While the prime minister and the chief ministers discussed the need to ensure that people didn't throng the streets once the ongoing 21-day Covid-19 lockdown ends on April 15, the findings of a new study by researchers at the Center for Disease Dynamics, Economics and Policy (CDDEP) and Princeton University would strongly suggest the need for an extended lockdown, or, at the very least, intermittent lockdowns. The CDDEP-Princeton researchers estimate that nearly 4.75 lakh Covid-19 cases will need hospitalisation in India, if the prevalence of the disease in the current outbreak is as low as 0.5% of the population. If the prevalence rises to 5% of the population, there will be nearly 48 lakh cases requiring hospitalisation. It is difficult to estimate, at this stage, what the eventual spread in the country will likely be, but some models for developed nations project relatively higher spread.
The CDDEP number is instructive in imagining the likely immense pressure on the country's health system-India's hospital bed capacity is estimated to be around 20-25% of what the 5% scenario demands. Anything that delays the onset of the disease-or flattening the curve, in jargon-will mean those who need more attention will not need to be hospitalised together. In other words, the hospital bed shortage will be less acute. And, keep in mind, that the health system needs to cater for other diseases too.
An analysis by Prachi Singh, Shamika Ravi, and Sikim Chakraborty of Brookings India shows that 12 states-Bihar, Jharkhand, Gujarat, Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Haryana, Maharashtra, Odisha, Assam, and Manipur-lie below the national level of 5.5 government hospital beds per 10,000 population while accounting for 70% of the country's population. Worse, critical care infrastructure, healthcare personnel strength, etc, will also be far short of the demand.
Many states are identifying hospitals that can be turned into dedicated Covid-19 treatment facilities, while some are turning stadiums into isolation facilities. Some private players in the hospitality sector, like the Mahindra Group, have volunteered resorts etc for serving as corona-care facilities. Whether the health system is overwhelmed or not will depend on how well India is able to flatten the curve of transmission.
The government considering, as per a report in The Indian Express, prioritising Covid-19 cases for hospitalistion based on the severity of the case seems rather prudent, but only if accompanying steps are taken to successfully quarantine mild cases. This can ease the pressure on the health system, particularly on healthcare workers, who are quite vulnerable due to their long, regular exposure to the virus.
But, this has to be accompanied with intensive awareness efforts, and serious monitoring-from tracking through phones to at-home monitoring by local healthcare workers. It will also need the states and the Centre to identify more facilities, from school buildings to hotels and guest-houses, to isolate mild cases where home isolation enhances the risk of transmission-for instance, in slums and rural areas, where there is no space to isolate a patient. But, given how there are enough reports of people violating quarantines, it is perhaps best to keep lockdown as a primary weapon in India's anti-Covid-19 arsenal.