State-wise estimates of current hospital beds, intensive care unit (ICU) beds and ventilators in India: Are we prepared for a surge in COVID-19 hospitalizations?

  1. Geetanjali Kapoor
  2. Stephanie Hauck
  3. Aditi Sriram
  4. Jyoti Joshi
  5. Emily Schueller
  6. Isabel Frost
  7. Ruchita Balasubramanian
  8. Ramanan Laxminarayan
  9. Arindam Nandi

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Abstract

Background

The rapid spread of COVID-19 globally has prompted policymakers to evaluate the capacity of health care infrastructure in their communities. Many hard-hit localities have witnessed a large influx of severe cases that strained existing hospitals. As COVID-19 spreads in India, it is essential to evaluate the country’s capacity to treat severe cases.

Methods

We combined data on public and private sector hospitals in India to produce state level estimates of hospital beds, ICU beds, and mechanical ventilators. Based on the number of public sector hospitals from the 2019 National Health Profile (NHP) of India and the relative proportions of public and private health care facilities from the National Sample Survey (NSS) 75 th round (2017-2018), we estimated capacity in each Indian state and union territory (UT). We assumed that 5% of all hospital beds were ICU beds and that 50% of ICU beds were equipped with ventilators.

Results

We estimated that India has approximately 1.9 million hospital beds, 95,000 ICU beds and 48,000 ventilators. Nationally, resources are concentrated in the private sector (hospital beds: 1,185,242 private vs 713,986 public; ICU beds: 59,262 private vs 35,699 public; ventilators: 29,631 private vs. 17,850 public). Our findings suggest substantial variation in available resources across states and UTs.

Conclusion

Some projections shave suggested a potential need for approximately 270,000 ICU beds in an optimistic scenario, over 2.8 times the estimated number of total available ICU beds in India. Additional resources will likely be required to accommodate patients with severe COVID-19 infections in India.

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    SciScore for 10.1101/2020.06.16.20132787: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Public mass testing could provide a more complete picture of the spread of COVID-19 in India but has yet to be rolled out due to limitations regarding testing facilities, equipment, trained personnel, availability of effective tests and high associated costs. Per existing guidelines, only a doctor can recommend a patient for a COVID-19 test after a suspected case presents at a facility or through the home care network, although some private labs began to offer tests to private citizens for INR 3500-4500 ($46-59.15 USD) as of April 20, 2020.[13] At the time of writing this report, 235 government and 86 private laboratories are authorized to test for COVID-19 in India.[3] This expansion in access to testing will provide useful data to inform the Indian health response to COVID-19; additionally, mass testing, facilitated by the pooling of multiple tests to minimize resource consumption[14], is necessary to monitor COVID-19 spread across India and identify hotspots of infection. Health policy is generally relegated to Indian state governments rather than the national government; therefore, our estimates seek to fill the gap in existing data sources to estimate the total resources available for critically ill patients in each Indian state and union territory. This analysis suggests that the availability of total beds, ICU beds, and ventilators in India is insufficient to handle a large influx of severely ill COVID-19 patients in addition to their utilization for other acute illnes...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.06.16.20132787v1 on medRxiv