Has the coronavirus pandemic exposed the deplorable state of medical infrastructure in our country?
This article throws light on the current situation of medical infrastructure in our country which is struggling to contain the pandemic. A complete lapse on behalf of the government in terms of investment and development has led to this condition where there are insufficient beds and lack of medicines in every state. The public health sector has always been lagging in terms of quality which has led to a boom of private hospitals which are overcharging and refusing patients as they see fit. Capping the prices has seldom helped the patients as the costs of treatment is still in lakhs in private hospitals. This article tries to find the reason behind this complete disaster of the health system and focuses on practical solutions to overcome it. This article also provides a comparative analysis of the public and private healthcare before, during and after the pandemic.
The country is suffering one of the worst disasters it has ever faced with over 8 lakh people suffering from the infection of the coronavirus. The infection was first recognised in China last year and has managed to travel across the world and has infected over 30 lakh people. The increasing infections has strained our healthcare system as focused care is necessary to combat it. Hospitals around the world are overflowing and temporary care centers are being set up in playgrounds and stadiums to provide treatment for mild symptomatic patients, so that patients with severe infections can be hospitalized. As the virus is capable of mutation and was relatively unknown before the outbreak, very less is known about the medicines available. Experimental medicines and generic medicines are mostly used on patients in combinations with the hope that one of them will work. This situation has further exposed a complete lapse in the development of the public health care system in our country, whose infrastructure is crumbling under the pressure of handling thousands of cases everyday. Private hospitals seldom work due to lack of staff and permission from the government to operate.
A lot of equipment, materials and personnel are required to treat a patient along with proper infrastructure. One of the main necessities is the PPE kit (Protective personnel equipment) which protects the doctors and nurses from exposure to the virus. Digital thermometers are necessary to periodically check the temperature and oximeters and oxygen tanks are required to check and maintain proper oxygen levels in patients with severe infections. Along with this drugs such as Remdesvir and Hydroxychloroquine are necessary to combat the infection. To manage the patients, a proper hospital setup is required with testing facilities and social distancing protocols for the patients. In a few cities, plasma therapy banks are being set up to monitor and aid patients. In cases of extremely severe infections, ventilators are provided to help the patient breathe. All these medical equipment has to be combined with qualified personnel and infrastructure to work efficiently. Currently, our country has 8,20,000 cases which are further expected to rise to 40 lakhs in the upcoming months. Data from the National health profile indicates that over 7 lakh beds are available in the country and over 1 lakh temporary beds are being set up. This is far from the number required as estimated by ICMR. Another difficulty in treatment is when the infection spreads to geriartic population and to people with comorbidities. They have to be given drugs and different dosages and their pre existing health condition has to be constantly monitored. The existing number of ICUs constitute only 5-8% of the total beds in the hospitals and only 50% of the beds are equipped with ventilators. Using this data researchers have estimated that India has 1.9 million hospital beds, 95,000 ICU beds and 48,000 ventilators. Indigenious companies have started manufacturing ventilators and a huge number has been imported from the countries as well. Most of the beds and ventilators are concentrated in 7 states – UP, Karnataka, Maharashtra, Tamil Nadu, West Bengal, Telangana and Kerala. The total number of beds available amounts to 0.55 beds per thousand but to have an effective health care system at least 2 beds per thousand people is necessary.The availability of beds for the vulnerable population is 5.18 beds per 1000 people. Bihar has an acute shortage of only 0.11government beds available per 1000 people. Delhi, Kerala and Tamil Nadu have the highest ratio of the number of beds available per thousand people. Karnataka ranks the highest at 8.6 beds per thousand available for elderly patients. It is approximated that 5-10% of the patients will need the ventilator which implies that 110,000 and 220,000 will be required in the upcoming days. Even with the best case scenario, we have only 57000, which is a quarter of the required capacity. This will lead to acute shortage and lack of proper care for the affected people.
WHO recommends every country to have at least 3 beds per 1000 people. This will help in quality treatment and proper control of the infection. The United States of America, India, Russia, Brazil, Peru and Italy are among the worst hit with lakhs of cases. 12.5 million cases have been discovered around the world till date with over 228,000 cases being added daily. 6.89 million people have recovered and 560,000 people have lost their lives to the fatal infection as of July 11th, 2020. In India, 27000 cases have been discovered on a single day which is the highest spike yet. The positive cases can only be discovered when people are tested in large numbers. In the beginning of the pandemic, only 13,125 samples were tested per day and only Kerala provided proper statewise data. The country has since ramped up the testing facilities by utilising private laboratories and the numbers increased to 20,000 tests by March 24th and over 1 lakh tests by May 7th. It has since remained stable, but patients have reported that it takes at least 4-5 days and sometimes a week before they can get the test results. The growth rate has hence remained stagnant at 2-3% and has not increased. The average number of tests conducted in the month of May stood at 1,23,976 indicating plateauing of the laboratories. Gujarat has the highest rate of positivity with 10% of the tested samples being positive for coronavirus. But the state decided to cut down their testing rates due to overstraining of the labs and lakh of available resources. There have been many cases where states have under reported the total number of fatal cases to maintain a positive fatality ratio. Another issue with treatment is lag of contact tracing due to lack of personnel with the health department. Maharashtra has not decreased the testing facilities despite plateauing since May. Lack of testing can lead to a sudden boom in the number of cases but the government laboratories are completely not capable of handling the workload. Private laboratories are known for overcharging patients and delaying reports despite the government capping the price per test between Rs.3000-5000.
The coronavirus pandemic has most certainly exposed the deplorable condition of the public health care system. Public health programmes such as immunization and neonatal care are also taking a toll due to workers being diverted towards the pandemic care. The central government’s decision to impose a nationwide lockdown had given sufficient time for the health system to ramp up it’s facilities. But despite support from the public and government, Public and private health sectors have failed to equip themselves to deal with the disaster. A stark contrast has been observed in the cost and quality of treatment provided by both the institutions with the private sector being more costly but has not been providing quality treatment due to lack of doctors. The government had announced free testing and insurance upto 25 lakh under Ayushmaan Bharath scheme but this has not been implemented efficiently due to lack of coordination among government agencies. They had also announced a relief package of 20,000 crores to help with the vulnerable and migrant population but the results of the same are seldom seen.
The only way to overcome this current situation is by combining the efforts of both private and public sectors to provide a more decentralized, locale oriented approach. Several states have mobilised COVID hospitals and isolation centers in record time. Tie ups with non governmental hospitals, railway department to convert coaches into isolation centers and converting hotels are some of the measures taken by district administration to combat the disease. Robots have been used on a trial basis to deliver food and necessities to patients in Tamil Nadu thereby reducing personnel exposure. Telemedicine is another development which allows the patient to communicate with doctors over video calls and discuss the symptoms. Technological advances are the forerunners in the fight with contact tracing apps and bio fencing methods to curb the spread. But these measures fail to acknowledge the main issue at hand, was the government prepared to deal with the pandemic? Were the infrastructure and development of medical facilities on par with global standards? These questions raise a certain notion that the government was truly ill prepared and has definitely learnt a lot from the current pandemic to prepare for the future.