Remembering the day she cradled her son’s lifeless body in her arms, Gudiya Devi stares silently into the horizon.
Five-year-old Vivek suffered from a genetic disease but over the summer his condition deteriorated and soon he became unable to eat. As the days passed in their impoverished village of Banka in India’s northern state of Jharkhand, he became weaker and weaker.
“My husband works as a labourer and has to look after our family yet it costs ₹300 (£3.15) to take our son to the hospital,” said Mrs Devi.
“My husband’s work stopped during the pandemic and when we are spending our days starving, where am I going to buy medicines?”
Vivek was one of the two million Indians who suffer from thalassaemia, a genetic disease which causes reduced haemoglobin production.
Unless they get monthly iron-rich blood transfusions, patients have an average life expectancy of 30 years due to a depleted immune system which leaves them vulnerable to infectious diseases like Hepatitis C.
The Indian Government does not provide transfusions and sufferers pay up to ₹4,000 (£42.00) a time in the unregulated private sector, unaffordable for many in a country where 270 million people still live below the poverty line.
Vivek, like thousands of poverty-stricken thalassaemia patients, relied on the Red Cross and another NGO, the Marwari Yuva Manch, for a free monthly transfusion.
However, the onset of Covid-19 caused almost all of India’s blood donations to cease as donors became afraid to visit hospitals.
For days, Mrs Devi phoned hospitals in Jharkhand in a desperate attempt to secure the blood her son’s life depended on.
Then, borrowing money from her neighbours, she hired a car and drove 30km to a blood bank to plead for any remaining supplies.
“They told me that if I wanted blood I had to bring my own donor or write to the Chief Medical Officer,” she said.
On September 1, she again returned to the blood bank, this time with Vivek in the hope his fragile condition would arouse sympathy.
“I reached the blood bank again with my son but it was too late,” said Mrs Devi, “My son died on my lap, right at the time I reached the gate of the blood bank.”
India surpassed the grim milestone of six million cases on Monday and is struggling to contain the world’s fastest growing epidemic.
As a result, it has been forced to direct all of its meagre public healthcare resources into halting the spread of Covid-19, at the expense of other diseases, like thalassaemia.
During the spring, social media was awash with stories of Indians struggling to get their relatives, seriously ill with the virus, admitted into hospitals.
Pre Covid-19, India only had 0.7 hospital beds per 1,000 people – fewer than Iraq, the Democratic Republic of Congo and the Central African Republic.
And, by June, more than 3,000 public hospitals had been designated solely for moderately and severely ill Covid-19 patients.
Many states also introduced their own legislation, such as Delhi, which mandated that 80 per cent of private hospital beds must also be reserved for virus patients.
Public health experts agree that while these policies may have played some part in keeping India’s Covid-19 fatality rates comparatively low – there have been around 94,000 deaths – they have led to a surge in deaths from other diseases.
Historically, the Indian government has been notoriously opaque when it comes to releasing data related to the causes, and numbers, of these deaths.
However, the limited information that is available makes for concerning reading.
In Mumbai, the number of deaths between March 1 and July 31 increased by 37 per cent to 49,040 compared to the previous year. And 6,663 of these additional deaths were from non-Covid-19 diseases.
The western city of Ahmedabad has also recorded an unusually large increase in non-Covid deaths this year.
Public health activists fear India is on the verge of an unprecedented number of deaths from thalassaemia, if the Indian Government does not react.
“It’s high time we demand attention for thalassaemia patients from public hospitals otherwise we are going to lose a lot of people,” said Atul Gera, the Founder of Life Savers, an NGO working for thalassaemia patients in Jharkhand.
“Covid-19 will hammer the last nail in the coffin of thalassaemia care in India, if proper steps are not taken now,” said Dr Soumya Santra, a doctor from the state of West Bengal.
“Deaths are already happening but they are going unrecorded or reported as the co-morbidity.”
Blood banks have either closed their doors or run out of supplies, while public hospitals are refusing to admit thalassaemia patients as they have run out of beds for non-Covid cases.
“There are no facilities open for the treatment of my disease and thus it is becoming a struggle to even stay alive,” said Sheikh Aman Ahmed, 38, another thalassaemia sufferer from Jharkhand, who has developed hepatitis C after being unable to acquire blood transfusions.
Cancer patients across India are facing similar problems. Critical care appointments for cancer have fallen by 80 per cent since February and more than 51,000 cancer surgeries have been postponed.
One nurse from the Lok Nayak Hospital in New Delhi said they were having to turn away 500 cancer patients daily, as they were no longer taking non-Covid cases.
“We can only take patients who are Covid-19 positive, I am very worried for them. I have no doubt there has been a rise in deaths from patients with cancer,” he said on condition of anonymity.
The Indian media has also reported deaths from kidney disease as patients were unable to get life-saving dialysis.
“If a patient has cancer or needs dialysis, or even if the patient has liver diseases, I am very much worried about their survival at the moment,” said Dr Harjit Singh Bhatti, the President of the Progressive Medicos and Scientists Forum.
“These patients are now ending up dead, or in a private hospital or with a quack [doctor with no medical qualifications]. The fate or outcome is very bad.”
In addition to reduced critical care provision, the Indian government has fallen behind on immunisations, with at least one million people having missed tuberculosis (TB) vaccines during the pandemic. India already has the highest number of TB cases in the world.
This will further cause the number of active TB cases to rise from 2.7 million to 6.3 million by 2025, according to a study by Mumbai’s P.D. Hinduja Hospital and Medical Research Centre.
Public health experts hope the Covid-19 pandemic will encourage the Indian government to spend more money on healthcare and reform its dilapidated hospitals.
Currently just £1.50 per person is allocated for healthcare, one of the lowest spends of any country in the world.
This forces many to pay for private healthcare, pushing 55 million Indians every year into poverty, according to the Public Health Foundation of India.
“There are short-term and long-term solutions,” explains Dr Jyoti Joshi, the head of South Asia at the Center for Disease Dynamics, Economics and Policy.
“In the long-term, investing in health system readiness and response and rolling out effective universal healthcare coverage would be important.”
“The pandemic is a great opportunity to rebuild the health system in India, rather than abdicating one’s responsibility and farm out profits to the private sector,” said Dr Yogesh Jain, a rural health expert.
“In particular, there is a real need to document the causes of all deaths and not just those from Covid-19.”
Further pressure on the Indian healthcare system is only one month away as India’s rainy season draws to an end and with it the perfect breeding conditions for dengue and malaria-carrying mosquitos.
In previous years, thousands of community healthcare workers, known as ASHAs, would carry out a nationwide awareness campaign and deliver mosquito nets to homes.
Already, at least ten million fewer house visits have been carried out due to Covid-19 restrictions and Dr Saibal Jana, a malaria specialist doctor from Chhattisgarh state, says hospitals there are already seeing a six-fold increase in cases compared to 2019.
“Post Covid-19, when India tries to limp back to normal, it is going to have a lot of work to do to catch up again,” said Dr Joshi. – Telegraph