India could see 1 mn Covid-19 deaths, says expert Print
Monday, 23 March 2020 03:31
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Sarthak, front page


After well-known epidemiologist associated with Imperial College, London, Neil Ferguson, predicted 510,000 Covid-19 deaths in the UK and 2.2 million in the US, if control measures are not instituted, Ramanan Laxminarayan, of the US-based Center for Disease Dynamics, Economics and Policy, has projected that 1 million could eventually die in India. No other expert, it has to be cautioned, has come up with a number even remotely close to Laxminarayan’s; also the numbers were based on a business-as-usual scenario, with no lockdowns and other restrictions of the type that have now been put in place.

Elaborating on this, Laxminarayan said in a video interview with Barkha Dutt, “I don't think the PM would believe that the country should be warned about something like the World War II if he thought that there were only 200 cases and 3 deaths.” 

While some have argued that the lockdown should have begin much earlier – that was a mistake in countries like the US, UK, Italy etc – the testing done so far showed no community spread. Some have, though, questioned the ICMR testing, suggesting that it was too limited.

Following a 14-hour janta (voluntary) curfew announced by the PM that ended at 9pm on Sunday, a total of 16 states in the country have announced partial or total lockdowns, shutting offices, public transport, etc. Indeed, while talking about measures to contain the spread of the SARS CoV-2 virus, Laxminrarayan had said, “If we had to do a lockdown, it would be now. We should lock down now.”

Report of Covid-19 cases growing exponentially—it took five days to reach 100 cases from 50, three days to reach 150 from 100, and two days to reach 200 (on March 19) from 150, and stood on 345 on March 22—could be a sign of community infection (Stage III of an outbreak). Indeed, while Indian Council of Medical Research (ICMR) tests suggested no community infection so far—nearly a 1,000 random tests among cases showing Covid-19-like symptoms have been found negative—ICMR itself changed its testing regime on March 20 to include all hospitalised patients with Severe Acute Respiratory Illness (fever and cough, and/or shortness of breath), apart from those covered earlier (individuals who have undertaken international travel in the past 14 days who turn symptomatic in the home quarantine period, all symptomatic contacts of laboratory-confirmed positive cases, and all symptomatic healthcare workers).

The government has also now allowed private labs certified by the National Accreditation Board for Laboratories, a sign of how India needs to rapidly ramp up testing get a fix on the corona impact. Given how under-equipped the country’s healthcare system is in case of a Covid-19 scale that Laxminarayan estimates—for instance, it has just 100,000 ICU beds—Laxminarayan suggests using stadiums across cities to set up hundred of thousands of beds with critical care instruments, including ventilators; with India simply not having that many number of ventilators, he urged the government to support the private sector to ramp up production.

To that end, the private sector can take a cue from Anand Mahindra of the Mahindra Group, who tweeted about immediately beginning work at Mahindra facilities to make ventilators, and offering up Mahindra Holidays resorts as temporary care facilities.


"To help in the response to this unprecedented threat, we at the Mahindra Group will immediately begin work on how our manufacturing facilities can make ventilators. —At Mahindra Holidays, we stand ready to offer our resorts as temporary care facilities."


A related issue will be the country’s healthcare workforce’s capabilities in handling critical care, including intubation in use of ventilators. McKinsey, which had earlier developed a protocol to train healthcare personnel on this in Italy, is learnt to be approaching the government to offer such training pro bono.