COVID-19 | Is India’s public health infrastructure bursting at the seams?

As I write this article, the total number of COVID-19 cases in India is nearing the 200,000 mark. The number of new cases being reported daily has consistently crossed the 6,000 mark for 10 of the past 11 days in a row. During this time, the average daily deaths due to the infection has been close to 150. All this is happening when the lockdown is officially into its third month.

The Blavatnik School of Government at the University of Oxford had ‘ranked’ our lockdown as the most stringent across all countries and it was strictly enforced using the police machinery of the states. Still we are seeing an increasing rate of incidence of COVID-19 daily, and the peak of the curve is still elusive.

We had taken the lockdown route when the number of COVID-19 cases in India was approximately 500, and now we are slowly opening up when the daily number of cases are above 6,000. Though certain sections of civil society and the government may claim that we have been successful in averting a major disaster through the lockdown and that the doubling time for cases have increased considerably, the fact is that none of it fully explains why stringent lockdown measures are relaxed considerably now.

Rise In Cases

What changed in the last two months, other than a drastic increase in the number of cases? We have learned that the virus cannot be eradicated from the country and we have to somehow learn to live with it. Our cities are bursting at its seams and the urban infrastructure is crumbling — which means that effective ‘social distancing’ cannot be maintained even with a strict lockdown protocol. Many public health experts have questioned the scientific basis of a lockdown, but the public support for such a decisive action has been instrumental in sustaining the measure this long.

It’s a no-brainer that the number of cases are going to invariably rise when the lockdown measures are finally eased — in fact the blueprint for Unlock 1.0 has already been laid out. That said, the million-dollar question is on the probable date till which the rate of increase in the daily number of cases is going to be positive.

Infrastructure Shortcomings

Past experience of dealing with outbreaks and reasonable guesses makes us anticipate at least 5-6 weeks of trouble ahead. In the recent past, several mathematical models have tried to predict the end of the epidemic, and the cumulative number of cases over time — most of them have failed and the actual numbers are far different from the predictions. This is because the number of unknowns in each of these models far outweighs the known variables.

COVID-19 has emerged as an urban disease and this increase in numbers will put enormous strain on the healthcare facilities, as is being reported from Mumbai. More than the physical infrastructure, the constraints in getting trained human resources for appropriate COVID-19 care is going to go up. There is very little spare capacity available in the health system managed by the states, and sharing valuable resources may not be prioritised. To get over this capacity crunch, the only option left will be to fully utilise the facilities of private healthcare providers.

In most states, the diagnostic and treatment facilities available with the private hospitals are not fully utilised; and this places enormous strain on the government facilities. When the private facilities are roped in for COVID-19 care, the governments have the responsibility of oversight and measures such as price-capping, as undertaken by Maharashtra.

Inadequate Testing

India’s testing rates have been a concern since the start of the outbreak. There have been calls from several experts to rapidly increase India’s testing capacity, but we still lag behind most of the nations who are at a similar stage of the outbreak. We have conducted 2,700-odd tests per million population, but it pales in comparison to Spain’s 86,000 and Russia’s 72,000.

All the private labs with Polymerase Chain Reaction (PCR) or Truenat facilities should be roped-in for running testing services. Enabling local companies to bring out their own test kits should be a key component of the strategy to ramp up testing services. Several small companies have been successful in bringing out their own test kits, but there is a concern that the Indian Council for Medical Research (ICMR) has been slow in its processes to validate these kits. An established and transparent regulatory system will serve as a great encouragement for all the start-ups and smaller players in this sector.

Lack of Research

The role played by the universities in India in COVID-19 mitigation efforts will be questioned in the time to come, as they have been seen as playing second fiddle to the government agencies and industry. Much of the vaccine research and testing of novel diagnostic tools have happened at the universities in High Income Countries. Why are we not able to replicate those successes in Indian universities?

The central research institutions and the universities, which often corner most of the research funding available in India, had a responsibility to contribute more. Unfortunately, the Indian academia has not been able to contribute much in terms of COVID-19-related technical and scientific outputs. Building accountability processes in university systems and more industry-academia integration may be the only way forward.

United States took just 22 days to progress from 500 cases to 150,000, but we took more than two months to reach that figure. Therefore, there is some truth in the claim that India was able to ‘flatten the curve’ to some extent. We surely see light at the end of the tunnel, but the question in front of us is: How long is the tunnel? –Moneycontrol