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India’s health in peril – lessons from COVID-19 

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Dr Vinay Aggarwal, Past National President, Indian Medical Association, Executive member, DMC discusses the importance of strengthening public, private healthcare with support from the government and how the lessons learnt from COVID-19 should be replicated in managing bigger killers in India like tuberculosis, malaria, dengue, typhoid etc.

It has almost been two months since PM Narendra Modi announced a complete lockdown in view of the emerging pandemic of COVID-19. It was indeed a bold and timely call taken for a country like ours and has been beneficial in terms of flattening the curve to a great extent. On the day India crossed one million tests its total number of positive cases were still far less than the likes of Germany, Italy, Spain and even the US. In terms of recovery we have seen a positive trend of almost 29 per cent cases that have recovered and mortality rate of around 3.3 per cent. Most of the positive cases were mild type / asymptomatic and did not warrant typical ICU care. Now that we have braved through lockdown 1.0, 2.0, 3.0 and have all grudgingly accepted the need for lockdown 4.0, we must not lose sight for the reason behind this bold call. The main reason for this complete lockdown was to prevent the surge of COVID-19 cases that may require increased hospitalisations and overwhelm the already fragile healthcare system of our country. The lockdown was also intended to give the bureaucracy (centre and state governments) enough time to prepare a contingency plan for readiness to manage the COVID-19 cases if requirement of hospital beds and healthcare facilities increases.

So now comes the real question- How is our healthcare system handling this crisis? Behind the claps, lamps, being showered with flowers from the sky-how are the healthcare corona warriors really coping? Currently healthcare sector in the country has taken a major hit. Most family physicians are sitting at home, all routine outpatient clinics have been blocked, all routine surgeries and elective procedures have been cancelled, small nursing homes / hospitals are almost running empty or have been foreclosed, big corporate hospitals have seen major occupancy drop down to less than 30 per cent and hence significant revenue losses all around in private healthcare. Major public hospitals have been converted to corona centres, leading to helplessness in the large number of patients they catered to. There is a growing fear amongst the healthcare personnel to discharge their duties in view of the reports of more than 15 healthcare workers (HCWs) who died due COVID-19 and even the authorities announcing strict actions like sealing these institutions .This situation is compounding the panic all around. Genuine patients who need healthcare services for routine and chronic non-COVID-19 illnesses are suffering. As we move into the third phase of lockdown, healthcare facilities are seeing a surge of preventable emergencies and non COVID-19 deaths due to unnecessary delays in treatment -like burst gall bladders, avoidable sepsis, fatal heart attacks, critical renal patients due to missed dialysis and many more. 

The government on its part may have the right intentions but chaos has been created all around in execution. For eg. Whenever a patient walks into a hospital even for a routine appointment they come in contact with at least five HCWs. In the unfortunate incident that during contact tracing or random testing the patient comes COVID-19 positive, the district authorities are asking to seal the establishment he visited, instead of quarantining and testing the contacts. This leads to loss of medical care for other non-COVID patients being treated, loss of employment for the HCWs besides severe financial losses. This amounts to breaking the back of the small nursing homes and hospitals, which provide much of the healthcare in this country. This is leading to doctors being over cautious in practice. Doctors are not doing any surgeries or small procedures without a proven negative corona report. A corona test report on average takes two days. So the patient loses two days of waiting time, or gets admitted in the hospital and an added test burden for a routine procedure. Multiple recent reports have emerged where magistrates, health secretaries and hospital heads have asked for strict action to be taken against HCWs who tested positive for COVID 19, squarely putting the blame of a confused and collapsing infection management system on the doctors and healthcare personnel. This is leading to the larger public perception of HCWs as carriers of infection and hence rising incidents of stigmatisation and violence against them. Reports emerged of authorities coming down hard on junior doctors and staff who protested putting themselves in harms way without proper PPE. Instead of helping out, many leaked documents in the media showed that protesting doctors, or those that tried to source PPE personally were asked to realign or resign. 

The government cannot solve this impending healthcare crisis without supporting and strengthening public and private healthcare. Millions of deaths every year in India are due to communicable diseases easily preventable by following basic hygiene and cleanliness practices, if enforced. The lessons learnt by the government from corona should be replicated in managing the bigger killers in India like tuberculosis, malaria, dengue, typhoid etc. India lags considerably behind the developed world in many health indices and the same level of determination, focus and unity is required by all stakeholders to improve them. Primary and secondary healthcare should be strengthened throughout the country, so that we don’t burden the tertiary care referral centres. Make in India movement should encourage the production of PPEs, test kits, ventilators and drugs. Telecommunication services should be freed from draconian laws. No part of the country should be left without access to a real or virtual health facility. Private healthcare provides almost 80 per cent doctors, 60 per cent hospitals and 30 per cent of the hospital beds in this country. The government has to stop ostracising its most valuable ally in healthcare and work with the private sector in developing policy, uniform guidelines and infection control procedures as we move forward. Authorities should strengthen and support the nursing homes and hospitals in their area instead of reprimanding them. Doctors and healthcare workers should be protected from the scourge of violence and stigma both in private and public establishments. This pandemic has been a wake up call and both centre and state governments should recognise the need for larger GDP allocation to health. The governments, medical associations, public / private hospitals and the public together can transform India into a world leader in health services.  

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