Avoidable health apocalypse

by April 21, 2020 0 comments

Had the healthcare experts been prepared and had the Government paid more attention to the sector, the curve could have been flattened fairly easily

Late last year, when the doctors in the city of Wuhan, China, reported that they were treating multiple adult patients having pneumonia with an undetermined cause, the world could not have gauged that there was a pandemic in the making. However, soon the situation turned alarming, as human to human transmission was confirmed and other countries confirmed cases. Indians continued to live in psychological denial; ignoring the scientific evidence about something that was progressing with alarming speed, fooling themselves into thinking that the virus would not touch us. The airports had screening processes in place, so that the people who screened positive could be quarantined or asked to self-isolate but it soon became apparent that asymptomatic transmission was occurring, too. By the first week of March, Delhi, Agra and Jaipur had confirmed cases.

For over three months, the virus has wreaked havoc on the planet, gripping around 213 countries and territories. This has put the spotlight on India’s already crumbling healthcare system. The positive cases have increased exponentially since the country reported its first case on January 30. In March infections were reported pan-India. Now, with close to 17,500 people already infected and the death toll crossing 500, it comes into question whether the Indian healthcare system can successfully avert a “health apocalypse.” If the virus can spread at lightning speed and can overwhelm the healthcare systems of Italy, France and the US, then it’s only fair to assume that with the current state of the economy and public health status, India is a sitting duck.

As a measure to control the spread of the virus, the country went into a complete 21-day lockdown, which now stands extended. It has disrupted all economic activities and threatens the already fragile economy. The population of 1.38 billion also comes as a bane in this time of turmoil and social as well as economic distress. This lockdown has left millions of people struggling to make ends meet, out of which, a majority are migrant, daily-wage workers who have been left stranded, without a job, money or a home. This has led them to travel back to their native villages, in search of a safe haven and has also caused several of them to die on the journey home. This is a glaring evidence of our under preparedness in the face of the pandemic and how the current measures have taken a toll on vulnerable groups.

As speculated by healthcare and economic experts, India is severely inadequately equipped to handle an outbreak. Decades of low investments and insufficient fund allocation to the health sector have rendered people unable to receive care and they are dependent on out-of-pocket expenditure. Kerala is the only State that has tested extensively and reported comparatively higher number of cases which further highlights the inadequacy of other States in doing so. As soon as the initial cases were reported, Kerala took stringent steps towards quarantining the patients while the Centre delayed in announcing any such measures. It has also reported the highest numbers of recoveries. The State employed aggressive testing measures, intensively tracing the contact history, increasing the duration of quarantine and arranging shelters and camps for migrant workers. All these have collectively led to a significant fall in Kerala’s cases, while the other States lag in terms of testing itself.

One plausible explanation for India’s poor testing ratio is its insufficiency in terms of medical infrastructure and the number of frontline healthcare workers.

In contrast with China, which has 4.2 beds per 1,000 inhabitants, India only has 0.7, with some States such as Bihar only having 0.11 beds per 1,000 people. As per the latest trend, infrastructure development has been privatised to such an extent that less than a third of cases of disease are now treated by public services.

The unwelcoming attitude of the general public towards services like health insurance cover also cripples people and leaves them unable to receive the required treatment in most instances. India spent barely 1.28  per cent of its GDP on health services in 2017-18, as per the figures released by the Government.

As testing is vital to check the spread of the virus, India is importing testing kits from other countries, which has delayed the country’s efforts to follow the Kerala model nationwide. The testing laboratories are unable to cater to the needs of the entire population, without which, several hundreds of cases might go undetected and the lack of preventive measures will further overwhelm the system. Not just testing, isolation wards where the patients are admitted are unsanitary. The Government has also been struggling with the availability of quarantine facilities. As per experts, the lack of testing and isolation measures also lays India open to the danger of “community transmission.”

Had its health services been good, India could have opted for the isolation and treatment strategy. But, except in the metropolitan and big cities, the patient to bed ratio and doctor to patient ratio are far below the national average.

As far as estimations go, if the worst case scenario prevails, India will see around 2.2 million cases by mid-May, out of which, around five to 10 per cent of the population will need life support. Only an estimated amount of around 70,000 ICU beds and 17,000 to 25,000 ventilators are available in India, so clearly the system lags severely. Although the Government has been able to curb the spread of infections to a significant extent by implementing “behavioural interventions” such as hand washing, social distancing, self-isolating when sick and others, the country is still prone to the spread of infection in high population density areas with poor supply of water, food and sanitary provisions. The alarming spread of cases in Dharavi, South Asia’s largest slum, has already got the Government of Maharashtra on its toes to prevent the further spread of disease. As per the latest data, Kerala is leading the nation in terms of curbing the illness, while Maharashtra is leading in terms of the spread of infections.

The district of Bhilwara in the State of Rajasthan is a commendable example of how an inevitable large-scale Coronavirus outbreak has been successfully contained due to vigilant and ruthless containment measures. Immediate case mapping, contact tracing, cluster mapping, tracing secondary contacts and imposing a curfew in the entire district were some of the intelligent measures that made Bhilwara emerge triumphant in avoiding the havoc that an outbreak could have caused.

If India’s healthcare infrastructure had been strong, the Government could have adopted the Singapore model, as per which, the city-State has not shut any of its operations and its people do not wear masks. The authorities are still keeping their defences up against the virus by implementing constant monitoring and testing and isolating confirmed cases immediately. It is safe to assume that Thailand and Taiwan’s previous experience of battling a similar virus in 2003 has also helped their governments. Thailand is keeping cases under control by employing aggressive public health campaigns and only 47 total deaths have been reported. The Taiwanese model of tackling the pandemic utilises a combination of vigilance, proactive decisions and maintaining transparency. This has led to only 422 cases reported and six deaths.

All three countries have relied on IT and a strongly geared medical system. The same measures could have been implemented in India if the healthcare system had been dependable and the country did not already have a crippling economy. The nation’s under-preparedness and its struggle towards curbing the spread of the disease, while also compromising the state of its economy, is a testament to the very foundations of our inefficient economy and how a multi-fold increase in focus is required for the healthcare sector.

The pandemic has rendered our economy non-functional and incapable of recovering the loss it has already undergone any time soon. Had the healthcare experts been prepared and had the Government paid more attention to the sector, the curve could have been flattened fairly easily. India could have easily dodged the destruction caused by the pandemic and utilised this as an opportunity to surpass China in the global economic arena. But with the current scenario, all this seems far-fetched and the country only has more restrictions to look forward to in the future.

(Writer: Sakhi John / Akshita kukreja; Courtesy: The Pioneer)

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