India has always been a spiritual nation. For the last 5000 years, we have believed that the source of our mental happiness and wellness is based on our spiritual way of life.
But the modern mechanical world has in a way disrupted that pattern and in the last 50 years, we have seen an increase in cases requiring mental wellness intervention. We also see an increase in cases where patients need counseling and therapy. While this is still an emerging trend it is believed that this year 2020, more than 20% of our po[ulation needs mental wellness interventions.
Covid19 has exposed the need for the same. It is believed that the number of people requiring treatment is almost 25% more than previously anticipated. Also, the infrastructure in terms of doctors, psychiatrists, and counselors is just not there. To discuss this and more Dr Sumeet Kad and I took up this issue in our third episode of India Health Talk. The link is below.
On the positive side, there is an increased awareness of the situation, also due to the rise of telemedicine, we would see an increase in the number of teleconsultations. However, the key is to increase awareness and not take your mental wellness for granted.
Just a few days ago I was on a webinar on Healthcare. The topic was the use of AI in Healthcare and the implications of Ethics in the same.
While all panelists spoke eloquently about the topic, I was trying to recall where have I seen AI in action in India. Unable to find too many instances, I spoke to my good friend and the editor of the New Age Healthcare Website Dr Sumeet Kad. Below is a recording of our interesting conversation.
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.
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
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)
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
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.
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.
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.
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.
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
Good States
States to be Watched
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.
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.
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%.
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.
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.
Change is difficult for all not only human. If you look back in human evolution you will find survival of the fittest. Change is never easy whether it is at work or at life specially when it is thrown at us without our buy-in. Many of us did not see COVID 19 coming. Hence, the resistance to accept the change it brought in our lives.
You have two choices – accept the change and find peace with it or rebel and go through the consequences.
Let’s start with good. The lockdown has brought us closer to our loved ones. I for sure have thought, what if these were my last 30 days of my life? What kind of legacy I want to leave behind? I want to be remembered as the perfect mother, a decent housewife, a great daughter, a helpful colleague and a best friend. Now, I have more time to spend with my family and loved ones. No more running Monday to Friday and then Saturday and Sunday to check off the list. COVID has taught me and reminded me of Mother Teresa and Mahatma Gandhi, Can I live a simple and peaceful life with bare minimum? Probably, we all could. Hence my request to look around and find happiness in what you have, what you have achieved and how you can help the needy or next-door neighbor. Once you accept the change you will find the ways to make best of it. Though it’s not easy, it is doable.
During such times, we are tested for our patience, endurance and adaptability quotient. At work, I have been asked to do more and better. As a working mom at home, it is quite challenging, when I feel, I am on the verge of breakdown. I look at my sister or friend who work at hospital. When we are locked down, she still had to go to work, risk her life and her loved ones to make life better for someone else. I find myself ashamed of not able to take this on. When my fellow nurses and healthcare staff going to much more than any of us are doing at home in our own comfort and away from sick and unhealthy. Imagine yourself in their shoes and you will find yourself – wearing masks and taking precaution, not only for you but all those brave souls who are risking their lives.
That’s not all, if you look closely you will find the worst affected ones – the small shopkeeper or hourly wages folks who barely had ends meet before COVID 19 and now struggling to survive each day. If you could just see past your uncomfortable zone, someone who lost family member to COVID 19 with no fault of their own. The anguish, pain of the young fellow who lost his job to COVID 19. Small business owners with loads of loan to pay and no hope of getting anywhere in near future. The mental state of such a human being at the verge of suicidal.
I found myself blessed and I want to share the joy I have with my kids, my family, friends and you readers. Reach out to your old friends whom you always thought of calling and never had time to make that call. Locked down in your own house is not easy for any of us but we can still do meditation, yoga, stretching to make ourselves ready for what’s coming next. Keep that hope alive, pass that unused food and items to the next-door neighbor.
Each drop of water counts – makes a difference. When you will look back after 10 years from now and recall COVID 19 – you should have a smile on your face and be proud of yourself. Until we find cure or vaccine to control COVID 19, my fellow friends I plead you to do your best to beat this – by keeping social distancing, wash hands, cover your face with mask and avoid gatherings. COVID 19 makes me find myself and taught me to accept today and enjoy it to the fullest as future is unknown for a short while.
About the author
Kiten Meena
A result-driven, enthusiastic healthcare professional with years of experience in healthcare information technology in the successful delivery of critical and strategic projects. The initial few years spent honing my analysis skills and building healthcare products.
Kiten has extensive experience in working with healthcare delivery, clinical optimization, health plans along with healthcare regulatory and compliance projects. With a Master’s in Healthcare Administration from the University of Southern California Sol Price School of Public Policy – I am interested in taking up challenges and work in patient care settings to improve the overall healthcare experience for all.
Last week I was at Hyderabad for a conference where the focus was on the elderly. India has roughly 120-130 million citizens above the age of 60, and this number is going to rise further due to better healthcare facilities and greater awareness of health. I also got a chance to visit my aunt, who had just recovered from fluid in the lungs. The whole visit to Hyderabad was an eye-opener for elderly care. I think we have a serious challenge in this space and currently, we have more questions than answers.
During the conference, I spent some time connecting with other healthcare professionals like Varma from Intel Health Innovation Group and Vikas Bhalla from Philips. I also had the opportunity to lead a panel discussion on how technology is helping increase access for senior citizens.
In the panel with me were, Dr. Mahesh Joshi, CEO Apollo Homecare, Vikas Bhalla – Director (Ultrasound,) Philips India and Rajagopal G – Founder CEO, KITES Senior Care. Raj and Dr. Joshi have worked extensively in senior care, both at the hospital level and services. The crux of the discussion was the breakdown of the family system that has led to a serious problem, with regards to caring for the elderly. This is more of a social problem. But it gets compounded by the fact that there is no one to care for the elderly. No one to care includes no one to monitor if they have taken their medicines on time or if they are keeping up their doctor’s appointment.
Also, we just don’t have the right number of qualified people to care for the elderly. Medical and Nursing schools are producing professionals who mostly cater to emergency cases and those that need chronic conditions. We are grossly under-equipped to take care of the physical and mental wellbeing.
To add to this we just don’t have the process in place to take into account, continuous monitoring using wearable devices. Also, there is no structure to incorporate that data into the health data to make the right decisions.
While there are many questions there have been some efforts in this space. A leading hospital in Bangalore is working on a model for remote patient monitoring of senior citizens at an old age home.
Gurgaon based Suvida is another venture in this direction where the Suvida Care Manager accompanies the elderly care recipient to the medical facility, takes detailed notes, including a personalized Visit Summary, and accompanies the care recipient back home, Suvida to become the first end-to-end medical coordination company, with a built-in unified user-first EMR (electronic medical record) system, so users don’t have to depend on individual medical facilities for their records.
While these are all steps in the right direction, the scale is clearly not enough to meet the demands of the nation. So the question to you is, is India really taking care of its senior citizens?
