Trump gift of ventilators welcome, India needs each machine coming its way

On a conservative basis a city like Mumbai would need 4,000 ventilators in a week or fortnight. While there are no official estimates, the city may not have more than 1,000 ICU beds for Covid-19

As India's coronavirus cases overtake China's, the scramble to create healthcare infrastructure grows. Experts have said that the country is likely to witness peak cases in July and August. Do we have enough intensive care beds or ventilators? 

Let's do a simple calculation - We are adding about 500 cases per day in the major hotspots. Mumbai is adding close to 1,000 cases per day. 

Around 20 per cent of these would need hospitalisation, assuming 80 per cent are asymptomatic or have mild sysmptoms. That is around 100 people in  requiring hospitalisation every day in a major city. Now, lets assume only 20 per cent of these 100 need ventilation, which is less than 5 per cent of the total number of cases; that would be 20 people to be put on ventilators in the city every day. For cities like Mumbai, this number would be around 35 ICU beds equipped with ventilators everyday. 

And the cases are yet to peak. All India Institute of Medical Sciences (AIIMS) director Randeep Guleria  has recently said that while some predictions vary from May to August and keep changing depending on parameters used according to modelling data, going by the way India's cases are increasing currently, our case peak can come in June and July. 

In order to understand the scale of the crisis, Mumbai is a good case in point. 

Mumbai is expecting that close to 20,000 people will need hospitalisation in the city within a week or so. Estimates say that Mumbai has 30,000 beds across its private and public hospitals capable of providing critical care. A state government task force comprising specialist doctors has recommended that now nearly 80 per cent of these beds or around 22,000 be set aside for Covid-19 patients. 

If only 20 per cent of these hospitalised people need ventilators, that means the city would require 4,000 ventilators in the next one week or fortnight. While there are no official estimates, but the city has not more than 1,000 ICU beds for Covid-19 now. 

How many ventilators do we have?

On May 1, the government said that India had 19,398 ventilators across the country. It has ordered 60,884 ventilators, of which 59,884 will be made by domestic manufacturers and 1,000 will be imported. 

Of the major domestic makers of ventilators Skanray is one - which along with Bharat Electronics Ltd has received orders for 30,000 ventilators. AgVa (in collaboration with Maruti Suzuki Ltd) has orders for 10,000 ventilators and AMTZ (AP Medtech Zone) has orders for 13,500 ventilators. 

The government estimates are, in fact, worse that what experts had estimated. 

According to the The Center For Disease Dynamics, Economics & Policy research team, India has approximately 1.9 mn hospital beds, 95,000 ICU beds and 48,000 ventilators. In an article titled Covid-19 in India: State-wise estimates of Current Hospital Beds, ICU Beds, and Ventilators on April 21,  the researchers estimated critical care beds constitute 5-8% of total hospital beds at large medical facilities in India. The research team conservatively assumed that number of ICU beds would be around 5% of hospital bed count in both public and private sector hospitals. In addition, it was also assumed that 50% of ICU beds would be equipped with ventilators. "Most of the beds and ventilators in India are concentrated in seven states – Uttar Pradesh (14.8%), Karnataka (13.8%), Maharashtra (12.2%), Tamil Nadu (8.1%), West Bengal (5.9%), Telangana (5.2%) and Kerala (5.2%)," the article read. 

How are we preparing? 

The government has claimed around end of April that only 0.33 per cent patients were on ventilators, around 1.5 per cent on oxygen support and 2.34 per cent patients in ICU. India's mortality rate too is lower than the global average, around 3 per cent against the global 7 per cent or so. The health minister has recently said that 86 per cent of all those who died had co-morbidities. 

Whether or not or the above numbers offer solace, the domestic makers are, nonetheless, gearing up to meet demand. 

Vishwaprasad Alva, the founder of Skanray Technologies, India's largest exporter of ventilators said that the company has been manufacturing ventilators for the domestic and exports since 2014 but haven’t had the demand of this scale. Skanray has started shipments to the Army and Government hospitals through Infosys foundation and Narayana Hospitals (NH) since mid-march . 

"We are additionally producing 30,000 units at BEL and the first lot of 1000 units are getting ready. The target is to ship about 15,000 units by end of May and the rest in June. Since there is a huge order load on some critical part suppliers there has been a delay in getting these parts," Alva said. 

He added that the Defence Research and Development Organisation, BEL, and the Ministry of external affairs have responded extremely quick in getting this resolved through alternates designs from Aerospace and Defence suppliers and faster logistics. "It’s a classic case of leverage of the Government and industry in crisis," Alva said. 

While the regular volumes can be churned out but a steep ramp up requires lot of creativity and innovation, the ventilator maker felt. "Along with M & M we designed one of the most advanced and simple user interface ventilators in a record time. The units are in testing now. This unit is designed around Automotive supply chain capabilities and is easier to ramp up," Alva said. 

Skanray has about 50 products in its basket of which about 20 are critical for this pandemic. 

Others too are ramping up and now President Donald Trump has said US would send 200 ventilators India's way, probably as a friendly gesture. But, India would need every single life saving machine that comes its way now.