity bit that should worry everyone, not any other. Indeed, people who are suddenly discovering and making impassioned pleas about the spiritual and psychological reasons not to post or publish photographs and videos of cremations and burials must understand and acknowledge that they are merely being (wittingly or unwittingly, and most certainly witlessly) apologists for governments that seem more worried about the narrative than the underlying facts. Every time someone has told me to be positive over the past few days (and there are some who are persistent), there’s a voice I hear in my head — it’s Neil Young, singing, “Don’t let it bring you down/ it’s only castles burning.”
But back to the country’s numbers. According to the Johns Hopkins Coronavirus Resource Center, India is currently one of the two countries (Colombia is the other one) among the 10 worst affected countries (by daily cases) where things are getting worse. And Colombia, to put things in perspective, is adding around 17,000 cases a day on average. On Wednesday, India added 379,423 new cases, for a weekly average of 349,029 cases. The country recorded 3,643 deaths on Wednesday for a weekly average of 2,877. On Wednesday, the number of active cases in the country surged to 3.08 million.
According to comments last week by All India Institute of Medical Sciences director Randeep Guleria, 10-15% of those infected may need hospitalisation, and less than 5% may require critical care.
These numbers are significantly higher than the ones I’ve seen for other countries, but they can still safely be considered upper bounds.
Even at 10%, that translates into a maximum of 300,000 people requiring hospitalisation, with 150,000 of them requiring critical care.
But there are other factors at play.
One is the absence of triage (simply, prioritising hospitalisation on the basis of the seriousness of the illness), something that is critical when demand exceeds supply.
Delhi, for instance, ended Wednesday with almost 100,000 active cases, which means it needs around 10,000 hospital beds, including 5,000 critical care ones. The city-state has around 20,000 beds, of which almost 19,000 are occupied according to the government’s dashboard. In addition, it has around 4,600 critical care ones, all of which are also occupied. Delhi’s excessive hospitalisation numbers may be on account of people from other states, notably Uttar Pradesh and Bihar, traditionally heading to the Capital for treatment, but, equally, with hospital beds becoming scarce, many Delhi residents have headed to Noida, even Ambala, over the past week, so there’s some natural balancing of numbers. This clearly points to the absence of triage (and also its importance). The second wave of the coronavirus disease has set off panic in some parts of the country (and Delhi is definitely one). Not everyone seeking it needs hospitalisation, just as not everyone looking for remdesivir injections needs them (in fact, most do not). Triage can address the first (but it needs to be done efficiently). Better medical advice can address the second. I am not mentioning the rush for plasma therapy because it doesn’t work.
The second factor is concentration of cases. Bengaluru, for instance, ended Wednesday with 224,152 active cases, the highest for any Indian city (and 7.3% of all active cases in the country). That means it needs around 22,000 beds, including 11,000 critical care ones. The city has nowhere that many. So, while triage may be able to lessen the pressure in the case of Bengaluru, the city still needs to urgently enhance hospital and ICU capacity.
Then, that can be said for almost any city in India.