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Healthcare: Choking On Covid

The sheer scale of the human tragedy unleashed by the second wave of the Covid pandemic is calling out loud for a reform of India’s decrepit healthcare system while underscoring the need for mega investments to repair and replenish the healthcare infrastructure

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It doesn’t get more macabre than this. People driving around with Covid positive patients, trying to find a hospital bed, not being able to find one and their wards dying before getting medical care. Entire families getting wiped out this way. NGOs appealing for people to adopt young children who have lost their parents.  Everywhere there are wailing mothers, fathers, sons, daughters, wives  and husbands. Corpses spilling out of  hospitals and crematoriums...

Words cannot capture the full extent of the horror that’s unfolding each day. There is a shortage of hospital beds, medication and trained medical staff to look after the diseased. Physicians are working 18 hour shifts and are exhausted down to the bone. People are begging, pleading, fighting — basically doing whatever they can to try to save a loved one who is afflicted. Sights like the ruckus that took place at Apollo Hospitals in the national capital a few days ago — when a family lost a loved one to the disease, and then attacked the medical staff present there and vandalised the reception area — are becoming commonplace.

Vaccination for people over the ages of 18 years has officially been announced but only a few private hospitals are carrying these out because of shortage of vaccine. On the day registration for vaccination was opened, the CoWIN site crashed because of the sheer volume of people trying to register. That glitch got fixed but the slots available were few because of the shortage of vaccine – till this shortage is not dealt with, getting a slot for vaccination will be like a lottery. The situation is going from bad to worse — the Ghazipur crematorium in Delhi recently reported over 100 dead bodies being brought to them every day, and since they do not have the capacity to deal with such volumes they reported having taken over the adjoining car park as a cremation ground.

How Did It Come To This?
Experts believe that it has been a combination of factors that has led to this situation — callousness on the part of the people who refused to follow Covid appropriate behavior, political rallies, religious and social gatherings (it is believed that 70 lakh people participated in the Kumbh Mela, and weddings in the national capital saw upwards of 150 guests) added to the count.

Once the cases started increasing after the lull earlier in the year — lockdown across states should have been imposed. However, keeping in view the massive economic dent and the financial distress to businesses, the government decided against it. Was this a right move? Opinion is divided. Take, for instance, the case of Uttar Pradesh, one of India’s largest and most populous states. It saw a surge in infections and as a result the Allahabad High Court ordered five key UP cities to lockdown but the state government moved the Supreme Court and got this order stayed citing administrative and economic difficulties.

Yes, lockdowns do cause disruption of livelihoods, but we are failing at being able to manage the spread of this deadly disease. Therefore, shouldn’t we be putting lives first? Looking at the recent surge in cases, Anthony Fauci, the White House Chief Medical Adviser suggested a nationwide lockdown. However, the Indian administration has no immediate plans of doing so.

WHO chief Tedros Adhanom Ghebreyesus called the situation in India “beyond heart breaking”. It is worth mentioning here that as per several reports, INSACOG, the Indian SARS-CoV-2 Genetics Consortium, warned the government of this spike a few months ago.

Considering we had prior information about this deadly variant, should it not have been incumbent on the administration to take measures to keep citizens safe? It is not the administration alone but also citizens – each one of us who is to blame. People became callous and did not practice the basic Covid safety protocol such as distancing and wearing their masks. Social media platforms were full of impassioned pleas to follow safety protocols from overwhelmed medics who were seeing the devastation firsthand. None of this was paid heed to and in fact weddings, gatherings and Holi parties were organised in large numbers. At the time of writing this report, visuals of TMC supporters celebrating their party’s lead in the West Bengal elections surfaced, they were flouting all Covid safety protocols at a time when coronavirus related deaths in the country were at their peak.

Where Do We Go From Here
This is no longer just an India problem.Whenever a virus spreads in any country at such a rate, it has ramifications for the entire world. Even with travel restrictions it is likely to spread to other parts of the world. Recent reports of 52 passengers on a Delhi-Hong Kong flight testing positive upon landing despite having negative reports when boarding just shows how easy it is for the virus to travel across borders.

India needs to get a handle on the situation and fast. “The way the numbers have gone up, the peak might come mid-May or in the latter part of May. India being a huge country there might also be a third and a fourth wave till we reach some sort of immunity, or ramp up vaccination -- we have to be prepared. Another key factor to keep in mind is that the benefits of vaccine will also come much later, we are vaccinating now but the benefits will show up six months down the line.” says Rommel Tickoo, Director - Internal Medicine, Max Hospital, Saket.

So far, we have 22,662,575 active Covid cases, and the official death toll figures being reported are over 246,146. However, international media reports state that the number of deaths are grossly underreported. A number of causes have been attributed to this, such as a lack of a proper death registry system especially for smaller towns, and even delayed Covid test results, in which case the death is given some other reason, and by the time the result comes, it’s too late. In addition to a stressed healthcare system, a lackadaisical attitude of the officials charged with the task of maintaining these records have been identified as the reason for low numbers. The last couple of weeks saw heartbreaking news coming from all quarters of the country of people dying because of oxygen shortage and unavailability of hospital beds. RT-PCR tests getting delayed because of labs being under pressure and facing excessive volume of customers booking tests. This begs the question: why did we not get our house in order earlier? We had one whole year to prepare.

The healthcare system in the country has been brought to its knees and is near collapse. In fact, top Indian and global corporates have stepped up to help India during this time of crisis. Countries from across the world, including the United States, Germany, Russia and the United Kingdom, have moved into helping us with oxygen cylinders, coronavirus test kits and medical supplies.

While aid in terms of medical equipment and financial help has arrived from all quarters of the world – the need remains for trained medical staff. Even before the pandemic struck there was a shortage of medical staff and now it is more pronounced. “As per the Indian Medical Registry, we have approximately one doctor for a population of 10,000 whereas the WHO norms mandate 44.5 healthcare workers including 10 doctors per 10,000 population. As per the National Survey Sample we have 5.9 doctors and 20.6 healthcare workers per 10,000 population. In rural India, this figure is much lower. We certainly need to do something about this,” says Manoj Luthra, CEO and Director Cardiac Surgery, Jaypee Hospital.

Averting Another Disaster
The nature of the virus is to keep mutating and we can expect more peaks in the near future -- how can we avoid the devastation the next time around? Vaccination is an important aspect of averting such a disaster. The key is to have a significant amount of the population vaccinated before the virus mutates. While the government has allowed vaccination for all adults, most centres are reporting vaccine shortages.

“At the current rate India will cover 30 per cent of the population by the end of 2021. By end of March 1.5 per cent of the population was covered, from May 1, we have 900 million people to cover (all those above 18 years of age) that means 1.8 billion doses are required. Our manufacturing capacity is 110 million doses per month taking both the vaccine manufacturing companies intoconsideration. Therefore, it will take at least one and a half years to cover these 900 million people. On the other hand, the government has opened the market and have allowed Johnson & Johnson, Sputnik and other international vaccines to come in. In addition, they have released raw materials and provided money to both Serum Institute and Bharat Biotech, but even with this, it goes up only 158 million doses a month from 110 million, which means we have reduced the vaccination period from 18 months to one year, but not less than that,” says Luthra.

Adar Poonawalla, the Serum Institute chief in a recent statement said that of the 26 crore doses requested so far, they have supplied more than 15 crore doses. Another 11 crore doses will be ready in the next few months. Bharat Biotech, the producer of Covaxin, stated that capacity expansion has been implemented across multiple facilities in Hyderabad and Bangalore to ramp up production to 700 million doses per year. The government is also in conversation with vaccine manufacturers from around the world to make their products available in India soon.

In addition to ramping up vaccine production and availability, increasing healthcare spend is important. Today, we are spending a little less than 2 per cent of the GDP on healthcare, we need to increase this spend substantially and encourage public-private partnership so as to be able to have a robust healthcare system.

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Magazine 5 May 2021 Hospital Chains coronavirus COVID-19