Covid-19: What you need to know today
India crossed 300,000 coronavirus disease (Covid-19) cases on Friday, ending the day with 309,324 cases, of which 146,292 are active. Thus far, 154,150 have recovered from the disease, and 8,882 have died. There are only three other countries that have more cases than India, Russia, Brazil and the US. India ended June 2 with 207,112 cases so its last 100,000 cases were added in 10 days.
These numbers shouldn’t worry anyone; in the absence of widespread (and indiscriminate) testing, they are also irrelevant. Many of the cases recorded are of asymptomatic people (a study by the Indian Council of Medical Research based on 40,000 patients put the proportion at 28%); and many other patients who are infected suffer mild symptoms and recover without hospitalization. Some require hospitalization; a few of these, critical care and ventilator support; and 2.85% of those infected, succumb to the disease.
On Thursday, India added 11,199 cases according to the HT dashboard. This is the most the country has added in a 24-hour period. Again, this number is largely irrelevant. But the break-up isn’t.
Here’s why: reports of the coronavirus disease across the world tell us that the disease ravages densely populated urban centres, spreading rapidly through communities, with no apparent source of infection, and overwhelming health systems. If that sounds familiar, it’s because this is exactly what’s happening in Delhi, Maharashtra, and Tamil Nadu or, more specifically, Delhi, Mumbai, and Chennai right now.
On Thursday, the three states accounted for 66% of all new cases reported in the country. This means that Thursday’s spike did not happen because of an emerging wave in a hitherto unaffected or less affected part of the country, but was driven by higher numbers in the three states. Over the seven-day period from last Friday (June 5) to Thursday (June 11), these three states accounted for 55%, 53%, 53%, 54%, 52%, 61%, and 66% of daily new cases. And within Maharashtra and Tamil Nadu, the cities of Mumbai and Chennai account for the most new cases — on Thursday, for instance, Mumbai accounted for 1,540 of the 3,607 new cases Maharashtra added, and Chennai, 1,407 of the 1,857 Tamil Nadu did.
The health systems of the three cities (and the states) have been overwhelmed or are on their way to being overwhelmed.
Still, with these three cities accounting for a significant proportion of cases, India has the opportunity of aggressively strengthening their health capacities to manage the coming peak of the infection. If it can manage the situation in Delhi, Mumbai (and Maharashtra) and Chennai (and Tamil Nadu), it would have addressed half (maybe even more) of the problem. Meanwhile, there are lessons from all three states that should be applied universally across India. These are simplicity personified (when put down in black and white) but no country or city has got it right so far.
One, test and trace. Two, define clear quarantine and isolation protocols, the last especially for people with mild cases of the disease (otherwise they will take up valuable hospital space).
Three, set up dedicated Covid-19 facilities and prevent Covid and non-Covid patients from being in the same space.
Four, train health-care workers on safety protocols and protect them (all three states, but especially Delhi and Maharashtra, have done poorly on this front).
Five, get the staffing of health care workers right -- both Mumbai and Delhi may or may not have adequate beds, but they are definitely facing a pinch when it comes to health care workers.
Six, plan for the worst and procure the requisite health-care equipment (including medical devices) early.
Seven, do not confuse hospitals, health care workers, and the public with hundreds of orders.
Eight, work out an effective patient admission and transfer system.
And nine, draft and implement a painless cremation/burial protocol.
There is still time to prepare.