Categories
Public Health

We might be seeing the end of the #Covid19 pandemic in India.

On 15th March 2020, India had just crossed 100 cases. Italy was at 24.7k cases, US at 3.6k cases, Brazil had just gone past 200 cases, Germany had crossed 5.8k cases and Russia at just 63 cases. In the last two months even with varying amount of restrictions, COVID19 has still wrecked havoc in these countries and the world.

No alt text provided for this image

With India now sitting at the threshold of 100K cases, we look at the effect various lockdowns has had on the Covid19 situation in India. We also take a look at how the countries continue to recover from COVID19.

We dig further in to our classification of Indian States with a new methodology that scores the states basis various parameters.

Note: We have removed Korea and Sweden from the study to Include Brazil and Russia. This gives us a better representation of the top countries with respect to no of cases reported

India and The world

On the 62nd day after crossing 100 cases India has the second highest daily growth rate (7 Day Rolling Average). If we look at the table only Brazil is ahead of India

No alt text provided for this image

India has had 3 Lockdowns and we will start Lockdown 4.0 from tomorrow. These lockdowns have ensured that we have done much better in the number of reported cases than other countries in the study. But has the curve really flattened out? When we look at the other countries, we see that most of the countries have nearly managed to flatten the curve albeit at a very high number of reported cases. Currently on a logarithmic scale India, Russia and Brazil are showing strong signs of growing while other countries have a flat curve.USA, Italy and Iran have all flattened their curve. (Spain and France also show a flat curve though not included in the below graph)

No alt text provided for this image

For India, the lockdown has ensured that we miss the steep growth path of other countries but we are still poised to hit a huge number, albeit at a slower rate. This means we have just prolonged our battle with the disease.

Although, India may seem to be trending towards a higher number of cases all may not be lost. India is doing well in terms of its recovery rate and outcome percentage.

Recovery Rate

Recovery Rate, i.e. no of people recovered by total outcomes continues to improve for the world and for India. India’s recovery rate has now crossed 90%. For the world it stands at 85%. The other countries in the study have also improved their recovery rate

No alt text provided for this image

Outcome Percentage

Recovery rate should be studied along with the outcome curve, i.e. how many cases have had an outcome with respect to active cases. For e.g Russia has a 96% recovery rate but 76% of the cases still await an outcome. Similarly Iran has a 93% recovery rate at a 85% outcome rate which more or less signifies the actual recovery rate for the country.

No alt text provided for this image

India has a good recovery rate with a decent outcome%.

Net Active Cases

Definitions

Net Active Cases = Total Cases – (Cases Recovered+Total Deaths)

India’s Net Active cases are at just a little above 53K. Except for Iran and Germany, all the other countries are much ahead of India. With India’s high recovery rate, it clearly shows that India is also recovering at a much higher pace than the other countries.

No alt text provided for this image

India has also seen a declining trend in the net active case added each day. In the past seven days we have added around 1700 net active cases per day compared to higher than 1900 net active cases in the week before.

No alt text provided for this image

This is a positive sign for the Indian Medical Fraternity as the reducing number of new active cases added does prevent the medical system from getting overwhelmed.

Lockdown Effect on India

When we take a look at the effect lockdown had on our growth rates, it can be observed that lockdown 1 certainly slowed us down, but lockdown 2 and lockdown 3 failed to have the desired effect of flattening the curve.

No alt text provided for this image

If we look at the Indian States, Maharashtra has had no effect in the lockdown. Its contribution to the cases in fact has grown during the three lockdowns.

Similarly Delhi is another state that has been contributing heavily during the lockdowns showing minimal effect of the lockdown.

States Classification

We have changed the methodology of classification of states (Good, States to be Watched and Worry States) from May onwards. We were classifying the states on the basis of their 7DAGR only. Now we have also included the following to arrive at a weighted score

  • Total Cases Reported
  • Cases/Mil
  • Test/Mil
  • Growth Rate
  • Positive%
  • Outcome%
  • Recovery Rate

Basis these parameters we have arrived at a group of 

  1. Good States
  2. States to be Watched
  3. Worry States

The Good States

As on 16th May 2020, the following states qualify as the Good States. These states are characterized by low growth rates, low cases/million, higher Outcome% and high recovery rates.

No alt text provided for this image

Haryana – Haryana has seen a recent spike in cases most of which are related to Delhi. Haryana, despite being surrounded by Delhi, UP, Punjab and Rajasthan (All these states have high number of cases) has done very well in terms of new cases. The Growth rate is below 4% and with aggressive testing it has maintained a low positive percentage also.

Jammu And Kashmir – This state saw a huge spurt in cases during the first lockdown. Most of the cases here were either linked to the religious event in Delhi or pilgrims returning from Iran. The state was once a worry state and now has come in the good states

Karnataka – There has been spurts seen in state but overall the state has maintained its low positive percentage and cases/million. The recovery rate is a bit lower compared to its peers but with outcome% also below 50%, the recovery rate may go up.

Kerala – This state was on its way to 100% recovery but with the return of Migrant Populations and Expats, there has been a minor spurt of cases. It will be interesting to see whether Kerala is able to control its cases as it had done previously.

Punjab – Punjab had more or less weathered the COVID19 storm in the first two lockdowns, but a sudden upsurge of cases from the last week of April saw Punjab come in the “Emerging Bad” category in my last article. But it has been an aberration due to infected pilgrims returning from Nanded and Punjab has controlled the situation well, to move in to the good states.

Jharkand – Less number of tests, but lesser cases and growth rate puts this state among the good states.

States to be watched

These states are those states that have either started showing a positive trend i.e. moving from a Worry State to a Good State or a negative trend i.e. moving from a Good State to a Worry State.

No alt text provided for this image

Andhra Pradesh – This state is on the way down and will probably move towards the good states in a day or two if the trend continues.

Madhya Pradesh – Another state on the way down. This state was showing alarming trends during the month of April and was a worry state. It has still not completely slowed down but is definitely on its way down

Odisha – This was an encouraging state but recent trends show a very huge growth rate and will probably move to a Worry State soon.

Rajashtan – Another state that was showing huge growth numbers in April has slowed down very well. It had moved down to a good state but another spurt of cases moved it back to States to be watched

Telangana – We are not sure of the numbers for this state as they have stopped reporting number of tests done. Hence we are keeping this state as a state to watch

Uttar Pradesh – Like Rajashtan, UP was also supposed to burst with cases. But UP has maintained its trend, although a lot more testing needs to still happen in UP.

The Worry States

The States that add most to the growth of the Indian cases have been categorized as the worry states. These states have high number of cases, a higher penetration of cases in the population, a high positive% and low outcome%.

No alt text provided for this image

Bihar – We had categorized this as an “Emerging Bad” State in our last article. It has now turned as a worry state. It has poor testing, a high growth rate and a low outcome%. This state may become a major problem especially with the migrant population traveling back.

Delhi – Delhi has tested a lot but it still has a high positive% and a high penetration rate. Delhi had slowed very well but with opening up of the wholesale market, cases have started zooming up again.

Gujarat – Gujarat was showing signs of slow down but still has a long way to go before it comes into a good state. high number of cases, poor recovery rate along with a sub 5% growth rate is making this state a huge worry for India.

Maharashtra – The state that refuses to slow down. Even after 54 days of crossing 100 cases the states growth rate of cases is still above 6%. This state has not slowed down once and daily number of cases have just shown an increasing trend. This is the most worrisome state in India, more so because of poor recovery rate also.

Tamil Nadu – A Covid19 explosion in one of its market turned this good state in to a huge worry state for India. This state is seeing a resurgence in cases after it was able to contain very well the effect of the religious event in Delhi, surge. The good part is that recovery rate is very high but still outcome% is very low.

West Bengal – Poor testing, High Growth Rate, very bad recovery rate along with questionable data sharing makes this state a time bomb. This state may explode or already has but we do not have the data for it.

In all, these worry states have to slow down. If they slow down and go below 4% India will see a reduction in cases. Also we should hope that in the coming days the list of Good States increases and worry states keeps going down.

CPM19 – The Road Ahead

On 2nd May, we predicted 75K cases for India by 17th May. There was another projection that the model made which showed more than 100K cases which was rejected as we were quite hopeful that growth trend would stabilize and we will not cross 3000 cases added per day.

This has not really happened and India has infact overshot our number by at least 18k cases. Nevertheless we will still try to predict the number for 31st May using this model.

We have used the CPM model to predict the growth trend for the states basis their classification as The Good State, States to be Watched and The Worry States. The prediction shows that by end of May we may very well be close to 150K cases. That’s another 60K cases in the next 15 days. The good news is that we may start showing a slow down in new cases reported after reaching a peak of close to 4900 cases per day. This may mean that we might start flattening the curve by end of this month.

No alt text provided for this image

If our prediction holds true we may see a step towards the end of this pandemic in India although as we said before the road to recovery is a very long one. Also as India continues to ease the lockdown the road ahead may still be very bumpy.

About the Author

Sanjeev Prakash is an Analytics and Marketing professional with more than 12 years of experience in Analytics, Data Management, Sales, Brand Management, Corporate Communications, Market Research and Customer Relationship Management. Sanjeev has an MBA from IMT Ghaziabad and a degree in economics.

(Article also published on LinkedIn: https://www.linkedin.com/pulse/covid19-india-fights-back-sanjeev-prakash/?trackingId=D3q6XmsjQ%2B%2BWS1bIqQe8ow%3D%3D)

Categories
Uncategorized

Telemedicine services critical to the wellness of senior citizens in India

On my 43rd birthday, I received an unexpected gift with the Medical Council of India along with Niti Aayog released the guidelines for the use of Telemedicine in India.

It was ironic as MCI and other state associations have been fighting a battle to stop teleconsultations and putting regulations around it. But the coming of Covid19 has changed all that.

Today after a long time we have a spurt in telemedicine providers in India. Industry experts like Bharat Gera former CIO of St Johns Hospital, are working with bodies like Telemedicine Society of India to put in a process to benchmark the functionality of these providers.

In the long run, I see this as a very positive move for senior citizens. These individuals fight it difficult to access healthcare. Especially as they have chronic conditions that need management, right from transportation, to long hours in the waiting room.

To discuss this and other associated topics, I got together with industry experts like Ravi Ramaswamy from Philips to discuss the impact telemedicine would have on seniors. We were joined by Dr Neeraj Bhalla and Dr Vallikiran to discuss the impact on areas like Cardiology and Psychiatry respectively.

The recording of the session is below.

I believe that Telemedicine is a boon to seniors. There would be a learning curve with respect to getting used to the platform, training to caregivers, and then managing concerns like security. But I think Telemedicine is here to stay.

Categories
Nursing

The evolving role of nurses during Covid19 thoughts on International Nurses Day

Today we are in the midst of one of the largest epidemics that the modern world has seen. As we write this India has been under lockdown for the last 60 days. Covid19 has put healthcare back on the main agenda for most public policymakers. While doctors and hospitals being recognized in this fight, the real soldiers in this war are the nurses. In any healthcare set up, its the nurses who are in the trenches, fighting day in and day out against known and unknown elements. Some time ago we had written about how the nursing services were at the cusp of change. Today we focus on how the role of nurses evolves during pandemics.

Nurses today are leading from front. They are the managers at forefront at bedside of the patients, keeping them on the path to recovery. Therefore it is importatn that we keep nurses motivated and inspired to stay on with enthusiasm in the Covid Era. On this international Nurses Days, we spoke to Col Binu Sharma, Vice President for Nursing Services at Columbia Asia Hospital. Col Sharma entered the nursing profession almost 40 years ago in 1977. She has been in charge of nursing at Columbia Asia since 2007. Today her organization has more than 2000 nurses and technicians in hospitals across the country. Below are some excerpts from the interview

Healthcare India: Nurses are the backbone for our healthcare system, how does their day to day role change during epidemics?

Col Binu Sharma: Articulating the changes in the nurses’ role during a global health crisis is helpful for communicating a plan to decrease the spread of disease and for implementing improved policies, procedures, and supplies. The nurses are not only the backbone of the health care team but they are the most important link in the health care delivery system.

During epidemics, the nurses become the “role models “rather than merely playing various day to day roles. The role of the nurse changes to adapt to the needs of the patient, their families, the hospital, and the community. During such crises nurses take up leadership roles at the forefront like this time in the fight against Covid19. They not only add to the development of policies to fight epidemics or pandemics but they also prepare for, identify, respond to, and direct recovery efforts from global epidemics that require an informed, coordinated response.

Healthcare India: What kind of training is provided by the nursing colleges to handle these situations as part of the curriculum?

Col Binu Sharma: In the revised basic nursing curriculum the Indian Nursing Council has included 100 hours of theory & 160 hours of practical to teach budding nurses on the various aspects of epidemiology & standard treatment protocols.  For community health practical the nurses are put in clinical areas in the remotest villages  & they are introduced to nursing care services in resource limited setting and they are given ample opportunities to link theory to practice in these sort of situations.

In fact the entire nursing curriculum and training is about learning to face the most complex and adverse situation with positivity & humility.

Healthcare India: What measures and steps have you initiated in your career to help nurses deal with epidemics?  

Col Binu Sharma: We have initiated many steps including

·        Improved engagement and networking

·        Providing job security and reassurance, Flexi hours, psychological counseling and support to relieve anxiety

·        Encouraging fun activities, quiz and other relaxation measures

·        Focus on their health screening, regular meals, hydration, power breaks, resting zones in hospital. Transport to pick up and drop

·        Provided with digital platforms, webinars to connect for training, live demos and team communication

·        Provided scope for continual training & development. Formulate revised SOPs based on protocols from various authorized national and international resources. Training on Infection control procedures, employee safety, and patient-related revised disease protocols

·        Supporting with adequate resources, manpower, medical disposables. Ensuring quality and quantity of personal protective equipment and other safety attire

·        Encouraging team spirit by listening to their needs, regularly talking to them, helping them, guiding & mentoring them and most importantly leading the way

Healthcare India: What are your recommendations that we are better prepared for the future?

Col Binu Sharma: No amount of preparedness can predict success or failure in the future but being prepared always helps us to develop a positive outlook.

  • Factors like creating awareness among the community, development of infrastructure of the health care system especially in rural areas , educating the population at the rural sectors, providing safety & security to health care workers may help us deal with future occurrences of epidemics & pandemics in a much more coordinated manner.
  • Keeping our nursing workforce well trained with mock drills on disaster preparedness
  • Keeping database of ready nurses to be hired in case of such emergencies
  • Developing mentors for taking higher responsibility
  • Engaging and education society in some of the recommended measures of hand washing, social distancing, respiratory hygiene, sharing right information with hospitals  are some of the regular improved measures.

It’s good to see nurses leading the fight, but as Col Sharma says in her interview, a lot of care and thought has to be given to keep the nurses encouraged and prepared to deal with the ever-changing complex scenario that has become Healthcare in India.

Categories
Healthcare Technology

Healthcare India among the top 100 Health Tech Websites in the World

Healthcare India has been again listed in the top 100 Health Tech Websites and Influencers for 2020. It has been a great comeback for us considering only a couple of months ago the site was hacked. The hacker not only added himself as admin but also created 1 lakh junk pages and google had blacklisted the site.

Due to the efforts of Ganesh Acharya our Chief Media Officer we were able to come back, and back into the top 100.

Healthcare India as a forum was created to address the lack of access, poor quality, and improved outcomes for millions of Indians. We believe this is possible only through technology and better processes. This new recognitiion helps us to strive harder to improve healthcare in India.

Also a shout out to our friends from HCIT and New Age Healthcare for being listed in the top 100 as well. Making India proud.

Below is the list of the top 100 Websites and influencers.

Categories
Healthcare Delivery

Regular patients are severely affected as India battled Corona Virus

In the last week of April 2020, a septuagenarian in the state of J&K who was a renal dialysis patient for 2 years, was asked to get his next round of dialysis from a private nursing home as the hospital where he normally went for treatment refused the dialysis procedure since the entire hospital was converted into a COVID care center. The nursing home neither had the apt infrastructure nor the skilled personnel to handle any kind of complications that is common during a dialysis. Unfortunately, the patient died in less than a week. Another dialysis patient in Mumbai had to wait for 7 hours for treatment as he was not carrying his covid test result report. Around 1,30,000 patients are on dialysis in India and most of them depend on private dialysis centers.

In another caustic case, last week, a 25 yr old pregnant woman in Delhi, visited 2 of the leading government hospitals in Delhi for antenatal care. Both the hospitals denied her admission as she was not Covid-19 positive. As a result, she visited 6 hospitals and maternity clinics in next 48hrs before giving birth outside AIIMS. Many hospitals and nursing homes are completely shut even if one case comes up in them.

There are a plethora of such cases rising across the country as our healthcare system is under stress from managing the contagion outbreak. This is despite the fact that the Government of India has asked state chief secretaries to ensure that hospitals and clinics do not ask for a Covid test report from every patient who requires medical treatment. This raises red-flags and serious questions on the local authorities and regulatory bodies who have also threatened to cancel the operating license of hospitals and clinics if they turn away any non-Covid patient. Patients also fear the escalated economic cost if their treatment cost is not claimed or reimbursed as not all nursing homes and clinics fall under health insurance policies.

Similar danger mounts on Cancer and TB patients. India has the world’s largest TB load of 25%. In Mumbai, due to COVID, lack of adherence to TB drug regimen has risen to 40% from 15%. A significant decrease in TB notification has been witnessed which indicated that access to a TB center and subsequent diagnosis and reporting has been severely hit. These are dangerous signs which are being ignored. A TB patient can infect 10-15 more, and such patient can become a breeding-ground of new Coronavirus cases as Covid hits hard on low immunity patients. Many senior oncologists have claimed that due to difficulty in travelling during lockdown, many hospitals not providing regular treatment, hospitals shutting down and fear of contracting covid, have resulted in a delayed diagnosis of cancer patients which can push them to an advanced stage of cancer.

There has to be clear and stringent guidelines by MoH to each state health authorities highlighting the delirious effect of not providing critical care to non-Covid cases. State should ensure that no patient is denied treatment for any ailment by a hospital (government or private). Instead of shutting down the entire hospital even for one covid case, a wiser approach of creating zones within the hospital can be implemented. Online, phone consultation and Tele-medicine modules should be made widespread thorough proper communication channels.

Our healthcare infrastructure is one of the weakest in the world with a lack of adequately qualified health care professionals adding to the woes. We certainly can’t afford to inflict more burden on the already fragile healthcare services by denying treatment to those who are in need.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care