COVID-19: ICMR study hints a quarter of India may be affected

Mathematical modelling indicates worst-case scenario may take death toll to 0.7 mln

By Banjot Kaur
Published: Tuesday 24 March 2020

As many as 348 million (34.8 crore) Indians may be infected by the novel coronavirus (SARS-COV-2). The pandemic (COVID-19) may eventually leave more than 0.7 million dead in a worst-case scenario, according to a mathematical modelling by the Indian Council of Medical Research (ICMR).

Down To Earth considered India's population at 1.34 billion to interpret what the ICMR wrote:

According to the reports from other affected countries, we may expect eight to ten severe and 40-50 non-severe COVID-19 cases for every death. In a closed setting of a similar nature, as that on the cruise ship ‘Diamond Princess,’ we may expect 26 per cent of the entire population to get infected and one in 450 infected individuals to die.

The focus of the analysis was not predicting the disease burden, but identifying rational interventions.

The report stressed that any containment strategy — “no matter, how aggressive it was” — would be negated if it focussed only on symptomatic cases. Asymptomatic cases “escape detection and can go on to cause onward transmission in the community”, it noted.

Researchers noted this in context of passenger screenings at airports before flying was stopped.

“Identifying at least 75 per cent of asymptomatic individuals is needed to delay the within-country outbreak by an appreciable amount. Additional detection of 90 per cent asymptomatic individuals would delay the average time of epidemic by 20 days,” the paper read.

Screening through measuring temperatures was not fool-proof. The paper quoted two studies to suggest that 46-50 per cent passengers may have been missed in screening and that India’s experience was no different.

What if it was

“Our analysis showed that even if symptomatic cases were comprehensively identified and quarantined, the delay in epidemic within India would be in days and not weeks,” it said.

It added that the screening would only delay the onset of infection and not prevent or mitigate it. Mounting a good public health response is the need of the hour.

The paper also highlighted the need to stress on finding symptomatic cases. The ICMR expanded its testing criteria only three days ago by allowing screening of people with severe respiratory illness without a history of travel or contact.

The paper predicted two reproductive numbers (R0) — the rate at which carriers can infect other individuals.

In the worst-case scenario, R0 could be four; in the most optimistic or best-case scenario, it could be 1.5.

The global average R0 is two-three. For Italy it is three.

The social distancing measures mounted so far would reduce the incidence by 60-62 per cent, the paper said. The possibility of interrupting chain of transmission was feasible only in the best-case scenario, it added.

India banned all international flights on March 22. The probability of an infected air traveller coming to India was only 0.209 per cent, with the highest relative import risk in Delhi (0.064 per cent), followed by Mumbai, Kolkata, Bengaluru, Chennai, Hyderabad and Kochi, the paper said.

Researchers added that it was difficult to make projections of the number of beds required, but deduced that around five per cent of infected patients will require intensive care and half of those admitted in the intensive care unit will require mechanical ventilation.

Healthcare workers should be provided insurance facilities if infected. They should be provided personnel protective equipment well before the outbreak peaks in India. Till the time public health response is scaled up, Kerala-like measures must be introduced to assure food supplies to people, the paper recommended.

The research was hypothesised on basis of four metropolitan cities. Rural areas were not accounted for.

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