How many actual number of Coronavirus - COVID-19 cases could be there in India and the World?

With COVID-19 declared as a pandemic, one big question in every body’s mind is just how many COVID-19 positive cases are out there. At the outset let me state that as of 18^th March, 2020 there could be more than 800 thousand COVID-19 cases in the world and more than 140 thousand in India. While professionals and researchers differ in estimate there seems to be a consensus that the COVID-19 cases are far higher than what is being reported. For instance, Dr. Mathew Carter from Connecticut health officials hints that there could be 100 untested positive cases for every confirmed case. In the subsequent part, I will present my analysis of the number I claim.

There are serious reasons to believe, that the number of confirmed cases are hugely under-reported and doesn't represents the true picture. The number of confirmed COVID-19 cases depends upon how many suspected cases are being tested for the disease and what is the criteria to determine suspect. It can be argued that, since the disease is novel and with the great speed with which it spread across the world, most countries did not had enough time to plan for detecting suspects and for arranging the resources to conduct lab tests on a required massive scale. The number of labs and the test kits available with many countries are minuscule compared to the number of tests that would ideally be required to be done in the given scenario. As a result, most countries have put stringent criteria to decide who can be tested. This means, many patients with actual COVID-19 will not get tested, due to the criteria and hence will not appear in the count.

With this understanding of resource constraints, it is reasonable to believe that the countries with sound economy will be better off in arranging resources and conducting tests at a larger scale, compared to countries with poor economy. To examine this, I ran a correlation between COVID-19 reported cases per million population with the GDP (PPP) per capita income of various countries. As per my expectation, the correlation came positive at 0.26, which means that per-capita income of country is positively associated with the reported confirmed COVID-19 cases per million. In simple words, richer countries are reporting more number of confirmed COVID-19 cases compared to poorer countries. While the correlation coefficient is mild to moderate, it does indicates that there could be significant number of undetected positive COVID-19 cases, specially in countries with low per-capita income. A comparison of cases per million population of top and bottom 25% countries by economy also showed a statistically significant difference (p = 0.007), with top 25% countries showing much higher number of cases compared to bottom 25% countries. To ensure that other factors are not confounding the result, I checked for the effect of geographic location and population. For geographic location, countries located nearby and having different economy, did showed remarkably different number of cases per million population. For instance, USA has reported 23 confirmed cases per million population which is a staggering 32.8 times that of Mexico, which has reported just 0.7 case per million. This is despite the fact that they share border and could be posibly because USA is much stronger economy than Mexico. In general also it can be observed that, irrespective of the countries location in the world, the rate of COVID-19 penetration was generally high in high income countries and generally low in low income countries. The co-orelation between population and cases per million population also does not exist, with correlation coefficient coming at -0.03. Thus geography or population doesn’t seems to have any role in the penetration rate of COVID-19.

There is no justifiable reason to believe that poor countries will have significantly lower number of COVID-19 cases, as is being reported by respective governments and it just suggests that the data on number of COVID-19 is highly under-reported. As data is key for fighting this menace, it is imperative that we have an idea of a more reliable number of COVID-19 cases. Estimating the actual number of cases would be difficult as it would require several assumptions to be made. One approach could be to assume that COVID-19 infections spreads at a similar rate in all countries irrespective of their population, economy, geography or climatic condition and apply the most reliable rate to all countries. As I have argued in first paragraph that resource rich nations are in better position to test COVID-19 in large numbers, we can use their figures as somewhat reliable and estimate the number of cases for other countries. For this, I took the top 50% countries by economy, using GDP (PPP) per capita, and calculated the COVID-19 cases per million population by combining all of their cases and all of their population. The result comes to 112.7. In contrast, the cases per million population of bottom 50% countries by economy is mere 37.4. If we ignore the rate of bottom 50% countries, considering the lack of tests being conducted, and use the rate obtained from top 50% countries, we can estimate how many COVID-19 cases could be there.

This would mean that for India, with a population of 1.3 billion and 112.7 COVID-19 cases per million, there could be 146,510 people who would have acquired COVID-19 till date, as against the reported number of 168 confirmed cases reported. This is not even the tip of the iceberg. Similarly, for the world with population of 7.7 billion, the number of COVID-19 cases could be alarming 867,790 against 216,425 reported so far.

Disclaimer – This is my independent analysis and is subjected to the assumptions stated in the article. Data taken from WHO situation reports, World Bank and the online site, www.worldometers.info. The data is as of 18th March, 2020

Arif Raza

Code red alert system in hospital

Code red is an emergency code which is used to alert employee and fire-fighting team in case a fire or possibility of fire is detected within the hospital premise. Unexpected fire is considered as an emergency situation and code red system is used to urgently activate a set of action intended to control the fire and prevent any major mishap. The system may slightly vary from hospital to hospital, depending upon how the hospital is structured and organized. Here is a code red system that can be used as a reference by hospitals. (Other codes - Code Blue, Code Pink)

Code Pink system in hospital

Code pink is an emergency code which is used to activate a set of action in case a child/baby is missing from the ward/room. As there is a fair possibility that the missing child/baby is abducted, it is considered as an emergency situation and a predefined set of actions are taken on an urgent basis to safeguard the missing child/baby. The entire system of coordination, communications, decisions and actions followed during such situation is called as a code pink system. (Also check Code Blue, Code Red)

Depending upon how a hospital is structured and organized the code pink system may vary from one hospital to another. The objective, however, remains the same, i.e. ‘Find the missing child as soon as possible’. The objective should be achieved in a manner that other critical activities in the hospital do not get hampered and that unnecessary scare or commotion of public be avoided. An illustrative code pink system has been described below. This can be taken as a reference for developing code pink system by various hospitals. 

Disaster Preparedness checklist for hospitals

Disaster can strike any time and can cause severe catastrophe to us. While it is very difficult to prevent disasters, it is certainly possible to be prepared for facing and handling the disaster situation in a way that ensures minimum damage to life, limb and property. Hospitals are organization that remains full of people round the clock and any disaster affecting hospital can cause heavy damage to life. More-soever, people struck by disaster needs medical care which are provided by hospitals. This makes it very important for hospitals to be prepared for all kind of disasters that are likely in the area where the hospital is located.

Here is a checklist of things that hospitals must be prepared with.

Code blue system in hospitals

Code blue is perhaps the most popular codes used in hospital for managing emergency situation. Code blue is a code given to identify and communicate that a medical emergency, of the nature of cardiac arrest, has occurred and the patient needs to be attended immediately for life saving measures. (Other codes - Code Pink, Code Red). Since it deals with the life threatening situation, swift and coordinated action by a team of professionals is of paramount importance. This calls for designing and implementing a highly efficient system, which can work in round the clock and can cover entire hospital. This posts elaborate on all considerations that should be made while designing a code blue system. Also check code blue form and crash cart checklist along-with this post.