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Public Health

ICHA Mitra ….. An initiative to help our Corona Warriors

Indian Confederation for Healthcare Accreditation (ICHA) has launched the ICHA MITRA a portal to support all front line health workers during the Covid 19 epidemic.

The august fraternity of ICHA is collectively capable of addressing issues faced by Corona warriors through appropriate interventions is the main thought process behind the project.

“ICHA MITRA – From Fear to Care”   Implementation Steps

a.   An access platform has beencreated https://www.icha.in/mitra/ where presently, for one week only volunteer enrolment is being undertaken.

b. Constituent Associations are requested to disseminate the information and link  https://www.icha.in/mitra/ to their respective members to enrol as volunteers.

The aim is to generate a city wise and region wise database of volunteers / Nodal coordinators who would be able to render help to any Corona Warrior seeking help and support.

c.     All members of your Association requested to share and disseminate ICHA Mitra information on their social media through WhatsApp, Facebook, Twitter, Linkedin among others.

d.     The request for support/help received from Corona Warriors will be redirected to the respective city /area Nodal coordinator. (S)he  in turn, through a local WhatsApp group or other such means redirect to the Registered Volunteers or assign the issue to a particular volunteer on phone.

e.  The volunteer after determining the veracity of issue received will start resolving the issue on phone or escalation to appropriate levels – Regional/ State / National level. This will be done in a time bound manner with information to ICHA Team.

f.     An online briefing / training will be done to equip the volunteers and clear all doubts.

g.    The entire records and summary will be visible on a dashboard on the platform and the progress of each submission will be continuously monitored by the ICHA Team.

h.    This will be a yeoman service to our Covid warriors and build a credible connect amongst them – from fear to care and a feeling that they have support to bank upon – ICHA being “Main Hoon Na”.

Considering the situation this is a step in the right direction and hopefully, ICHA MITRA would support many health workers during this epidemic.

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Public Health

Covid19 – Data shows happy days will have to wait…

Lockdown 2.0 was supposed to get over today. Unfortunately, Lockdown 3.0 has been announced and we are now sitting at the cusp of 40K cases. We have gone from 20K cases to 40K cases in less than 2weeks, whereas the first 20K cases came in 2.5 months. Various states are showing a spike in cases, while new states are showing some disturbing trends. Is this the explosion that we were waiting for? Are we on the path of the US and Europe?

We look at the data and try to form a picture of the situation of India. We also take a look at the Indian States in clusters of the Encouraging States, the Worry States and the Emerging Bad. We also use CPM19 to see if we can predict how 17th May 2020 may look like for India.

Recovery Rate Update

We had introduced the recovery rate as a new parameter in our last article. In the 10 days that have passed since our last article, let us look at the recovery rates now. Green means improved from the last article and red means deterioration from the last article. Yellow means no significant change.

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Except for Spain all countries have either improved their recovery rates or stayed the same. France continues to recover poorly.

India With the World

India is on its 49th day after the 100th case. The 7 day rolling average of the growth rate for the country is 5.95%. When, compared with other countries studied it is the highest among all countries on their 49th day (See table)

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India, has clearly not followed the 42 day theory. To counter this we hypothesized that India should be treated as an amalgamation of several different countries. Hence, we broke India in 7 different parts basis cases reported. Maharashtra, Delhi, Gujarat, Madhya Pradesh, Uttar Pradesh, Rajasthan, and Tamil Nadu were taken separately and assumed to be a separate country. The remaining states were considered as ROI. When we look at it in this format, most of the states with a high number of cases are still at least 9-10 days away from the 42-day mark, except Maharashtra.

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As, it can be observed by the above table, most of the states are considerably slower than the other countries in the study as on that day. Even Maharashtra is slower than USA on the 40th day. ROI which is on its 45th day is also on the cusp of crossing below the 5% threshold. ROI had crossed the 5% threshold on the 42nd day but due to emergence of cases in Punjab it has gone above the 5% threshold again today.

India and Its States

In previous articles we had identified clusters of the state as

  • The Worry States – These were the states that had shown high growth in lockdown 1.0. These states were Delhi, Gujarat, Madhya Pradesh, Maharashtra, Rajashtan, Uttar Pradesh and West Bengal
  • The Encouraging States – These states were those that had shown signs of slowness in lockdown 1.0. These states are Andhra Pradesh, Harayana, Karnataka, Kerala, Tamil Nadu and Telengana

In this article we introduce a new category

  • The Emerging Bad – These states have shown sudden spurt of cases in lockdown 2.0. These states are Bihar and Punjab.

The Worry States

The Good news is that all the “Worry States”, 7 day rolling average of growth rates has now come below 10% (See Graph). The bad news is that even at this rate these states will continue to add somewhere between 1500 to 2000 cases daily.

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As you can see in the graph, states are showing trends of slowing down with UP and Rajasthan seemingly going below 5%, but until states like Maharashtra, Gujarat and Delhi come well below 5% there is little hope of a slowdown in these “Worry States”

These states are characterized by

  • High Positive% – The Positive%, which is total cases upon total tests is very high for these states. Except for UP and Rajasthan, the positive% is higher than 4% (the national average). Maharashtra and Delhi have a positive% higher than 7%
  • Low Outcome % – Only 26% of the cases have seen an outcome in these states. Outcome means that either a recovery or death has happened in that particular case. This is lower than the national average of 30%
  • Low Recovery Rate – The recovery rate is 86% which means in these states out of 100 outcomes, 86 people recovered. For states like Gujarat, Maharashtra and West Bengal it is lower than 80% which means that for every 4 people who recover there is one death.
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We will keep a watch on these three parameters to see if they improve over time.

The Encouraging States

Most of the states are now well settled under 5% growth rate except for Andhra Pradesh and Tamil Nadu. Andhra Pradesh also seems to be moving towards the 5% mark. Tamil Nadu is one blip on these states as after being well below 5% for a while it has now started moving up and has broken the 5% threshold. Tamil Nadu will be the state to watch

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These States are Characterized by

  • Low Positive% – Most of the states are well below 2% except Telangana and Tamil Nadu. Telangana also might be an aberration as the state has not updated its test numbers since 29th April.
  • High Outcome% – Almost 50% of the cases have seen an outcome in these states. Except for Andhra Pradesh, almost all states have an outcome% higher than 50%
  • High Recovery Rate – All the states have a recovery rate in excess of 90%. This means for every death in these states there are 9 people who recover. Kerala and Harayana infact are almost at 100% recovery rate.
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The Emerging Bad

Bihar and Punjab have shown growth trends in the past seven days that has motivated us to look at these states closely

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These states have a poor outcome%(this is because recency of cases) , although they seem to be doing okay with respect to recovery rate and positive%. These states will be monitored closely

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17th May 2020 – Where will we be?

The lockdown continues till 17th May 2020 albeit with some ease in restrictions. With economic activity starting again, the situation does not look like improving in the next two weeks. Using CPM19 we have tried to make some predictions as to where we might be on 17th May.

Although our daily growth rate will go down below 5%, but in terms of cases reported we will be hitting a peak by 17th May.

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Total cases according to the CPM19 Model will hit 75K. Our exponential growth curve would have started flattening but as of now it seems it will flatten only after reaching 100K cases.

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We have been in lockdown now for 40 days. In these 40 days we have ensured that we dont have a situation that overwhelms our medical system. But we have also failed to flatten the curve. At this juncture, if we see another exponential growth then Indian numbers will be very high and will probably end up going well past Europe by end of May. Instead of easing lockdown, the need of the hour is for a more stricter lockdown. Easing will just increase cases. Also as temperature is not playing any role in stopping this pandemic, India faces some tough days ahead.

On a brighter note, India seems to recovering well from the Covid19 with high recovery rates. If this trend continues then we may have a situation like Germany, high infections but low mortality rates. All we can now do is to try to stay as safe as possible because the next few days are going to be very risky.

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.

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Public Health

Covid 19: Reality check for India

By Dr Sumeet Kad

Today, India steps up its battle against Covid-19 by implementing a 12 hours self-imposed curfew across the nation, Many states have already declared the extended lockdown till March 31 and this could continue for even a longer period of time as the new cases keep rising. India’s approach has ranged from screening people at airport arrivals, evacuating citizen from foreign affected areas, shutdown of mass gathering and public places, requesting people with mild symptoms for undergoing self-quarantine and widening the criteria for testing to avoid spreading of community transmission.

But are these steps enough? The more important question being why India didn’t take any proactive steps to boost its healthcare system? India’s dismal health infrastructure can come under severe stress if the cases continue to rise. Clearly, with a bed: population ratio of nearly 1:1000 and less than 100,000 ICU beds, India is hardly prepared to confront this pandemic which can lead to severe consequences. Italy, the US, and China have 3.2, 2.8 and 4.3 hospital beds per 1000 people respectively and they are struggling to handle the coronavirus cases.

With inadequate insurance penetration, India population is largely dependent on public sector hospitals which are severely inadequate. Nearly, 75% of private corporate hospitals are located in less than 40 districts and over 80% of hospitals have less than 30 beds. Infection control, patient management and isolation standards are under severe doubts. There is also a huge deficiency of skilled healthcare professionals adding to the existing woes (doctor-populations ratio of 1:10000 which is way below the WHO norm of 1:1000).

India’s healthcare system is devoid of integrated and inter operable data systems and platforms. This along with non-standardisation and inadequate mobility of health records and data is a vital hurdle in deploying targeted, continuous and connected care. Digital infrastructure needs to be strengthened and monitored regularly. Such technologies can be very effective in isolating and diagnosing positive cases, as shown by state of Kerala.

From pharma side, India is overly dependent on China for bulk drugs or APIs (active pharmaceutical ingredients), around 70% of APIs need of India is catered by China. Now, with China being under indefinite lockdown, India will struggle to produce basic medicines for cancer, malaria, HIV and even antibiotics for its own usage. There is an imminent need to make India a manufacturing hub for APIs. India needs to invest in setting up R&D facilities and provide tax incentives to encourage API manufacturing within the borders.

For these steps to be implemented India needs to increase the budgetary spend on health from current 2% of GDP to 5% in next 5 years. This crisis does provides an opportunity to reflect on the failures and issues within India’s weak healthcare policies. A huge chunk of the government healthcare spending goes into urban-based infrastructure whereas the primary healthcare centers are being neglected since decades.

In this article, I have listed these challenges and measures that need to be taken by India to establish a robust healthcare ecosystem in the coming years. Time is right to evaluate and assess in these trying times and look into the future.

About the author

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

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Public Health

Combating ‘infodemic’ to tackle a pandemic

By Dr Sumeet Kad

As the global population is marred by the pandemic coronavirus outbreak, a flurry of websites, dashboards, online services and apps related to COVID1-19 are being encountered across the globe. These tools developed by tech giants, start-ups, govt bodies, and healthcare organizations provides relevant information about the symptoms, prevention methods, screening steps, tracking virus spread and offer advice to limit the risk to exposure. However, it is important for us to be aware of which are the most authentic ones to be visited.

Here are some of the latest ones which are out for all us to utilize:

Tech giant Microsoft has launched a new interactive dashboard to provide information on the spread of the virus. The map highlights the total number of cases so far (218, 400 as of today with 8500+ deaths in over 164 countries) which is further broken down into cases per country. The tool pulls live data from variety of sources such as WHO, the US Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and Wikipedia.

Quro is a Covid-19 risk assessment tool developed by Medius Health, an AI digital health company in Australia. This easy to use online conversational platform is in accordance with WHO guidelines, and aids in determining  your level of risk based on your symptoms, medical & travel history. It thereby provides accurate education to the public on the virus and collects data for healthcare providers for early intervention.

As increasing number of countries are shutting down schools and colleges, there are various online tools available which can be used by students and educators. Ekstep, an on-demand open learning platform, that facilitates creation and consumption of educational content. Plenty of educational content is available on the app which can be used by students in a self-paced manner. Online tutoring platform Vedantu is providing free live classes for all its courses including IIT preparation modules. Latest ed-tech unicorn, Byju’s, is offering free access to its learning app till the end of April.

Apart from this pandemic, populations have to address another menace in the form of false news, videos and content that are flooding social channels. To counter these, Facebook owned WhatsApp has launched a coronavirus-related information website in partnership with WHO, UNICEF and UNDP. This page has latest and accurate info for general population, governments and healthcare professionals enabling them to communicate efficiently in these tragic times.

Regional language content start-ups have started publishing accurate content in local languages related to coronavirus in order to tackle misinformation. Josh Talks has added advisories to all its videos on eight different languages and has also initiated a series of videos by doctors and healthcare professionals spreading more awareness about the disease. These videos are dubbed in local languages for people to easily understand. Local news platform Lokal, which delivers local news, information and classifieds to 900 million non-English speaking users in India, is amplifying awareness through sharing relevant and accurate info, emergency contact numbers, videos etc.

The novel coronavirus global pandemic is a medical emergency that requires a substantial individual effort as well to combat its spread and impact. We should make sure that only authentic information is gained and spread for the benefit of all.

About the author

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

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Public Health

The next 2 weeks are critical to stopping the spread of Corona Virus in India

As I write this the official government of India website is giving us the figures of 110 cases in India. Interesting the cases have doubled by the week. Most schools are shut and offices have been encouraging professionals to work from home.

Many in India feel that the worst is behind us but that’s not the case. Currently our testing rate is around 1.2%, this is higher than UK or France as we are specifically testing those coming from the affected countries, or those in direct contact with these individuals. Our next wave will come from those infected in India itself.

Source: http://truthdive.com/2020/03/13/covid-19-india-has-30-days-to-stop-the-start-of-stage-iii-says-dg-icmr-india-news/ and ICMR

If you refer to the diagram above you can clearly see that India is at STage 2 where we see local transmission from positive cases. But the next stage is where the infection spreads locally.

I had written a piece earlier on the similar guidelines for quarantine for keeping the infection in Stage 2 of STage 3. We also would have to stop mass gatherings, being prepared for the inevitable. Here is the link to the article. https://healthcare-in-india.net/uncategorized/key-steps-for-home-quarantine-during-the-corona-virus-epidemic/

Also, I believe it is important to refer to government sources when it comes to accurate data. I get most of my information from the Ministry of Health and Family Welfare Site or from other government sites like ICMR (Indian Council of Medical Research).

Most of our cases are in states like Kerala and Maharashtra which have a sound health infrastructure and would be able to prevent the spread of the disease. But at the same time, Awareness and Preparation are the two weapons we have that we have in our arsenal.

Please take care and please follow these simple steps to understand if you need testing at all.

https://www.mohfw.gov.in/FINAL_14_03_2020_ENg.pdf