Glimmer in Covid surge: Less than 5% of all patients require critical care

Of the total 83,004 active cases on May 27, less than 3500 needed any kind of intervention -- oxygen therapy, ICU or ventilators.

As returning migrants and easing lockdown push the coronavirus far and wide, an analysis of statewise data shows that when it comes to Covid patients requiring critical care, their share, even in high-burden states like Maharashtra, Delhi, Gujarat and Tamil Nadu, remains low. So is the demand for ventilators.

Similar is the case in states like Bihar, Jharkhand, Chhattisgarh and Odisha where the migrant influx is pushing up Covid numbers.

Of the total 83,004 active cases on May 27, less than 3500 needed any kind of intervention — oxygen therapy, ICU or ventilators.

A total of 1,868 patients needed ICU (2.25 per cent), of whom just three were on ventilators while 1585 people (1.91 per cent) were on oxygen. This trend has remained largely unchanged since the first cases came in.

Until May 15, 18,855 ventilators were available in the country for Covid care, this number would have gone up since. In addition, 60,000 ventilators have been ordered.

These figures assume significance given the apprehension about medical infrastructure being overwhelmed by the pandemic as testing ramps up and more cases pour in.

Replying to a question on the way ahead during Lockdown 4.0, Niti Aayog’s Dr Vinod Paul said: “Our goal is to control the pandemic and then restore normalcy so that life can go on. That balance is key to all decisions on restrictions. We have to make sure that the size of the pandemic remains below our capacity to treat patients.”

In Chhattisgarh, Jharkhand and Bihar where returning migrants are a cause for concern, so far no patients are on ventilators, oxygen or in the ICU. The reasons aren’t clear: there is speculation that the epidemic may be in its early stages in these states or that few patients need critical care or that the health infrastructure isn’t uniformly distributed in these states.

Of the 2,680 active cases in Uttar Pradesh till May 27, 61 needed ICU and 38 needed oxygen. No patient was required to be put on a ventilator.

In Maharashtra, which has seen the most number of deaths, the percentage of people on oxygen is just 2.21 per cent. In Delhi the percentage is 3.56 but on May 27, when the number of active cases in Maharashtra was 36012, there were just 796 people on oxygen while in Delhi, of the 6954 active cases, 248 were on oxygen.

Overall, the percentage of people on oxygen (1.91% of total active cases in the country) is an important metric because it has often been seen in Covid cases that patients recover quickly after a few days on oxygen. However, if timely oxygen is not given, there are increased chances of organ damage and quick deterioration. Until May 26, Delhi had 303 deaths while Maharashtra till May 27 had 1897 deaths.

“The data suggest low levels of need for intensive care, except in West Bengal and MP. Use of ventilators appears to be very low and oxygen therapy has been used more than mechanical ventilators. Overall, the data are consistent with good clinical outcomes with a very limited requirement for advanced intensive care,” said Dr K Srinath Reddy, president Public Health Foundation of India and member of the ICMR’s Covid.

Bengal, in fact, has the highest percentage of people in the ICU: 10.34% of the 2240 active cases — and also a relatively high proportion (5.8%) on oxygen.

The state saw 289 deaths till May 27. Of the 3030 active cases in MP till May 27, 7.85% were on oxygen and 6.44% were in the ICU. There were 313 deaths till May 27.

The data show that critical cases needing any of these three interventions are limited to only about a dozen states. In India 69% patients are asymptomatic and less than 15% of the active cases need hospitalisation. Others are in home quarantine, paid quarantine, quarantine centres or Covid Care Centres which are makeshift setups with minimal medical facilities where patients are kept under observation so that they can be quickly shifted to hospitals in case of sudden deterioration.

On May 27, there were 930 dedicated Covid hospitals with 1,58,747 isolation beds, 20,355 ICU beds and 69,076 oxygen-supported beds; 2,362 dedicated Covid Health Centres with 1,32,593 isolation beds, 10,903 ICU beds and 45,562 oxgen-supported beds; and 10,341 quarantine centres and 7,195 Covid Care Centres with 6,52,830 beds.

Meanwhile, the total number of Covid cases in the country touched 1,58,333 with the addition of 6566 cases and 194 deaths in the last 24 hours. A total of 1,19,976 samples were tested in the last 24 hours taking the total to 33.62 lakh.