April 02, 2020
The Question: The purpose of this analysis was to determine hospitalization needs in each Indian state for different assumed levels of infection of COVID-19. Hospitalization needs projected here are conservative and do not reflect peak needs. Peak projections will be available once we are able to project the shape of the epidemic curve with further testing data.
*Disclaimer: At this time, given insufficient testing data, we have not been able to assess the impact of the lockdown (issued on 25 March 2020) on transmission. We will be able to offer better guidance on the projected number of cases in coming days. As with all responsive research, this work has not been peer-reviewed.
Assumptions
- India’s population age structure: This was adapted from the NFHS4 2015-2016 [1]. The majority (92.1%) of India’s population is in the age group 0-64 years.
- COVID-19 infection rate: We develop 3 possible scenarios assuming 0.5%, 1%, and 5% of the population is infected with COVID-19.
- Proportion of COVID-19 patients who are asymptomatic/mild symptoms: 16.39% of infections in age group 0-64 years are assumed to be asymptomatic or mildly symptomatic while only 9.86% of infections in >64 years are assumed to be asymptomatic or mildly symptomatic. These values are estimated from Liu et al. (2020) [3], and reflect similar rates found in a study by Mizumoto et al. (2020) [4], which reported 320 asymptomatic cases out of a total of 634 COVID-19 positive cases during a two week quarantine period (5-20 February 2020) aboard the Diamond Princess cruise ship. Based on statistical modeling, the authors estimated a delay-adjusted asymptomatic rate of 17.9% for COVID-19 infections.
- Proportion of COVID-19 patients who are symptomatic: 83.61% of infections in age group 0-65 years are assumed to be symptomatic while 90.14% of infections in age group >65 years are assumed to be symptomatic. These values are estimated from Liu et al. (2020) [3] and exclude individuals who are mildly symptomatic.
- Proportion of COVID-19 patients who require hospitalization: We assume that COVID-19 patients who require hospitalization are those that are severely or critically ill, as defined by Liu et al. (2020) [3], and have estimated that 6.04% of infected cases in persons aged 0-64 years will require hospitalization while 28.17% of infected cases in persons 65 years and over will require hospitalization.
What We Found:
Assuming 0.5% of India’s population is infected with COVID-19:
Assuming 1% of India’s population is infected with COVID-19:
Assuming 5% of India’s population is infected with COVID-19:
References
Note: Our assumptions are based on the study by Liu et al. (2020) [3]. The symptomatic rates for moderate symptomatic, severe symptomatic and critically ill symptomatic were calculated from Liu et al. based on the z-scores obtained from the mean age and standard deviation reported for each level of disease severity. The hospitalization rate was calculated as the sum of the severe symptomatic and critically ill symptomatic rates. Asymptomatic rates were calculated similarly to symptomatic rates and included both asymptomatic and mildly symptomatic cases.
- International Institute for Population Sciences. National Family Health Survey.http://rchiips.org/NFHS/nfhs4.shtml.
- Government of India. State/UT wise Aadhaar Saturation: 15th January, 2020.https://uidai.gov.in/images/state-wise-aadhaar-saturation.pdf.
- Liu S, Luo H, Wang Y, Wang D, Ju S, Yang Y. Characteristics and Associations with Severity in COVID-19 Patients: A Multicentre Cohort Study from Jiangsu Province, China. SSRN. 2020.http://dx.doi.org/10.2139/ssrn.3548753.
- Mizumoto Kenji, Kagaya Katsushi, Zarebski Alexander, Chowell Gerardo. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25(10):pii=2000180.https://doi.org/10.2807/1560-7917.ES.2020.25.10.2000180.
