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What happens now?

The situation in India is both dire and consequential to the global fight against the pandemic. The biggest challenge in India is an already small and impacted health infrastructure crumbling under duress.
The biggest shortages fall under Oxygen, Vaccines, Tests, Hospital Beds, Masks and Doctors:


India has the lowest number of hospital beds per capita of any developed country. When the pandemic started, India had only ~63,000 beds with oxygen attached. In the last year, they’ve added close to 100K more beds with Oxygen. You can do the math. 400,000 reported infections per day in a country with less than 200,000 total beds with oxygen attached. There is an absolute crisis around Oxygen availability.
The crisis exists in two different arenas.
Oxygen availability. There’s an immediate need to get oxygen both into India from other countries and from areas with lower case counts to those with higher numbers.
Oxygen distribution. This is a massive supply chain and logistics issue. Transporting oxygen requires specialized containers that can keep oxygen cryogenically liquid so that it’s usable for patients in hospitals and homes. These containers are not readily available and will be needed to save those lives most in danger.


There’s a big shortage of hospital capacity that is eerily reminiscent of Spring 2020 in the US. Sick patients are travelling hospital to hospital gasping for air while they hope to find a bed that they can use. Relatives are braving this health Armageddon just to try and get their loved ones a fighting chance to survive. Both the government and the private sector have jumped forward to add hospital bed capacity but more is needed quickly.


A shortage of masks exists for the infected population, their caretakers and doctors. Beyond supply, Compliance around mask wearing is essential given only 2 percent of the population is vaccinated to date. Law enforcement can’t be expected to enforce this — many officers are working under dangerous conditions to maintain law and order and even doing things like lighting funeral pyres for the recently deceased. This has to become culturally normative across India until herd immunity is across the line.


Vaccine availability is a complicated issue in India. India is one of the largest producer/exporters of vaccines for the last decade that are used across the world. The Serum Institute of India (SII) is considered one the premier vaccine producers in the world. Both the SII and Bharat Biotech (a two decade old vaccine producer out of India) received approval to produce vaccines for use within India. Interestingly, neither produced the mRNA equivalents of what Pfizer and Moderna produced in the US. Over 60 million doses of the vaccine were exported to over 80 countries across the world.
What’s worrisome is production capacity is now halted and diverted to help manage the crisis in India and away from other developing countries. This will cause delays in vaccine availability in South America, Africa and European countries. The global vaccine marketplace is a great example of supply/demand imbalance. I sit in California with numerous hospitals, pharmacies and universities begging for people to show up to take the vaccine. Meanwhile, friends in India are desperately trying to find the vaccine but can’t. While the government has announced availability for any Indian resident over 18, the supply has not kept up. The Biden administration was late to the party but announced this past week that they will send unused supplies of the 60 million AstraZeneca vaccines stockpiled to India for immediate use.
How much of the 60M will be sent to India is still TBD and how quickly it can be utilized is essential to saving lives. The hope is the world’s excess supply can be sent to fulfill the massively needed demand in India.


There is a massive shortage of doctors to help care for those in greatest need. The frontline workers had already been paralyzed with long hours, dire conditions and genuine fear for the safety of their own lives along with their families. One area that doctors around the world may help with is volunteering to help answer basic questions for patients and their families. Mobile penetration is huge in India and lightweight telemedicine may actually make a material difference.

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