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After the largest single-day increase in the number of novel coronavirus cases in India, it has never been clearer that the pandemic is upon us and the next few weeks are going to throw up a scenario that many still find hard to imagine. From the data we have, here’s a look at the near future, and what the Narendra Modi government needs to do.

India is hitting a period of exponential growth

It took India forty days to reach the first 50 cases, five more days to reach 100 cases, three more days to reach 150 cases and then just two more days to reach 200 cases. From here on, the juggernaut is going to roll fast.

The number of confirmed cases in India is now doubling in five days or less, down from six days earlier this month. This puts India in line with trajectories of countries across the world — in the United States, cases are now doubling every two days.

Italy discovered its first case 10 days after South Korea. For another 20 days it had less than 10 cases, even as South Korea’s case count began to rise steadily. But then in a span of one frightening week, Italy’s case count multiplied a hundredfold. Within the next week, South Korea began to flatten the curve, while Italy’s case count continues to skyrocket, completely overwhelming its health system. India needs to try to move its own growth curve away from the Italy trajectory, and fast, with strict implementation of the social distancing measures it has already announced, if not even stricter lockdowns.

Moreover, these are only confirmed cases; to ascertain the true number of cases, India will need to ramp up its conservative testing. On Friday, the Modi government took one small step closer to that by expanding testing to those hospitalised with respiratory distress who did not have known contact with a person with foreign travel history.

India is set for an explosion of cases

At this rate of growth, and assuming the 3.4 per cent fatality rate relative to confirmed cases calculated by the World Health Organization, India is headed for nearly a million confirmed cases by the end of May and over 30,000 deaths. These are conservative estimates. A team of bio-statisticians used predictive modelling and estimated that the number could be even higher, reaching nearly a million cases by 15 May instead.

Sudden single-day spikes, or a higher ratio of estimated to confirmed cases — nearly impossible to put a number to in the absence of more widespread testing — could tip these numbers higher, faster. By assuming that there are eight times as many undiscovered as confirmed cases, Indian software entrepreneur Mayank Chhabra estimated over five million cases and over 1.7 lakh deaths by the end of May.

Many people do not yet realise the severity of what lies ahead — these numbers are vital, particularly in the context of India where the majority of workers do not have job protections. A compensation package on the lines of the one announced by Kerala will be essential pan-India for the long haul ahead.

This will mean health systems will be overwhelmed

With a ratio of just 0.5 beds per 1,000 people as of 2017, India’s existing healthcare infrastructure will be swamped in the coming months. At the current rate of growth of confirmed cases, by early June, India will be out of hospital beds. Factoring in usual bed availability and a faster doubling rate, Chhabra estimates India will be out of hospital beds by the end of April.

The number of critical care beds and ventilators in India is not officially known, but is believed to be sharply lacking. With ICU beds estimated at 70,000 nationally, if even one out of every 10 cases was to require an ICU bed by the end of May, India would be running at full capacity, if not earlier.

Richer countries have struggled, with Italian doctors having to make the impossible decision of choosing who gets a ventilator and who does not, and the army being called in to produce medical supplies. The United States is heading there. Unofficial estimates of the number of ventilators in India stand at around 40,000. Yet, apart from assuring that there are “sufficient ventilators”, the Modi government has been thin on detail on the ramping up of critical care that it is, or should be, doing.

Some states in particular will struggle, hard

Indian states vary widely in capacity on all counts, including health. The poorest states are also the ones with the weakest capacity to deliver health outcomes. In June 2019, the Niti Aayog’s ranking of states on health found that “the health outcomes of some states are comparable to that of some upper middle-income countries and high-income countries (for example, Neonatal Mortality Rate (NMR) in Kerala is similar to that of Brazil or Argentina), while some other states have health outcomes similar to those of the poorest countries in the world (for example, NMR in Odisha is close to that of Sierra Leone).”

Bihar has just one government hospital bed for every 1 lakh people, while Goa has 20. In Italy, in comparison, the rate of infection has now reached 1 in every 1,280 people. Chhattisgarh has 71 per cent vacancies for specialists at district hospitals. Despite an established treatment plan, Uttar Pradesh has a treatment success rate of just 64 per cent for new microbiologically confirmed tuberculosis cases. Just 15 per cent of facilities at Bihar’s First Referral Units were functional.

There is no clear sign yet that the Modi government will be able to help these states make up for their lack of health care infrastructure, or, even, that it can be done at this late stage.

The time to act was yesterday.

The author is a Chennai-based data journalist. Views are personal.

This article has been updated to reflect that the number of ventilators in India, according to several statements, is 40,000.

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