With 1.9 million hospital beds why is India struggling?

Abstract

From the editor: An audio interview with Dr. Jones about this article's subject matter can be found HERE

India has 1.9 million hospital beds yet is in the news for people unable to access hospital care for severe COVID-19 infection. “Reported” COVID-19 deaths for India are insufficient to explain this conundrum. This article is part of a wider series investigating gross under counting of COVID-19 mortality around the world, and how nearness-to-death drives the marginal changes in hospital bed pressures. It uses a new method for international bed comparison applied across Indian states. This new method is sensitive to both population age structure and nearness-to-death. Indian states have massive disparities in income with the richest state having average salaries 9-times higher than the poorest. In India, the distribution of beds follows wealth and not need. The 10 richest Indian states have bed provision equal to that seen in the most affluent Western economies, indeed far higher than the USA and the UK. The 10 poorest states have bed provision equivalent to that seen in the world’s poorest countries. Gross under reporting of COVID-19 deaths is also occurring in India, as it is also occurring in many other less developed countries. A total of 20 Indian states (half of all states) are below the average for moderate developed countries, and it will be these states where hospitals will be overwhelmed. This is indeed the case with Ladakh, Chhattisgarh, Delhi and Goa having a high ratio of deaths per bed. To make matters worse the COVID-19 mortality reporting process in India appears to be unfit for purpose, especially in a pandemic. Alas the same can be said for many African countries and probably half of Asia. Some Asian countries do not even report COVID-19 testing and mortality.