Predictions, role of interventions and effects of a historic national lockdown in India's response to the COVID-19 pandemic: data science call to arms

Debashree Ray; Maxwell Salvatore; Rupam Bhattacharyya; Lili Wang; Shariq Mohammed; Soumik Purkayastha; Aritra Halder; Alexander Rix; Daniel Barker; Michael Kleinsasser; Yiwang Zhou; Peter Song; Debraj Bose; Mousumi Banerjee; Veerabhadran Baladandayuthapani; Parikshit Ghosh; Bhramar Mukherjee

Our projections using current daily data on case counts until April 7 in India show that the lockdown, if implemented correctly in the end, has a high chance of reducing the number of COVID-19 cases in the short term and buy India invaluable time to prepare its healthcare and disease monitoring system. In the long-term, we need to have some measures of suppression in place after the lockdown is lifted to prevent a massive surge in the number of cases that can quickly overwhelm an already over-stretched Indian healthcare system resulting in increased fatalities. Specific vulnerable populations will be at higher risk of severity and fatality from COVID-19 infection: older persons and persons with pre-existing medical conditions (e.g., high blood pressure, heart disease, lung disease, cancer, diabetes, immunocompromised persons). 24,25 Supplementary Table 1 provides a description of the approximate number of individuals in these high-risk categories in India. Beyond the fragile population characterized by health and economic indicators, we have to remember that healthcare workers and first responders at the front line of this pandemic are amongst the most vulnerable. 16 It is important to note that a massive surge in the number of cases can quickly overwhelm an already over-stretched Indian healthcare system. The estimated capacity of hospital beds in India is 70 per 100,000, 26 which is an upper bound on treatment capacity. Given an average occupancy rate of 75%, only a quarter of these are available. 27 Moreover, critically ill COVID-19 patients (about 5-10% of those infected) will require ICU beds and ventilator support. India has only 35-58 thousand ICU beds with very high occupancy rates and at most 1 ventilator per 2 ICU beds. 28 From a purely public health perspective, this analysis shows the impact and necessity of lockdown and subsequent measures of suppression after lockdown is lifted. All the people in India, regardless of their vulnerability to COVID-19, need to adhere to the public health guidelines issued by the Ministry of Health and Family Welfare in India, and continue to be cautious in their post-lockdown activities to guarantee a long-term benefit of the national lockdown.