Capacity-need gap in hospital resources for varying mitigation and containment strategies in India in the face of COVID-19 pandemic

Abstract

Background Due to uncertainties encompassing the transmission dynamics of COVID-19, mathematical models informing the trajectory of disease are being proposed throughout the world. Current pandemic is also characterized by surge in hospitalizations which has overwhelmed even the most resilient health systems. Therefore, it is imperative to assess health system preparedness in tandem with need projections for comprehensive outlook. Objective We attempted this study to forecast the need for hospital resources for one year period and correspondingly assessed capacity and tipping points of Indian health system to absorb surges in need due to COVID-19. Methods We employed age-structured deterministic SEIR model and modified it to allow for testing and isolation capacity to forecast the need under varying scenarios. Projections for documented cases were made for varying degree of containment and mitigation strategies. Correspondingly, data on health resources was collated from various government records. Further, we computed daily turnover of each of these resources which was then adjusted for proportion of cases requiring mild, severe and critical care to arrive at maximum number of COVID-19 cases manageable by health care system of India. Findings Our results revealed pervasive deficits in the capacity of public health system to absorb surge in need during peak of epidemic. Also, model suggests that continuing strict lockdown measures in India after mid-May 2020 would have been ineffective in suppressing total infections significantly. Augmenting testing to 1,500,000 tests per day during projected peak (mid-September) under social-distancing measures and current test to positive rate of 9.7% would lead to more documented cases (60, 000, 000 to 90, 000, 000) culminating to surge in demand for hospital resources. A minimum allocation of 13x, 70x and 37x times more beds for mild cases, ICU beds and mechanical ventilators respectively would be required to commensurate with need under that scenario. However, if testing capacity is limited to 9,000,000 tests per day (current situation as of 19th August 2020) under continued social-distancing measures, documented cases would plummet significantly, still requiring 5x, 31x and 16x times the current allocated resources (beds for mild cases, ICU beds and mechanical ventilators respectively) to meet unmet need for COVID-19 treatment in India.

An Agent Based Model for assessing spread and health systems burden for COVID-19 using a synthetic population in Rangareddy district, Telangana state, India

“…In the present study, a decrease in number of contacts at various locations such as in schools, works, etc., was incorporated to enact lockdown scenarios whilst maintaining the contacts made at house [74]. It is evident from the results of present study that as the percentage of lockdown imposed was increased, the magnitudes of peak infections reduced with a delay in their corresponding occurrences, which provides more time for the policymakers to increase their capacities to meet the influx of cases.…”

“…In India, several COVID-19 models have been conducted based on Susceptible (S), Exposed (E), Infective (I) and Recovered (R) (SEIR) [14; 67; 74; 79], Susceptible (S), Exposed (E), Symptomatic (I), Purely Asymptomatic (P), Hospitalized or Quarantined (H), Recovered (R) and Deceased (D) (SIPHERD) [49], mathematical models [2; 68], etc., to compare the spread during lockdown and no lockdown scenarios. Nation-wide models restrict the policymakers locally to devise strategies based on the results as they might not fit properly to the locality [10].…”

Bed Surge Capacity in Saudi Hospitals During the COVID-19 Pandemic

“…An adequate measure of health system surge capacity involves different elements, including human resources, equipment, infrastructure, and management. 5,7,21,22 For example, the adequate capacity of general hospital and ICU beds should be supplemented by well-trained health workers and medical supplies for case management. 5,7 Therefore, the current estimate of health system capacity is underestimated since it does not consider other components of health system https://doi.org/10.1017/dmp.2021.117…”

“…Results from most countries, including the US, Australia, India, Italy, and Kenya, indicated a low adequate to inadequate general hospital and ICU beds capacity and insufficient staffing in the face of the COVID-19 pandemic 7,10,21,26,[28][29][30][31][32]. For example, the Kenyan health system surge capacity is somewhat adequate concerning the general hospital beds.…”

An Agent-Based Model to assess COVID-19 spread and health systems burden in Telangana state, India

“…Most studies from India on COVID-19 have largely followed compartmental approach adhering to either the basic Susceptible (S), Infective (I) and Recovered (R) model or its variations that include additional states. These include, the Susceptible (S), Exposed (E), Symptomatic (I), Purely Asymptomatic (P), Hospitalized or Quarantined (H), Recovered (R) and Deceased (D) (SIPHERD) [50], Susceptible (S), Exposed (E), Infective (I) and Recovered (R) (SEIR) [13; 66; 74; 78], analytical models [2; 67].…”