key: cord-0812969-g88ke56h authors: Singh, Vaibhav Pratap; Haribabu, P.; Bindhumadhava, B.S. title: COVID Curve Guides India’s Health Infrastructure Growth Needs date: 2020-06-19 journal: J Emerg Nurs DOI: 10.1016/j.jen.2020.06.007 sha: 3202fa01e5a47cbd3437f2059d180939795a0ed4 doc_id: 812969 cord_uid: g88ke56h COVID-19 has led to many unprecedented situations across the world. With lockdowns and severe restrictions on movement and activities, countries have managed to slow down the COVID curve but developing countries like India are likely to face a humongous task of containing the virus spread in coming months. High population density, continuing economic activities, movement of people etc. will keep causing newer hotspots across India. We look at the compounded daily growth rates (CDGR) of USA, Spain, India and Brazil over the duration of the virus spread since January, 2020. We also analyze the correlation between the total cases and active cases across India. We estimate the projected number of beds, ICU beds, oxygen support and ventilators for different CDGRs in the coming months and also define a metric target to control the virus spread through various preventive measures. Abstract 2 COVID-19 has led to many unprecedented situations across the world. With lockdowns and severe 3 restrictions on movement and activities, countries have managed to slow down the COVID curve but 4 developing countries like India are likely to face a humongous task of containing the virus spread in 5 coming months. High population density, continuing economic activities, movement of people etc. will 6 keep causing newer hotspots across India. We look at the compounded daily growth rates (CDGR) of 7 USA, Spain, India and Brazil over the duration of the virus spread since January, 2020. We also analyze 8 the correlation between the total cases and active cases across India. We predict the projected number 9 of beds, ICU beds, oxygen support and ventilators for different CDGRs in the coming 3 months and also 10 define a metric target to control the virus spread through various preventive measures. be effective measures in slowing the COVID curve in many countries. With the world starring at an 20 economic recession, many countries across the world have slowly and steadily started easing their 21 respective lockdowns in the hope that the above stated measures will prevent an uncontrollable rise in 22 COVID cases. In this letter we discuss why the cases will keep on increasing especially in the countries 23 with high population density pockets, analyze the growth rate of COVID cases, define metrics leading to 24 flattening of the COVID curve and also discuss the rate at which countries should scale up their health 25 infrastructure in the coming months. Although the analysis is generic and shall apply to other countries 26 as well, we take the example of India which has conditions like high population and its density, large 27 economically vulnerable population due to multiple lockdowns, developing health infrastructure etc. 28 Multiple lockdowns, since 25 th March 2020, have immensely helped in slowing the COVID curve in India 29 and have given the much needed time to the central and state governments to scale up the health 30 infrastructure as well as to sensitize the population on various preventive measures which will go a long 31 way in keeping the curve within control in the coming months. Economic slowdown has caused large 32 scale migration from urban pockets which in turn have led to an increase in the COVID curve in India. 33 Thus the government has started relaxing the lockdown to start various organized and unorganized 34 economic sectors, ease the movement of people etc. in a bid to give relief to the ones in need. Such 35 relaxations, coupled with the large population and its density, are likely to increase the COVID-19 cases 36 in the coming months. 37 Highlighting the federal government structure in India, the COVID containment strategy has been 38 implemented state wise. Various Indian states are adopting a strategy of 14-days quarantine for any 39 individual coming from outside the state. But the number of individuals coming from outside the states 40 is huge. For e.g. Bihar is expecting a total of 27 lakhs migrants to come back 2 . Institutional quarantine 41 has its own infrastructural limitations. Home quarantine seems to be a possible option for asymptomatic 42 and mildly symptomatic cases but should be implemented in a strict manner. The social fabric and the 43 culture of joint families shall help in the successful implementation of the home quarantine scheme. we focus on combing only the hotspots, the high number of asymptomatic cases will keep on causing 51 more hotspots at different locations and further a person tested today might get infected tomorrow due 52 to easing of lockdown norms. 53 The disease incidence usually decreases only once herd immunity is reached in a community. Herd 54 immunity is a phenomenon where a considerable size of a community becomes immune to a particular 55 communicable disease thereby reducing the number of disease carriers 45 . Usually vaccination assists in 56 achieving herd immunity but a vaccine for COVID-19 looks far away. The other method is of natural 57 infection where a sizeable portion of the community is exposed to the virus in a controlled manner such 58 that they develop antibodies in response and become immune to the disease 6 . In such natural 59 infections 19 is predicted to be between 2 and 3 910 11 . Thus according to the below given equations, the threshold 68 population to reach herd immunity shall be between 50 to 66.66% 7 9 . In a country like India, with a population of 1.37 billion 12 , the threshold to reach herd immunity will be 75 91.32 crore. The COVID-19 curve will flatten either when the total number of COVID-19 cases will start 76 approaching the threshold herd immunity population or when all the current cases (both symptomatic 77 and asymptomatic) will be strictly isolated and no new positive cases will be allowed into the 78 population. Both the conditions are extremely difficult to achieve making it clear that COVID-19 is going 79 to stay for a very long time. The compounded daily growth rate (CDGR) calculated over 7 days for India, USA, Brazil and Spain is 83 plotted in Figure 1 for a duration from 28 th Jan, 2020 to 25 th May, 2020. The initial spikes are majorly due 84 to small number of cases but a generic trend observed in the plot is that lockdowns have played a 85 significant role in slowing down the CDGR of the countries. Developed countries i.e., USA and Spain have 86 a CDGR over 7 days of 1.44% and 0.23% as on 25 th May 2020 whereas developing countries i.e., India 87 and Brazil have a CDGR over 7 days of 5.4% and 6.03% as on 25 th May 2020. Figure 2 gives Taking these numbers into consideration, Table 1 gives the health infrastructure needs in the coming 3 119 months in India. India needs to focus all its might at reducing the CDGR of health infrastructural needs to 120 as close to zero. At zero the need of scaling up the health infrastructure will seize to exist. Coronavirus Cases. Accessed Nitish govt gets to work to bring 27 lakh migrants, students back but says it'll 143 take months Concepts of herd protection and immunity The flaws of "herd immunity: Whose duty is it to protect the very young/old, 151 pregnant, vaccine allergic, and the immunosuppressed? Understanding Herd Immunity Comment What policy makers need to know about COVID-19 156 protective immunity The reproductive number of COVID-19 is higher 158 compared to SARS coronavirus COVID-19: Herd Immunity and Convalescent Plasma Transfer Therapy Public Health Measures and the Reproduction Number of SARS-CoV-2 Herd immunity -estimating the level required to 164 halt the COVID-19 epidemics in affected countries Our World in Data. Coronavirus Pandemic (COVID-19). Accessed COVID Curve Guides India's Health Infrastructure Growth 172 Needs Ministry of Home Affairs G of I. Consolidated Guidelines: 1st Lockdown Press Information Bureau Government Of India. Extension of Lockdown up to 44 lakh passengers travel in 3274 Shramik special trains till May 25: Indian Railways. 185 Published 2020 Press Information Bureau Government Of India. Our recovery rate has improved at 37.5%, and 189 more than 22 lakh tests have been conducted The authors declare that they have no known competing financial interests or personal relationships 203 that could have appeared to influence the work ☐The authors declare the following financial interests/personal relationships which may be considered 206 as potential competing interests