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Public Health

Covid19 the real path to recovery

Since our last article, new Covid19 cases have started showing a declining trend in the countries most affected by the virus. India, on the other hand, has started showing a disturbing trend. The ‘42 day theory’ has held true for all the countries under study (except S.Korea, an outlier). Will it hold true for India or will India also be an outlier to this theory?

With declining new cases, the recovery rates and the mortality rates start to come in play. Countries that we studied are all exhibiting different recovery rates. What factors influence recovery rates? Do some countries have an advantage over the other?

India has also crossed 20K cases. Are the same states still contributing to Indian cases or are there new states with high growth? 

These are some of the questions we will try to answer in this article with the data that is available with us. And finally we will look at this week’s performance of states that we had identified as “Encouraging” states and “Worry” states in our last article.

But first we look at the CPM19 model Performance

CPM19 – On the Mark

The model has now caught the trend of all the 9 countries in study and for the last 3 days it has been predicting with almost 0% error.

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The significance of this is that now we are able to predict daily growth rate and extrapolate the growth rate for the next 10 days with little error. We used this to look at the next 7 days for the countries in study and it definitely looks like all of them are on the path to recovery, except India.

The 42 day Theory – Update

In our last article, we had postulated the 42 day theory. (Read it again) All but the USA, India and Sweden had gone below the 5% threshold as on last update.

USA – US was on its 45th day and we had predicted it will go below the 5% threshold on the 48th day. It went below the threshold on 48th day

Sweden – Sweden was on its 41st day and we had predicted it will go below the 5% threshold on the 42nd day. It went below the threshold on the 42nd day.

So, for the USA and Sweden, our predictions were right on the mark. Also, we had postulated that once any country goes below the 5% threshold on a 7 day rolling average, they really slow down. That theory also seems to be holding true. (See table)

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Except for Sweden which showed a slight increase on one day, all the other countries have shown a steady decline in their daily growth rates over the last week.

Unfortunately, the theory does not seem to be holding true for India. India is on its 38th day and with the current daily growth rate of India, we do not see India going below the 5% threshold till day 50. We are unable to predict beyond the 50th day for India as India has shown erratic trends recently.

On the 38th day, India stands 3rd behind USA and France in terms of seven day rolling average of the daily growth rate. With the trend seen in the graph India might breach the max mark.(See graph)

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The Recovery Rate

Different countries are showing different rates of recovery, even though they may be on the same life cycle of the virus. We looked at various parameters to see if we could identify the reason for difference in recovery rates. 

To begin with, let’s define recovery rate.

Recovery Rate  = Total number of recoveries / Total number of outcomes (death + recoveries)

We analyzed correlations between various parameters and recovery rate. We also checked the correlation of these parameters with the average daily number of cases reported after the 100th case. 

Parameters Studied

Test/Million – We looked at test/million as the first factor that may aid recovery and also may explain the number of cases. Surprisingly, test per million parameter had very poor correlation with number of cases and negligible correlation with recovery rate

Obesity Rate – We looked at the obesity rate of the country that is percent of people in the country who are obese. This had a strong positive correlation with the number of cases. This means that higher obesity rate resulted in a higher number of daily cases. There was also a moderate to weak negative correlation with recovery rate. Higher the obesity rate, lower was the recovery rate.

Overall Population Age – Average age of the population had no correlation with either recovery rate or cases reported

Percentage of population infected over 50 – Since age had no correlation, we looked at the percentage of infected out of total infected, that were over 50 years. This showed a strong negative correlation to recovery rate. If the percentage of infected over 50 years out of total infected was less, the recovery rate was higher

T Factor – We looked at the amount of tourists that visit the country. Our hypothesis here was that a popular tourist destination would be more susceptible to the infection. We indexed the tourists basis the total tourists that visited the country in 2019 and called it the T factor, This showed a strong positive correlation to the daily number of cases reported

CD Factor – We also looked at the Chinese Diaspora. We hypothesized that a higher Chinese Diaspora would mean more travel of infected population from China to that country, both business and tourist. This also has held true as there is a huge positive correlation between CD factor and daily number of cases reported

We take a look at the impact of these factors for each country. 

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India

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India is green or light green on all the parameters except test/mil. This clearly shows in the recovery rate. India needs to take care that its %infected over 50 does not increase. 

Also India’s total outcome percentage that is total cases that have had an outcome over total reported cases is very low (23%). So the recovery rate may fluctuate.

Italy

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Italy has a medium obesity rate and high T factor along with a moderate CD factor. Italy is also a favorite destination amongst the Chinese. This was one of the factors for initial infection. The fact that 71.2% of its infected cases are above 50, it has a low recovery rate also

USA

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USA has a high T and CD factor. Combined with the high obesity rate, it has the highest number of cases. Also the high obesity rate and 50% of infected people being above 50 has led to its low recovery rates. The outcome percentage for the USA is only 16%. We still await results in 84% of the cases

Iran

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We did not have the age of infected people in Iran so could not review the recovery rate versus age. Iran has low T and CD factors, however, we know from news report that the initial infections in Iran were from closer interactions with China, that rose exponentially because of a religious event in the area of the outbreak.

South Korea

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South Korea is the anomaly in our study with respect to Per Day Cases. South Korea has both a high tourist population from China and a huge Chinese Diaspora. But proper management of people inflow from China helped control the spread in initial days, though they did not ban travel from China. The latter increase in cases were attributed to patient 31 who was a super spreader. The source of that infection has never been identified but post that Korean administration did well to control the spread with aggressive contact tracing.

Spain

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Spain also suffered a lot in the initial days of the outbreak. However it was able to stabilize the growth rate. With a high obesity rate and a high T factor it has reported moderate per day cases and its recovery rate is also moderate. This is due to a high percentage of infections being reported in those above 50. Also 49% of the cases still are awaiting outcome, so the recovery rate may fluctuate.

Germany

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Germany has had the fifth highest cases worldwide. Most factors were poor or moderate. This has meant that Germany though has reported a higher number of cases has managed the infection well amongst the elderly. Infact, Germany was lucky as the infection came in the country through youngsters holidaying in Italy. Rigorous testing ensured that the asymptomatic cases were also identified so that they were not able unknowingly to spread the infection amongst the older population.

France

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Due to a high T factor and its popularity amongst the Chinese, France has seen high per day cases. It has a low recovery rate also as the majority of infections are amongst the greater than 50. Outcome% for France is also low at 38% so there could be an impact on the recovery rate.

Sweden

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Everything was in favor of Sweden, except the fact that it has a moderate obesity rate and it has let the infection spread amongst the elderly. It has the poorest recovery rate and the outcome% is also very low so that recovery rate may further worsen. Sweden’s main concern is the spread of infection in old age homes.

With only 34% of the cases that have had an outcome, this might be a little early to be looking at recovery rates but this gives us a direction of things to come. We will continue to track recovery rates across countries.

India – 20,000 and beyond.

India has become the 17th country to go beyond the 20K mark. It has crossed that mark almost after 3 months since the first reported case. Let’s take a look at the daily growth rate of new cases after India reported its 100th case.

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Although the trend is downward, it is not a rapid downward trend which is not resulting in a slow down for growth rate. India’s problem seems to be arising from the fact that new states keep emerging as growth drivers while not enough states seem to be slowing down. 

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We looked at which states contributed the most in the first 10K cases and then in the next 10K cases. While Maharashtra remained top in terms of contribution, Gujarat, MP and UP have taken over the top 5. These states are also growing at a much faster pace than even Maharashtra.

Story of the States

The Worry States

In our last article we had identified states that were a worry or were showing worrisome signs. The graph below shows their 7 day rolling average of daily growth rate since the last update

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The good news is that Delhi has definitely slowed down and the growth rate has now gone below 5%. Rajasthan is also showing some slowing trends as the growth rate has just gone below 10%. 

Gujarat, MP, UP and WB are the major cause of concern currently. All these states are trending higher than Maharashtra. Although, Maharashtra is slowing down its not slowing down fast enough. Since a high number of cases have already been reported in Maharashtra, a 10% growth rate also means around 500 to 600 cases daily in the current scenario.

Encouraging States

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The empty space above 10% tells the story here. All these states have now come below 10% and have stayed below 10% over the last 7 days. Haryana has joined Kerala in the below 5% club of 7 day average growth rate. Tamil Nadu also seems to be following suit. Karnataka and AP are two states that also need to slow down and get below 5%.

India’s Road To Recovery 

The road to recovery is highly dependent on the UP, MP, Rajasthan, Gujarat, Maharashtra and WB. 

These are also the most populated states of India. Except Rajasthan, they are showing a growth rate in excess of 10%.

Extreme poverty in these states means that they also have a huge migrant population.Residents of UP, WB and Rajasthan travel all around the country as migrant laborers which will put all the other states which have controlled the cases during the lockdown at risk. 

Daily wage workers form an important part of our agricultural and infrastructural economy, keeping them under lockdown for a longer period will also be detrimental to our economy. 

Unless these states show dramatic improvement May 3rd does not seem enough for India.

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.

In Collaboration with Parinay Pande

(Also published on LinkedIn https://www.linkedin.com/pulse/covid-19-real-path-recovery-sanjeev-prakash/?trackingId=4oI3Xc4ESvOb3m%2FU%2B2jOcw%3D%3D)

Categories
Public Health

A new approach to Public Health: Transforming Maternal and Newborn Care in Telangana

More than 659,000 newborn babies die every year in India. It is the highest number of newborn deaths in the world. The country also accounts for twenty percent of all maternal deaths worldwide, with more than 150 women dying in India each day due to preventable causes related to pregnancy and childbirth. Concerns about maternal mortality ratio and infant mortality rate keep surfacing. Both remain unacceptably high and too much focus is put on childbirth itself and not the periods before or after. India is committed to reaching the Global Sustainable Development Goals and achieving its own national development goals. To improve the quality of care during the intrapartum and postpartum periods, in 2016 the Indian Ministry of Health and Family Welfare released guidelines for the standardization of all labor rooms. This was primarily to reach development targets on maternal and newborn mortality. The guidelines help states reorganize their labor rooms for maximum efficiency and quality service delivery.

Categories
Public Health

Is having insurance (private and public) really the answer to India’s healthcare issues?

Reading Dr Vikram’s post on “is-health-insurance-the-answer-to-indias-healthcare-woes?” made me think. Well, in the United States, despite healthcare being the highest capita spend of the GDP as per Organization for economic Co-operation and development (OECD) survey. But yet still we are unable to meet the healthcare needs of the population. That made me think – Is having insurance (private and public) the answer to India’s healthcare issues?

I would like to give my perspective whether we should invest heavily in insurance and the role of the government, based on my knowledge of Unites States healthcare systems.

Categories
Public Health

How alcoholism is creating a socio-economic problem in India?

alcohol_india

Alcoholism has many negative connotations in India. Not only is it considered an unfavorable practice but also one which is banned on religious days. But the above graph shows a very different story with Alcohol indeed being consumed by 25-50 % of men in most regions of the country.

Though most of the recent references to alcohol are in the urban areas, where growing western lifestyle is seeing young men and women consuming beverages laden with alcohol, the severe socio-economic implications of this practice are in the rural hinterlands.

My interest in the subject started one day during the visit to Kerala. I was there to attend a Toastmasters conference and to my amazement I found out that all wine shops were closed in Kerala on the first of a month. This was because all salaries were given on the first and most men would take that money directly to the booze shop rather than the bank or the house.

In fact an average male in Kerala consumes 8 litres per capita that is double the country average for India. Some states in the country like Mizoram, Manipur and Gujrat have banned the consumption of alcohol. But still many other states have no such rules except the age limits.

Alcohol leads to some health implications, which in turn lead to economic implications for the affected families.

The most common condition associated with alcohol is cirrhosis of the liver. Other complications include- Diabetes Mellitus, Cancer, Coronary heart Disease, poisoning and epilepsy.

But the most important complication resulting from this is the addictive nature of alcohol consumption which often leads to repeat purchase and is currently driving the growth of the Industry. In rural India the use of alcohol leads to loss of pay. Most workers in these areas are working on daily wages and inability to work due to intoxicated state leads to this issue.

To add to this is the complex problem of not having Government health cover leads to these workers and their families taking loans from money lenders which finally leads to their perdition.

So alcohol in India has very difficult socio-economic questions. This can be sometimes the hidden cause for rural indebtedness and loss of pay.

Though some states have banned the consumption of alcohol, I think education is the best way to deal with the issue. Already some Government channels like All India Radio run programs in various languages focusing on the challenges with Alcohol and its implications. Also many NGOs have started working with women and educating them on the ills of alcoholic husbands on the family. Interestingly many estate owners in Coorg and Munnar now hand over the monthly salaries of the workers to the wife’s, so stop these men from wasting money on Alcohol.

As India chugs into a world of development, it is habits like these that keep the rural folks still in the dark ages and it is upto to society to take its destiny in its own hands by saying no to Alcohol.

As usual I would love to hear your views. How can we help people in the hinterlands overcome this addiction which destroys entire societies? Suggestions and thoughts welcome.

 

 

Categories
Healthcare Start ups Healthcare Technology Public Health

How Tele-medicine is changing Healthcare delivery in India

when we talk of tele-medicine the first thing that comes to our mind is helplines. Like the 104 helpline that has been running in Assam and Andhra Pradesh.  The success of the 104 helpline has led to it being set up in Karnataka as well.

But Tele-Medicine is more than just helplines. It is the delivery of healthcare consultancy, advice and treatment guidelines over technology negating the need for the patient and doctor to be co-located. It is nothing but the extension of how we work in virtual teams, connected by internet and telephony.

What makes Tele-Medicine a necessity in India is the distribution of the Indian population, 70 % of which is spread over 700,000 villages in India, most with population less than 1000 people. The second factor necessitating the need for Tele-Medicine in India is the lack of doctors and trained nurses. If current estimates are to believed there is a short fall of 600,ooo doctors in India. To add to it now we have low cost portable monitoring device like the $ 100 Ultra Sound developed by GE. and Finally we have the wide spread reach of mobile communication, where India has more mobile phones than toilets.

According to a report by Infinity research the global tele-medicine market is around $ 9 billion with a CAGR of around 20 %. But the Indian market is relatively very small at about $ 7.5 Million according to a quote from KSA Technopak in a Wharton interview.

When I was a practicing dentist, I would often receive telephone calls from my friends and relatives for advice on their dental problems. I have also analysed and studies X rays sent over MMS and SMS and given by diagnosis. So I was way into Tele-medicine space before it was established as a practice. Even today my colleagues  give advice and prescriptions to their patients over phone for non critical symptoms.

But the challenge remains can doctors make money by consulting over phone? Because the basis of capitalism is gtting compensated for effort otherwise the idea does not take off.

hellomy_logoIn my search for the answer, I came across the Hyderabad based start up “Hello my Doctor”. Founded by Raj SN, the venture is looking at ways to monetize phone consultations for doctors. ” Most Doctors are already consulting patients over phone” Says Raj, “Our vision was to create a platform by whoch doctors could provide consultation for their existing patients”.

The system is based on the simple fact that doctors should be able to provide preliminary care over phone and cal only those patients that require intervention to the clinics. That was both the doctor and the patientcan optimize their time.  Currently Hello my doctor has around 150 doctors already registered, and Raj and his team are embarking on the next step and that is to educate the patients on the advantages of Tele-medicine consulting.

The process is simple, the patients receive a toll  number and an extension number of the doctor they want to reach. The doctor chooses how much he wants to charge for the consultation. ” We usually advice the doctors to set limits per minute as it goes along with the call metering methodology followed by most telecom providers”

The patient has to buy coupons for various denominations from the site and then he can call his doctor. The doctor also sets the best times that he is available for the consultation. So this is a win win situation as the doctor saves time and gets paid for consulting over phone and the patient is able to talk to the doctor and probably avoid a visit to the clinic.

But doctors want more than just tele-consulting their existing patients, they would ideally want to take on more patients through this medium. and this is where patient education becomes important and a necessary step for the idea to succeed.

This model is  unique and has been successfully been implemented in UP by US based World Health Partners. They have set up an extensive Tele-Medicine network in UP, which has received almost 35,000 calls till date since 2008. All patients requiring intervention are then directed to WHP’s franchisee clinics in the area. The model covers Meerut, Bijnor and Muzzafarnagar. The solution is branded under the name of Sky Care Providers and Sky Health Centers. All of them are provided basic training and given infrastructure to enable them to run the Tele-Medicine centers.

Similar system is being run by Apollo group, Narayana Hruduyalaya, Aravind Eye Hospital and Asia Heart Foundation. But none of them have the scale currently to cover the entire nation.

In such a situation the state supported 104 numbers seem to be the best bets.  also in my opinion there is a need to develop these facilities with a focus on providing primary care and basic consultation which can cover the bulk of the Indian population.

But a public helpline number funded by Pharmaceutical and Medical Device firms seems to be another option that is opening up. Raj SN of Hello my Doctor is working on one such model.

Some very successful initiatives like the AIDs helpline in Hyderabad are a testament to the fact that Tele-medicine has a future in the country.”The AIDs helpline receives more than 700 calls a day” Says Raj “And that shows that there is a need”

In conclusion, Telemedicine is all set to erupt in the Indian Healthcare Space. What it needs is a push and hopefully efforts like the 104 numbers and ‘Hello my Doctor” would just give the right fillip to lead India to healthier times.