Bihar’s creaky healthcare system struggles to curb surging COVID infections

Sarvar Ali, 48, a resident of Patna City, takes private tuitions for a living. He is hard pressed to pay Rs 50,000 per day, living as he is on an artificial life support system at a private nursing home , after having contracted the coronavirus disease (Covid-19) on July 30. The All India Institute of Medical Sciences (AIIMS) in Patna refused Ali admission, saying the rapid antigen detection (RAD) test report was not valid, says his nephew Amber Ali.

According to Amber Ali, his uncle had to wait in a private ambulance, with oxygen support, for four hours outside AIIMS before the authorities finally refused him admission. “By the time we got him to a private clinic on the 99 feet Bypass Road at Kankerbagh, his condition had deteriorated and he was put on ventilator support,” he added.

After doctors prescribed his uncle plasma therapy, Amber said he made around 350 calls to find just two convalescent plasma donors. He went with them from one blood bank to another and from one medical college to another on August 5, but none was willing to oblige.

The reason: Most blood banks, including those in government medical colleges, did not have a plasmapheresis machine, required for convalescent plasma donations. The private clinic where Ali is admitted has neither the machine nor the government permission to carry out the procedure. “My uncle is not eating or talking, his condition remains critical,” said Amber, criticising the state government for not capping the cost of treatment in private facilities.

Shaukat Ali, 52, another Covid-19 patient, was admitted in the government’s Nalanda Medical College Hospital (NMCH) on July 24. He died a day later. “No doctor attended to my uncle. The nurse came just once and asked me to learn how to administer the drip, saying she would not come again, as she feared contracting the virus,” recollected Aamir Hasmi, 26, a businessman.

“Though there are ventilators, there is no functional team to run and manage them. As a result,the ventilators there are underutilised. Doctors do not visit patients, they get medical updates on phone,” he added.

Septuagenarian Dr RB Jha, a retired professor and head of the department of surgery at the Jawaharlal Nehru Medical College Hospital (JLNMCH), Bhagalpur, died of Covid-19 on August 5. Dr Sanjay Kumar Singh, former vice-president of Indian Medical Association, Bihar, alleged Jha died of medical neglect.

“Dr Jha was in the ICU, with no one to treat him. Most 60-plus doctors are scared to go near Covid-19 patients. The paramedical staff is equally reluctant. If he were to be left at the mercy of God, a temple would have been better than the ICU,” says Dr Singh.

With nearly 80,000 infections and a chronically underfunded health care system, Bihar is struggling to arrest the spread of Covid-19, which has been made worse by the influx of hundreds of thousands of migrant labourers over two months.

The state, which has largest share of rural population among states in India, has only 0.11 beds and 0.39 doctors available per thousand people, according to the National Health Profile, 2019. In comparison, the figures were 0.46 and 1.54 respectively for Maharashtra, the worst-hit state.

The state has conducted 7,917 tests per million people, the lowest of any state in the country, according to HT’s internal Covid-19 dashboard, compared to the national average of 18,086.

Bihar also has the third-worst doubling rate, a measure of how many days for infections to double from a given point in time, in the country. The state’s doubling rate stands at 14.7 days, behind only Andhra Pradesh and Jharkhand — both at 13.2 days. In contrast, India’s doubling rate stands at 23.6 days.

To be sure, testing in the state has increased in recent days. Bihar was testing just 2,352 samples a day on June 1. The figure rose to 8,500 by the end of June. For the week ending August 1, the state conducted 19,000 daily tests at an average. Last week, this number stood at 52,000 tests a day at an average.

The increased testing has led to a fall in positivity rate, which is the ratio of positive results to the total number of tests conduced. On July 28, this number stood at 17.1% and came down to 6% on August 8.

The government, however, said the situation is slowly improving after a change of guard at the helm of the health department, with Pratyaya Amrit having taking over as principal secretary, health, on July 27. This is the second change the state government has effected since May 20, when Sanjay Kumar was shifted and then Uday Singh Kumawat.

Amrit did not respond to calls and text messages.

On August 1, Bihar launched a mobile application, Sanjivan, to enrol for home isolation, check availability of beds and requisition ambulance, besides dedicated helpline numbers for tele-consultation.

It also set up control rooms, headed by probationary Indian Administrative Service and Indian Police Service officers at dedicated Covid-19 hospitals. It has also set up dedicated personnel to source medicines for patients, instead of asking their attendants to get them.

Bihar health secretary Lokesh Kumar Singh said new cases have to be seen in the perspective of testing, indicating that spike in cases was due to higher testing.

Less than 10% of the total 71,520 tests Friday were done through the reverse transcription-polymerase chain reaction (RT PCR) test, considered to be the gold standard for Covid-19, and the rest were rapid antigen tests, which search for substances that trigger an immune response in the patient and can give results in less than an hour.

“We have taken testing through rapid antigen kits to the primary health centre level in districts. We are also testing non-Covid patients coming to hospitals with other ailments. We are also testing people at flood relief camps, besides testing those in containment zones,” said a state government official, on condition of anonymity.

“The governments at the Centre and state are doing a reasonably good job. It is the people who are behaving irresponsibly by not adhering to norms of social distancing, wearing nasal masks and practising hand-washing habit,” said Dr Ajay Kumar, former national president of the Indian Medical Association and ex-council member of the World Medical Association, which has its headquarters at Geneva. – Hindustan Times