COVID-19 patients on Critical Care Support – Huge mismatch between data from various sources

• Bharath Kancharla

The Union Minister for Health & Family Welfare recently announced that around 6.4% of the active COVID-19 cases in the country are on critical care support like oxygen, ICU & Ventilators. However, the data from the states does not match this number. Here is a deep dive. 

The 25^th meeting of the high-level Group of Ministers (GoM) on COVID-19 was held on 08 May 2021. After reporting more than 4 Lakh new cases a day at the beginning of May, the daily numbers have since reduced slightly. However, as per the updates from the Ministry of Health & Family Welfare (MOHFW), India has been consistently reporting more than 3 lakh cases a day, currently the highest in the world. 

Amidst this, the high-level GoM on COVID-19 assumes prominence. Among the various updates, the Minister of Health & Family Welfare provided information about critical patients being treated and the healthcare infrastructure made available to them. As per the update, around 4.88 lakh critical patients have required ICU beds so far. Further, around 1.7 lakh patients required ventilator support, and around 9.02 lakh patients were extended oxygen support since the beginning of the pandemic in India. 

This would imply that out of the 2.43 crore COVID-19 cases (as of 15 May 2021), around 6.4% were considered as critical cases requiring ICU beds, ventilator support, or oxygen support. 

The minister further updated that out of the current active caseload, 1.34% are in ICU, 0.39% are on ventilator support and 3.7% are on oxygen support. Considering that the number of active cases currently is in the range of 36-37 lakh, this would translate to around 50 thousand patients in ICU, around 14 thousand patients on ventilator support, and nearly 1.37 lakh patients on Oxygen support. 

Apart from this occasional update from the Central government, there are no regular updates on the number of persons requiring such critical care support across the country. There is also no centralized database on the availability of the beds with critical care facilities and the occupancy of the same. 

On the other hand, there are multiple reports in the media about the lack of adequate beds in hospitals and health support for critical patients infected with COVID-19. All these raise important questions about the accuracy & veracity of the official numbers. For instance, going by the data provided by the Government in February 2021, in the Rajya Sabha about the public health infrastructure, there were 1.57 lakh oxygen-supported beds, 36 thousand ICU beds, and more than 23 thousand ventilator beds just in the public health facilities. If the beds in the private health facilities are added to these numbers, we should have more than enough infrastructure to deal with the current crisis. However, the constant reports of lack of beds raise important questions about the veracity of the official numbers. 

We looked at the official numbers on bed availability being maintained centrally by a few states to understand this in more detail. Here is what we found. 

Information availability of COVID-19 beds is not uniform across the states 

One of the biggest challenges in consolidating state-wise numbers on beds & availability is the lack of uniformity. States of Andhra Pradesh, Chhattisgarh, Telangana, Delhi, Haryana, Kerala, Madhya Pradesh, Rajasthan, Uttarakhand, etc. have dedicated dashboards that provide State-level updates on the beds occupied and available. We could not ascertain if the numbers provided by states are accurate. But there have been reports questioning the accuracy of the numbers in these dashboards in certain states. 

On the other hand,  states including Maharashtra, Uttar Pradesh, Tamil Nadu ,Karnataka, etc. have dedicated dashboards but these do not provide a state overview, rather the information on beds availability is provided only on a more granular district or hospital level. 

For most of the remaining states, we could not find a central dashboard or a monitoring system in place. Few of these states have provided the information about the list of COVID-19 hospitals with their capacities and also included helplines but without the updated data on beds & availability. 

Among States analysed, Telangana, Delhi & M.P have higher share of patients needing critical support 

Based on the information provided & the availability of dashboards, we have analysed 9 states – the 9 states mentioned above with dedicated dashboards. For Karnataka, the information is available only under BBMP.  Furthermore, the information for Maharashtra is partial as only 3 of the 5 dedicated dashboards by region have overall information. 

An analysis of these states shows varying trends with respect to the number of patients requiring critical care support among the total active patients. Critical Care Support includes – Oxygen beds, ICUs, Ventilators, and in few cases HDUs (High-Dependency Unit). 

• Approximately 43% of the active COVID-19 cases in Telangana are on Critical Support as of 14 May 2021. Out of the approximately 53 thousand active cases, around 22.7 thousand are on critical care support. Of these, more than 8 thousand patients are on ICU/Ventilator support, while another 14 thousand are using beds with Oxygen support. 
• Delhi & Madhya Pradesh have 32% and 26% of their active COVID-19 patients using one of the Critical care support systems. 
• In Chhattisgarh, Kerala & Uttarakhand, a comparatively lower number of COVID-19 active patients are on critical support with around 8%, 5% & 4% respectively. 
• In Andhra Pradesh & Haryana, around 14 % of the active cases are using critical care. 
• As per the information available for BBMP (Bengaluru) in Karnataka, there are around 1.6 lakh COVID-19 active cases in home isolation compared to about 17 thousand patients in critical care medical facilities. 

For most of these states, the data indicates a higher occupancy of the critical care units – Oxygen beds, ICUs & Ventilator supports, compared to the 6.4% average as announced by the Union Health Minister. 

The countrywide numbers could be higher than the ones stated by MoHFW

As noted earlier, the MoHFW stated on 08 May 2021 that a total of 6.4% of the active COVID-19 patients are using any of the critical care support. This comes to around 2.3 lakh patients across the country based on the current active caseload (considering that there is no huge difference in the active caseload in the last one week). 

As per the information analysed for the aforementioned 9 states, around 1.71 lakh cases are on critical care support in just these 9 states. This includes around 52 thousand in ICUs, 1.32 lakh using oxygen beds, and around 11 thousand on ventilator support. Adding the partial information for Karnataka & Maharashtra, this number goes up to nearly 1.96 lakhs. It ought to be noted that Karnataka & Maharashtra are the two states with the highest active patients as of date.  Complete information from these two states could further increase the number of patients who are on critical support. These 11 states alone could make up 2.3 lakh or 6.4% of the national figure as stated by the MoHFW recently. 

But the above numbers relate to only around 1/3^rd of all the states.  States like Uttar Pradesh, Tamil Nadu, West Bengal, Gujarat, Odisha, Bihar, Punjab, etc. have not even been considered for analysis. These states together make up for close to 9 lakh active cases as of date. In other words, if the number of COVID-19 active cases who are on critical care support in these seven states are also included to the earlier number, the overall number could be much higher than 2.3 lakh or 6.4% of the total national active caseload, as being reported by the MoHFW. 

What could be the reasons for this mismatch?

One could think of multiple reasons for this mismatch between the numbers stated by the Government of India and the states. 

• The first major reason could be the under-reporting of the actual number of cases. The actual number of daily cases could be higher than what is reported officially. The higher number of cases could be reflected in the higher bed occupancy.
• The second major reason could be the lack of standard definition for different types of beds and what could be considered an ICU bed, Oxygen Bed, or ICU bed with ventilator support, etc. For instance, Karnataka has reported ICU Beds and HDU Beds separately and does not have a separate category for Oxygen beds whereas in the case of Madhya Pradesh, ICU & HDU beds are reported under the same category. In the case of Telangana, ICU beds with CPAP/Ventilator are reported together. It is not clear whether temporary beds with oxygen support that are set up in various states are included in these numbers. It is also not clear whether occupancy numbers are reported based on beds or patients. For instance, a patient occupying an oxygen bed may not necessarily use oxygen. 

Whatever be the reason for this mismatch, it looks like the number & proportion of active cases that are on critical care support is higher than what is reported by the MOHFW on 08 May 2021. There is also a need for standardization of definitions & record-keeping across the states so that the information is more accessible and transparent. A national dashboard with information sourced from the states could be a starting point. 

Featured Image: Patients on Critical Care Support