Even as universal testing seems a challenge given the size of the country’s population, researchers at Armed Forces Medical College (AFMC), Pune, and at Indian Naval Hospital Asvini, Mumbai, are attempting to track, monitor, and help control the spread of the Covid-19 outbreak at a local level.
A paper recently published in the Medical Journal Armed Forces India has reported how researchers have created a ‘q-metric’, measuring the percentage of infective people who were successfully contained. Since the lockdown cannot be indefinitely continued, they suggest achieving at least a q-metric of 19 (where 19 per cent infective people are contained) or more, which would ensure the country stays within the projected healthcare constraints.
This is the second report on the mathematical modelling of the Covid-19 pandemic in India. In the new paper, ‘Coronavirus disease 2019 in India: Post-lockdown scenarios and provisioning for healthcare’, AFMC researchers Prof Kaushik Chatterjee, Air Cmde S Shankar, and Associate Prof Arun Kumar Yadav have identified healthcare manpower and intensive care requirement as key constraints.
The duration of the lockdown has become a crucial question. Using their mathematical model, the researchers assessed various hypothetical post-lockdown scenarios. At one end, the scenario of immediate resumption of free mixing of population since May 20 yielded a curve with the pandemic peaking by end of June.
According to the experts, at its peak, there will be 102 million active cases translating to peak critical care and ventilator requirements of approximately eight lakh ICU (intensive care unit) beds, representing 20 to 25 times of increase over current availability. In the other extreme, they looked at possible continued strict lockdown till mid-August. The isolation of 50 to 90 per cent infective persons, representing a q-metric of 50 to 90, would cause countrywide figures to reduce to less than 100 active cases. The actual situation, however, is somewhere in between.
“To ensure that healthcare resources are not overwhelmed, it would be crucial to keep the peak number of infectious cases below six million. At a q-metric of 19 — where it is possible to prevent 19 per cent or more of infected cases from transmitting the disease — the peak ventilator requirement will be 44,575, and India can then stay within the projected healthcare constraints,” states the study.
According to the authors, there is no ready surrogate measure available for the number of actual infectious cases in the population, to track the effectiveness of containment measures. An objective measure available is the number of deaths due to the infection on a given day, which can be indirectly extrapolated to the number of active cases in the population around two weeks earlier.
For this, there is a need to establish a monitoring system to be able to track if the measures of containment fall below the expected trajectory of q-metric of 19.
The authors have pointed out that quantification of critical constraints against the ‘q-metric’ – a measure that quantifies the current spread of the epidemic – gives a method to health planners to plan and provide for an adequate response to infrastructure, personnel, and other demands caused by the outbreak.
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