A projection of 300 million coronavirus cases in India by Washington-based Laxminarayan appears to be far- fetched

India is going to be the next hotspot for the coronavirus epidemic and could see a Tsunami with the total number of cases going as high as 300 million, Director Center for Disease Dynamics, Economics & Policy (CDDEP) Ramanan Laxminarayan has said in a series of interviews to international as well as Indian news organisations over the past week.

In an interview to BBC on March 19, he said, “We are likely to see the same Tsunami of cases that Italy or Spain witnessed recently or was earlier seen in China as well in a few weeks”.

He spoke about the “problem of under-testing” and warned that India’s caseload could go up to the thousands when more extensive testing was taken up.

So, is Ramanan Laxminarayan an epidemiologist?
Going by the body of work that his official profile lists, it is unclear if Dr Laxminarayan has the merit and expertise to make projections like those he has made in recent days.

In addition to being the founder and director of the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, United States, Laxminarayan is also the founder of HealthCube, which works to improve access to healthcare and diagnostics worldwide.

His profile on the official CDDEP website talks about his work, since 1995, “to improve the understanding of antibiotic resistance as a problem of managing a shared global resource”.

His profile talks about his role in creating a novel financing mechanism for anti-malarials in the US and setting up the Immunization Technical Support Unit for India’s health ministry. He has also worked as Vice President, Research and Policy at the Public Health Foundation of India (PHFI) between 2011 and 2015.

No community spread of coronavirus detected yet
Based on how the number of cases spiralled at rapid speed in other affected countries, Laxminarayan has said that India is going through the community spread phase of the coronavirus epidemic. “The disease is probably transmitting in the community and very quickly,” he told BBC.

The Indian Council of Medical Research (ICMR), the apex body for the formulation, coordination and promotion of biomedical research in India, has repeatedly said that it is yet to detect any case of community spread.

Over 820 samples from 50 sites taken for a random sampling study for community transmission of coronavirus had tested negative, ICMR Director General Balram Bhargava said on March 19. This indicated that community spread of the disease had not taken place in the country so far.

The current cases of Covid-19 are “mostly related to travel and local transmission from imported cases to their immediate contacts,” the organisation reiterated in an update on March 20.

Is it correct to use US and UK mathematical models for India?
Laxminarayan does not mention a specific model for India, choosing instead to use references to what has happened in the United States, United Kingdom, and other countries around the world.

Pointing out that between 20% to 60% people will be affected in the United States and the United Kingdom, he said India would see about 300 million cases if 20% of the people would be affected.

He could have waited for an official estimation based on mathematical models from the Indian Council of Medical Research (ICMR).

The ICMR is in the process of formulating estimations of the best and the worst case scenarios on the number of new coronavirus cases in India over the next few months.

Quarantine and testing for coronavirus cases in India
Laxminarayan’s assertions are negated by facts and official figures.

The ICMR has clearly explained the quarantine and testing process that has been adopted in the country.

People with a travel history to coronavirus affected countries are advised home quarantine for 14 days even if they show no symptoms of coronavirus. They are tested if they show symptoms like fever, cough, and difficulty in breathing. All family members living with a confirmed case are quarantined.

All those who have come in contact with “laboratory confirmed” cases of coronavirus and have shown symptoms are to be tested.

The strategy for testing is an evolving process. It has been reviewed and updated on March 9, March 16, and March 20. The testing strategy is reviewed by the National Task Force set up to deal with Covid-19.

Testing and health care facilities in India
In the interview to BBC, Laxminarayan tried to underscore India’s lack of preparedness to deal with an epidemic of this magnitude.

India began coronavirus testing at the National Institute of Virology, Pune, and soon expanded the process to more centres across the country. The number of testing facilities went up gradually and it stood at 51 on March 18. By Monday, as many as 114 labs across the country had been authorised to conduct the tests.

60 private labs had approached the ICMR for registration; their capacity to handle samples without it posing a biosecurity hazard was reviewed. On Sunday, three private laboratory chains were authorised to conduct Coronavirus tests. Twelve more private laboratory chains were given permission to conduct Coronavirus tests on Monday.

Indian health authorities are also addressing the need for more beds for coronavirus patients
For instance, all states have been asked to identify empty or under-utilised hospitals so that separate Covid-19 quarantine and isolation facilities can be set up. According to the ICMR, Delhi has identified the National Cancer Institute in Jhajjar (Haryana), run by the All India Institute of Medical Sciences, as a Covid-19 hospital set up.

Only 5% of patients affected by Covid-19 require hospitalisation, Bhargava said in a media briefing on Sunday. "It is essential to understand the ailment. 80% of the people will experience cold-like fever & they will recover. 20% may experience cough, cold, fever & some of them may need to be admitted to hospital," he explained.

The corporate sector is also chipping in
Reliance Industries Limited (RIL) has set up India’s first dedicated coronavirus hospital with a 100-bed facility in Mumbai.

Mahindra has offered its holiday resorts across the country as facilities for temporary care. The company is also looking at how it can use its existing manufacturing facilities to make ventilators needed for treating severe coronavirus cases.

World Health Organisation (WHO) has praised India’s efforts
On March 17, the World Health Organisation (WHO) praised India for the steps it has taken to deal with the coronavirus epidemic.

“I think the commitment of the Indian government from the top level -- the Prime Minister's office himself -- has been enormous, very impressive. This is one of the reasons why India is doing very well. I am very impressed that everyone has been mobilised," WHO representative to India Hank Bekedam said.

The WHO representative’s remark was an acknowledgement that the Indian health authorities were moving in the right direction.