Corona Alarm Bells
By Poonam I Kaushish
It was a matter of time before the deadly corona virus COVID19 attacked India. And when it did our rulers were ill-prepared. Notwithstanding tom-tomming health preparedness, setting up committees to track the virus and sermons of ‘Don’t panic…The Government is doing everything that is necessary…we have thermal imaging scanners at airports….testing and isolation centres…..” Really, you could have fooled me!
Scandalously, even as the Government claims it began screening people at airports from 17 January onwards, all the 33 infected cases so far are travel-related. Of these 28 are from Italy: 16 Italian tourists and their driver in Jaipur, two Delhi residents one of whom one has passed the infection to 6 relatives in Agra and two in Amritsar, another from Thailand and Malaysia, one each in Ghaziabad and Hyderabad from Dubai and three in Kerala now recovered Thirteen tourists from Iran have been quarantined at a hotel in Amritsar.
The scene at Delhi airport was a sure giveaway. There were no scanners instead long queues greeted one where you are handed a form querying countries travelled in the last six month, a box to tick ‘All Well’ which the officer stamps and you are inside the country. Unlike even small countries where one is subjected to detailed thermal checks. Unsurprising, given our ki pharak painda hai aur sab chalta hai attitude.
Yet the health authorities are doing their best. Across cities, they have swung into action to trace people — family, friends, colleagues — the infected may have come into contact with, for testing and segregation. Nearly 4,000 gram sabhas in border villages have been organized for awareness. Exams are being deferred, schools being shut and Holi celebrations, including by the Government, called off.
But this might not be enough as we have a large population. In fact the virus underscores India’s appalling state of healthcare system which makes us particularly vulnerable to disease. Add to it a severely hampered public health system, extreme shortage of healthcare personnel, limited public funding and a very inadequately functioning primary healthcare structure.
In fact, India is ill-prepared for epidemics and outbreaks as it spends just 1.4% of GDP on healthcare which accentuates why its needs have remained underserved specially for the poor. Hospitals can be easily overwhelmed by a sudden spike in admissions. Already masks, gloves, gowns, drugs and ventilators are out of stock. Personal hygiene is lacking due to water shortage in many areas. Toh kya karein?
Appallingly, the country is crippled by a shortage of over 600,000 doctors and two million nurses, according to a Centre for Disease Dynamics, Economics & Policy study. Only 58% of those who call themselves doctors in cities have a medical degree; in rural areas the proportion is just 19% and a third of ‘doctors’ have only secondary school education.
Further, there is only one allopathic doctor per 10,189 people, only one hospital bed per 2046 persons and one State-run hospital per 90,343 people, one million allopathic doctors for 1.3 billion people of which only 10% work in the public health sector and 700 million have no access to specialist care as 80% of specialists live in urban areas.
Moreover there is shortage of medical equipments with 70% machines out of order including oxygen resulting in infections and nearly one million die annually due to scarce healthcare facilities and the highest annual death toll due to tuberculosis, malaria, dengue and cholera, preventable and treatable diseases. This is compounded by high rates of internal migration resulting in epidemics of dengue, swine flu and chikungunya in the country.
A study by the Global Antibiotic Resistance Partnership-India Working Group found infections rate of hospitals wards and intensive care units is five times more than globally. Resulting in some diseases not only being difficult but also impossible to treat leading to death. Highlighting the real filth is more administrative and political.
Additionally, poor care leads to more deaths than insufficient access to healthcare —- 16 lakh Indians died due to poor quality of care in 2016, nearly twice as many as due to non-utilisation of healthcare services (838,000 persons). Is providing care without ensuring the quality of health services effective? Some 24 lakh Indians die of treatable conditions every year, the worst situation among 136 nations according to a study in The Lancet.
Undeniably, with India’s healthcare in a state of ‘emergency’ the Government needing urgent ‘oxygen’, public and private service providers, medical professionals and patients collectively need to make constructive efforts to improve healthcare. Our polity needs to have respect for human life and reshape the paradigm of healthcare to achieve the goal of Healthy India.
It could take a leaf from practices followed by other countries. China, the epicentre of this bio-earthquake has shown the way by declaring unprecedented lockdown, cordon sanitaires in Wuhan and unleashing its massively organised State apparatus to taper off the threat, after over 3,000 deaths it pulled off a stunning feat — a 1,000-bed hospital built in 10 days.
In the UK and Thailand, 80% of services provided is by Government hospitals where doctors and staff salaries are fixed. In Japan, private doctors offer services based on fixed prices by the Health Ministry in consultation with staff holders. Government ensures that there should be no overbilling by imposing stringent penalties.
Can India likewise marshal a counterforce? Given everything about COVID-19 has been about breakneck speed. Clearly, we cannot afford to loosen our vigil as the health system is already battling infectious diseases from TB to H1N1. It needs to expand testing and surveillance must be strengthened.
The authorities need to take a set of actions ranging from ensuring laboratory capacity, availability of testing kits, protection of frontline healthcare workers, infection control in health facilities, case management protocols, oxygen supplies, ventilators and facilities for treating a large number of patients. Equally, risk communication and engagement.
The silver lining is that over 80% infections are mild, 15% result in severe disease and only 3-5% critical. Health experts stress on the need to assess health systems. “The healthcare you get in Kerala is not the same as you can get in Assam or Bihar. And there is no mechanism to ensure all States are able to deliver a certain quality of care in case of an outbreak,” averred a specialist.
Added another, “The corona virus is unchartered territory. What is a strict no-no is the spread of misinformation, and the panic and stigmatisation it sets off. Alongside a general strengthening of the health system will help rather than disease-specific programmes. It cannot be tackled by the Government alone, the fight has to be fought at the community level and civil society as therrmal screening can only catch between 20%-50% cases, consequently, NGOs need to be involved to do symptomatic surveillance.
All in all, Covid-19 is a red flag to the country, highlighting the urgent need to ramp up public healthcare systems, efficient and effective disease surveillance system which is functional throughout the country. The bottom line? There are no short-cuts possible.
Time our no-nonsense Prime Minister ensures his Administration lives up to expectations of fighting the epidemic. Remember, life is not collating numbers, but flesh and blood with beating hearts. Follow a ‘womb to tomb’ policy of keeping them healthy and get its act together. Governance cannot be infected! —— INFA