We are all probably sick and tired of hearing and reading articles related to COVID-19 and how to protect ourselves. We have also all heard opposing tales of individual heroism of first responders like healthcare staff in Wuhan, and the incredible irresponsibility of certain individuals not following their quarantine orders. I will, instead, share some statistics on why military grade ‘social distancing’ is a MUST – and not merely something that is optional to India.
India’s Hospital Bed Occupancy is at 80-90%. What Does This Mean?
Let’s look at the hard facts.
Italy, which is arguably the worst-hit country, has about 50,000 cases and a population of about 60 million. This means that about 0.085 percent of its population is symptomatic and has COVID-19, most of which is in the affluent and rich northern half of the country. The Italians have among the best and most robust healthcare systems in Europe, with about 3.7 beds per 1000 population.
India, by comparison, has only about 0.7 beds per 1000, and the US has about 2.9 per 1000.
What is not being realised is that the Indian bed occupancy is usually high at about 80-90 percent, and quality matters – and most of our beds are in underfunded government healthcare set ups with minimal equipment and worse levels in training and staffing. There is no denying the skill and motivation of our healthcare staff, but this does not replace training and equipment.
In a Doomsday Situation, How Many Coronavirus Deaths Would Kolkata See?
Western Europe, Japan, Australia/New Zealand and North America also have very stringent quality control, credentialing, and training requirements for their staff, something which is not replicated here in India. India is also far more densely populated as compared to all these countries, the exceptions being the northeast states, mountain states and Rajasthan.
In a hypothetical situation, Kolkata and nearby suburbs, with a population of an estimated 15 million, is infected at about 1 percent. That means about 1,50,000 people in 2 weeks. Of these, about 15 percent need ICU admission, or they will not survive – so that is about 9,000 people.
Assuming Kolkata has 5 times the Indian average of beds, this is about 52,500 beds – of which 20 percent are in the ICU; so about 1,050 beds.
With 80 percent baseline occupancy, this means that only about 200 ICU beds and 8,000 ward beds are available. This also means that healthcare workers and doctors will be forced to make some very hard choices on a scale that makes Italy look like a dream.
In such a doomsday situation, Kolkata itself would see about 8,700 fatalities.
You might ask why so many, because after the first wave, patients in the ICU usually need about 10-14 days to come out, unless they die. This means that over a span of 2 weeks, we have 200x14 = 2,800 bed days. After the first batch of 200 patients, only 100 beds are available – and that too about one week later.
Coronavirus Precautions: Why Social Distancing & Quarantine Are Top Priority
Kolkata only has the capacity to treat about 300 ICU patients of COVID-19 over a two-week period in the ICU. This is its healthcare capacity. Therefore, we are trying the ‘flatten the curve’ where, via social distancing, we space out the rate of infections – so that we have less than 8,000 symptomatic patients every two weeks, to not saturate the healthcare capacity of the area one lives in.
The authorities know this, which is why we are being so direct and aggressive with social distancing and quarantine.
We simply do not have the capability of defending an uncontrolled spread of this disease. Also to be taken into account is the fact that the stress a pandemic puts on the economy is severe. With stock markets down, the reserves of most companies are limited, especially insurance companies – who will start to see high levels of claims for both illness and possibly death, and may struggle to meet these.
Coronavirus Impact: The Butterfly Effect
Private hospitals will undergo even higher levels of stress, as prices of medical equipment, personal protection and medicine start to shoot up due to supply-side constraints. Payments will also dry up as elective procedures stop, and health insurers reduce payments initially; even cash patients may not be able to pay, as they themselves may not have gotten their salaries or are on leave without pay – their savings being wiped out in the current stock market collapse.
This will compromise the ability to take care of a large number of patients, and we will start to see infections in the hospital staff that will further curtail operations.
Other diseases will continue unabated, and those that were previously curable will start becoming deadly, as the healthcare capacity is all used up by coronavirus.
These are the facts, and not predictions. So, let’s listen to our leaders, use our minds, and please just get our act together. We are all together in this, and need to remain together for us to get through unscathed.
(Dr Aviral Roy is a consultant with MEDICA Superspecialty Hospital, Kolkata, in the Department of Internal Medicine & Critical Care. His areas of expertise include H1N1 pneumonia, dengue fever, ARDS, septic shock, heart failure, use of ECMO for lung failure and neuro-critical care. You can reach him at aviral.roy@gmail.com. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)
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