In the Russian roulette called coronavirus, India has a lot at stake

Living in the age of the new coronavirus is like playing the Russian roulette. It is true that the virus will not kill everyone, but nobody can predict which unlucky person, like in the roulette, will get the only bullet in the chamber. So, theoretically, everyone in this world is at risk.

Till a week ago, India was smug in the belief that the virus will not enter its borders. But, the virus has now reached several states — from Kerala right up to Ladakh — and new cases are emerging every day. There are fears that some people — like the recently diagnosed family in Kerala and the Italian tourists who travelled across Rajasthan before getting tested — may have left the virus in the community and its carriers are moving around the country.

Within a fortnight or so, we would know the exact status of the virus in India. The cases will either see an explosion, like in Iran and Italy, or remain low as they have in countries like Thailand, Malaysia, and Indonesia.

From the last week of January, when the first patients were diagnosed in Kerala, India had a six-week window of opportunity. While the numbers remained low, it had the time to stock up on necessary medical equipment, train medical staff, buy testing kits, equip hospitals with treatment and isolation facilities, and to run a contact-tracing programme to inhibit the spread of the virus. In a fortnight, we should know if the Indian government is ready.

There is enough data now available on the virus to predict the disruption it can cause and the mayhem it is capable of unleashing. Detailed studies conducted by the World Health Organisation (WHO) on around 50,000 cases have revealed three basic trends. One, around 80 per cent patients get a mild form of the disease and do not require any treatment. Two, about 15 per cent patients require hospitalisation; half of them need intensive care for 2-3 weeks, and between 2-4 per cent of the diagnosed patients can die of severe pneumonia. In theory, about 90 per cent of the population may not need prolonged and intensive treatment. But, this is where the good news ends.

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Since the virus is new, experts believe it might infect anywhere between 40-70 per cent of the world population over the next few months. Let’s put this figure in the Indian context: even if half of India (around 65 crore people) is infected, nearly 6.5 crore patients will require treatment in a hospital for weeks. (In comparison, the flu infects around 10 per cent of the population every season and its mortality rate is just 0.1 per cent).

Are we ready for this?

At the moment, we have around 1.6 million hospital beds in India. Most of these are already occupied by patients admitted for other ailments. In addition, the number of beds available in intensive care units — much lower than the desired 5% of hospital capacity — could be woefully inadequate to handle the crisis. So, if the doomsday predictions turn out to be right, Indian healthcare system will collapse under the attack of the virus —and just about two per cent patients might have access to any treatment.

The problem with the coronavirus is that if adequate treatment is not available, the mortality rate can shoot up drastically.

So, in the absence of critical care in a pandemic, there are fears of more people dying in countries like India because of lack of facilities. A study in Wuhan — the epicentre of the outbreak in China —revealed a mortality rate of around 5 per cent compared to a death-rate of just about 0.6% in the rest of the country. This ten-fold increase happened because there weren’t adequate number of beds available to deal with the crisis — only 110 in three hospitals treating patients. This is precisely why China built new hospitals in record time in Wuhan.

The other worrying statistic is the high mortality rate in the 65-80 age group. If you are young, healthy and a bit lucky, the chances of the virus killing you are just about 0.2 per cent. But, in people older than 65, it can kill anywhere between 5 to 15 per cent of the victims — a trend that’s underlined by the high mortality in Italy, which has a high proportion of people aged above 60. In India, around 6.5% of people are above 65 — that’s almost 8 crore people at high risk. Most of them are either poor, or live on meagre incomes, pensions, and doles. The impact of an outbreak can be severe on them.

There are already fears that the government has not done enough to take on the evolving pandemic. Hospital staff have not been trained or equipped with masks and other protective gear. The number of beds set aside for patients —Delhi has kept aside just 235 in 25 isolation facilities — is abysmal. And steps taken to prevent the spread of the disease — detection, contact-tracing, and isolation — have had major gaps, allowing suspects to slip away or even escape from hospitals.

This is what it means: An infection rate exceeding ten per cent (13 crore Indians) will lead to chaos, shortage of beds and, perhaps, an unfortunate increase in mortality.

The government — like Donald Trump who is now being branded a fool by experts in the US for his cavalier approach to the crisis — has so far believed the virus would either disappear with the onset of summer or not lead to a public-health crisis. We should all hope this faith is vindicated. But, the evidence so far to support the argument that the Indian heat would kill the virus is inconclusive.

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Let us hope the predictions are wrong and the virus will disappear soon without creating too many problems. But, if the crisis evolves the way it is unfolding in Europe and the US, India will suffer a lot of pain. There could be chaos as the healthcare system is put under immense pressure, mortality figures go up and the government finds itself caught in a war without any arsenal, strategy or ideas. Cities will have to be shut, make-shift hospitals will have to be built, and the public will have to be mobilised on an unprecedented scale.

In all likelihood, India is on the verge of facing its biggest crisis. How the country, its citizens, its healthcare staff, and leaders respond would decide how many of us survive the virus while it rages.

Let us hope the worst-case scenario never unfolds and the fears remain just that. But, hope doesn’t kill a virus or defeat an epidemic.