India’s population is 1.3 billion as of 2020 based on the population forecast (1). India is home to 18% of the world population. As per the Mathematical Modeling of Infectious Disease Dynamics (EPI Model), at least 40% of the people are likely to be infected in the US. As per Prof. Lipsitch (2) a well-known Epidemiologist of Harvard school of public health, “40% to 70% of people worldwide are likely to be infected by COVID-19 in the coming year”.
If we take very conservative figures, at least 10% of Indians (132 million) are likely to get infected by COVID-19 in India. As per Guan et al., 2020 (3) at least 5% of the COVID-19 patients require ICU admission and 2.3% require mechanical ventilation.
It is estimated that there are about 70,000 ICU beds available in India including all types and across all hospitals and small time nursing homes in India that cater to 5 million patients requiring ICU admission every year.
At the moment, it is established that India have roughly about 30,000 (4) ventilators. However reports (5) suggest that not all the ventilators are in working condition. If 2.3% of the 132 million COVID-19 patients need ventilators, nearly 3 million (30 Lakhs) mechanical ventilators are required.
These numbers will overwhelm our capacity and we are totally unprepared to face this pandemic. It now really is the time we strengthen our public health systems more than ever.
India spends about 1.28% of GDP on public health and this is considered to be the lowest among the countries globally. The Government is planning to increase public health spending to 2.5% of the GDP by 2025. However this will not be adequate given the larger population and public health challenges faced in the country today.
It is important that we integrate our health systems through National Health Information Exchange both at the national and state levels. Health Information Exchanges (HIE) are designed to achieve interoperability across the healthcare ecosystem bringing care value chain across primary, secondary, tertiary care, payers, diagnostic laboratories, policy makers and researchers on a same platform to collaborate over consistent and reliable patient information.
The real time information sharing and access to the patients’ past history, allergies, comorbidity conditions and more importantly identifying patients with respiratory symptoms will help the healthcare providers in quick diagnosis. The Covid-19 outbreak has brought in a very interesting question about the definition of health data whether it should go beyond medical data of patients and include wider variety of data types and patients self reported data such as vital signs, travel history etc.
Viruses like Covid-19 spread by making copies of themselves. Each time they replicate, there are chances for mutation in the viral genome, making the latest copy slightly different from the previous one. The sharing of Covid-19 specimens with the researchers and health professionals is very important to understand the outbreak along with patient risk factors, travel history, and case reports.
The National Genomics Bio-bank needs to be established in order to store biopsy data from citizens. The access to this database can be granted to research communities taking part in the development of precision medicines based on the patient’s consent. The Council of Scientific and Industrial Research’s (CSIR) initiative such as whole genome sequencing of 1000 Indians needs to move beyond the pilot program and include the larger population data across the country.
The existing disease surveillance approach leveraged by Integrated Disease Surveillance Programme (IDSP) (6) in India needs to be augmented with technology based real time disease surveillance across the country. IDSP data is collected on epidemic prone diseases on weekly basis (Monday–Sunday). The information is collected on three specified reporting formats, namely “S” (suspected cases), “P” (presumptive cases) and “L” (laboratory confirmed cases) filled by Health Workers, Clinicians and Laboratory staff respectively. The weekly data gives information on the disease trends and seasonality of the diseases.
However this approach is no longer sustainable, given the larger population in the country and the nature of the disease outbreaks like COVID-19. Enabling the hospitals to send data from the clinical encounters directly to the Integrated Disease Surveillance Database is a critical step in real-time monitoring and managing of disease outbreaks like COVID-19. Leveraging Healthcare Data-warehouse techniques like multivariate statistical detection algorithms in IDSP can automatically classify syndrome categories and identify anomalous patterns in the syndrome counts in real time.
The integrated health systems in India will help monitor epidemics or disease outbreaks, identify local hotspots for medical conditions, infectious diseases, malnutrition etc. in addition to comprehensive clinical care.
Note: This is my personal opinion based on the available data. The above post should be read as indicative of magnitude rather than exact figures.
Sources:
1. https://www.worldometers.info/world-population/india-population/
2. https://www.worldometers.info/coronavirus/coronavirus-expert-opinions/
3. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
The article was first published on the author’s LinkedIn pulse blog, it’s published here with the author’s permission
