Need to ensure localised strategies to address any event of future COVID waves: FICCI-EY Study

Vaccination is significantly reducing the severity of the disease and mortality. However, it is necessary to maintain focus on prevention, planning and preparation for any sudden surge

The second wave of the pandemic hit the nation in an unprecedented fashion. The country needs to ensure a future-ready and localized strategic plan to be well-prepared for surge loads in event of any subsequent COVID waves.

FICCI-EY Report, ‘Prevent, Plan and Prepare: Strategies to win against the pandemic’, states that any future strategy must ensure that the right level of care is being provided to patients who need it the most and therefore should include a specific action plan to cater to moderate COVID cases without overloading the existing hospital bed capacities.

This report has been led by Subhrakant Panda, Vice President, FICCI, who is also the Chair of the FICCI COVID Task Force.

Kaivaan Movdawalla, Partner- Healthcare, EY India said “While  global data indicates that severe cases and hospitalization rates have come down over the last few months, given the erratic nature of the virus leading to a continued threat of new escape mutations and the precedence of multiple waves globally, it is imperative that the country’s policy makers, healthcare providers and the public continue to demonstrate a laser like focus on prevention, planning and preparation for any sudden surge in incidence. Given the experience of previous waves, which led to severe crisis of bed availability, the country must have a specific response strategy to address the need for surge capacity arising out of peak load situations in the pandemic, which though temporary are tempestuous in their immediate manifestation.”

Sharing the highlights of the report, Panda observed that, “Given that most countries have faced COVID-19 pandemic in waves, it is imperative to prepare as well as plan appropriately for any future waves. India’s historic achievement of vaccinating 100+ crore people is a significant milestone in the country’s fight against COVID as both international and domestic experience has shown vaccines to be effective in significantly reducing the severity of infection and mortality.”

While cautioning against lowering the guard during the festive season, Panda stated “it is crucial that the general public does not develop ‘COVID fatigue’ and ‘vaccine complacency’ presuming that the pandemic is over”.

Srimayee Chakraborty, Partner- Healthcare, Business Consulting, EY India, says, “A repeated peak of 4 lakh cases per day, would necessitate a mammoth requirement of 9 to 10 lakh beds to cater to moderate and severe cases, with shortages in over 200 under-served districts. As part of their pandemic response plan, some countries have experimented with makeshift facilities to reduce the overwhelming burden on the existing hospital infrastructure. Intermediate or Transition Care Centers can be an effective low cost and scalable option to address surge capacity specifically for management of moderate COVID cases. If the prevailing case load continues, existing infrastructure would be able to absorb the demand for COVID beds and requirement of surge capacity may not exist.”

Dr Mahesh Joshi, Member, FICCI COVID Task Force and President & CEO, Apollo Homecare, further shared that, “these transition care centers will help free up available beds and resources in hospitals for management of severe COVID cases.” However, he added, “in order to meet the objectives of the COVID intermediate care centers, clinical criteria for admission and transfer for step-up/step-down care of patients would need to be pre-defined and adhered to”.

Key highlights of the report:

• An analysis of Wave 2 reveals that nearly 9 to 10 lakh COVID beds (which was over 60% of total available hospital bed capacity in India) were needed to cater to moderate and severe cases which led to severe crisis of bed availability during the peak. This was further accentuated due to inequity in the bed capacity distribution across different states and districts which led to extreme shortages in over 200 districts. Given this learning, it is imperative that strategy for managing similar situations in the future must include a specific action plan to cater to moderate COVID cases without overloading the existing hospital bed capacities.
• COVID Intermediate Care Centers (CICC) or transition care facilities could offer a potential low cost and scalable option to prepare for ‘surge capacity’ requirement. Seamless and effective management of patients and hospital resources can be enabled by a hub and spoke model wherein these centers are attached to or in proximity to a traditional hospital. Certain threshold parameters such as positivity rate, average occupied oxygenated beds, etc. can be pre-defined to serve as a potential trigger or inflexion point to determine the right timing to start creating these transition care facilities.

Localised preparedness plans

While at a country level we experienced two distinct waves, localized wave patterns were observed when data was studied at a state or district level. Given this variation, a highly localized plan instead of a common nation-wide plan may be critical to designing an effective pandemic response in case of subsequent waves.

Learnings from international experience of third wave

• UK has shown reduction in severity of the cases i.e., lower hospitalisations and mortality due to effective vaccination coverage.
• A few states in US and Indonesia are witnessing an increase in incidence in pediatric population. Given that majority of population under 18 years is presently unvaccinated, they would be amongst the most vulnerable groups which could be impacted in the event of a third wave.
• Relaxation of lockdown restrictions are being seen as possible reasons for spikes in cases in Indonesia and Israel. Signs of waning immunity are also being observed in Israel which has witnessed a nearly doubling of peak cases per million in wave 3 compared to wave 2.

Transition care centers offer a scalable option to meet surge capacity requirements

Moderate cases not requiring immediate critical care can be managed in a transition care facility with provisions for oxygenation. These transition care centers could help free up beds and resources in hospitals to be utilised for more severe cases. Prioritisation and stage gating basis patient acuity would be critical to ensure that the right level of care is provided to patients who need it the most.

Continued focus on vaccination and focused mobility restrictions

While government interventions in building an effective response plan to meet subsequent possible waves is imperative, it is crucial that the general public continues to be cautious and does not develop ‘COVID fatigue’ and ‘Vaccine hesitancy’ presuming that the pandemic is over. Since daily case numbers have been consistently low in last few months, people may be susceptible to an ‘exponential growth bias’ tending to believe that even if there is a third wave, cases will grow only linearly. With the end of year festival season having already commenced, it is important that mobility restrictions and controlled social gatherings are continued to be imposed by governments. An equally important role needs to be played by the general public who must not show apathy to these measures while coming forward for vaccination and strictly adhering to safety guidelines including social distancing and wearing masks.