Political Diary
New Delhi, 10 March
2020
Corona Alarm Bells
ARE WE PREPARED?
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
(Copyright, India News & Feature Alliance)
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