April – the month of spring breezes, almond blossoms and Tulips – something that we look forward to eagerly every year. But, this April is different, turning out to be a dreadful one, with exponentially growing casualties of the pandemic. India recorded 69 Lakh cases against 11 L the previous month, while fatalities rose from 5776 to 48879 (which is more than the sum of numbers recorded in previous six months). These sky rocketing figures can be solely attributed to gross disregard of specified protocols. People and administration were complacent enough to lower their guards, allowing this pandemic to spread at a spiraling pace.
The current scenario created by extensive transmission of the disease is distressing and claiming far too many lives. The main problem is not covid, it is the panic surrounding it. With the country’s recovery rate more than 97%, most of us can counter this pandemic with timely and proper care. Since the severity of any pandemic reduces with time, it could have reduced in the instant situation but infectivity has increased multiple-fold, resulting in a huge number of cases. It is the colossal volumes that are posing a challenge to control the second wave. The positive news is that India is doing much better vis-a-vis other developed countries. Although outperforming others in terms of metrics, we are impeded by absolute numbers. Despite India having maximum number of fresh cases today, our Case Fatality ratio is 1.11% as compared to 1.78% for US and 2.88% for UK.
The present crisis and resulting panic are attributed to a shortage of Hospital Beds, ICUs, Oxygen, Medicines and Ambulance services. It is clearly a supply chain management issue. Let us look at a couple of these :
Beds – As per medical statistics, only 10% patients require hospitalisation. With 35 Lakh active cases across the country, there is a requirement of 3.5 Lakh beds. India has 19 L hospital beds, with at least 7.6 L having oxygen facility. Thus, the availability of hospital beds should not have been an issue unless people are rushing to hospitals en masse, irrespective of their hospitalisation needs. Such a rush can happen only due to panic, against proper medical advice. Doctors have been repeatedly saying that most of the cases can recover with home-care only. Scarcity of Hospital beds is something that can be addressed through existing resources, albeit with proper planning, as shortage at one location could be fulfilled by surplus at another location, which can be safely managed by shifting patients thereat. In addition to this, the administration is also augmenting by way of make-shift hospitals set up in open areas, vacant buildings, stadia and other institutions.
Oxygen – Oxygen support is required for less than 10% patients, out of which some could be home-managed with portable cylinders and concentrators. With the sudden increase in numbers, demand for Medicinal oxygen has gone up multifold. While the requirement was 2800 Metric Tonnes per day (TPD) during wave1, it has currently gone up to 5000 TPD. The production capacity of the country being 7500 TPD (it is pertinent to mention that India has exported 9300 MT in the past nine months), we should have been sufficiently covered to meet this demand, except for issue of transporting the same from manufacturing to end-usage points. Shortage of cylinders for storage and Tankers for transportation are contributing factors for oxygen scarcity in the country. Some of the remedial steps that are being taken on priority are :
- Transporting Oxygen by Air and Trains, rather than relying on conventional road transport.
- Usage of Argon and Nitrogen tanks for transportation.
- Installation of Oxygen plants at various locations (preferably large hospital premises, to make them self-sufficient)
- Restarting dysfunctional plants.
- Import of Liquid Oxygen and Concentrators.
We could further look at mitigating this scarcity by optimising the oxygen requirements. This can be done by subjecting patients to Awake proning – a positioning technique. Moreover, supplemental Oxygen is required when SpO2 levels fall below threshold, whereas a lot of Covid patients under home-care start the same at even higher SpO2 levels, thereby increasing the demand for oxygen in excess of realistic requirements.
Shortage of these facilities has led to their hoarding, further compounding the problem. Black marketers are having a field day selling oxygen cylinders, concentrators and medicines at astronomically inflated prices. In sheer desperation, people are compelled to approach these agents, as hospitals run dry of both medicines as well as oxygen. In addition, people have started stockpiling oxygen cylinders, concentrators and medicines in anticipation, depriving those who need it badly.
It is highly debatable whether these shortages are real or perceived, but the fact remains that with 97% recovery rate in India, most of the patients should not be running after these facilities, rather concentrate on medical advice. Most of us ignore minor symptoms in the beginning and seek help only once the virus has progressed significantly in our body. Aversion to testing and wishful thinking of being covid-negative are two major deterrents to successful recovery. The key to fight the pandemic is – early detection, treatment and no panic.
The author publishes daily covid metrics on twitter @suneelwattal