For How Long Can India’s Healthcare Workers Battle Coronavirus Without Essential Supplies?

On March 22, people across India gathered on balconies, terraces and roads, clapping and clanging pots and pans to express their gratitude towards “essential services” personnel such as doctors, nurses, sanitation workers, and deliverymen who are on the frontlines of the battle against the coronavirus pandemic.

Barely 10 days on, healthcare workers are struggling for basic supplies. They are reportedly using raincoats and helmets in lieu of coveralls and masks; they are being evicted from their homes by paranoid neighbours and forced to sleep on hospital floors.

In recent weeks, there have been several reports about how the Indian government’s mismanagement and “malintention” left healthcare workers without protective gear and essential supplies just as the outbreak began. The lockdown has only compounded the problem.

The consequence: six doctors have so far tested positive for coronavirus in Delhi alone. Today, the Delhi State Cancer Institute was closed after a doctor tested positive for the virus. The hospital said the doctor may have contracted the virus from relatives who had returned from the United Kingdom. Last week, a doctor couple who work in the capital’s mohalla clinics were found infected, after coming in contact with a patient who had recently visited Saudi Arabia.

A staffer at Mumbai’s Kasturba Hospital today tested positive as well, the first such case at a government hospital. Hospital workers told the Indian Express that “doctors and nurses get N95 masks and proper protective gear while cleaners are given an inferior quality knee-length gown and 2-ply or 3-ply mask”.

Three nurses have also tested positive at Mumbai’s Jaslok Hospital and Wockhardt Hospital, as well as a surgeon at Saifee Hospital.

In Rajasthan, three doctors and as many nurses at the Brijesh Bangar Memorial Hospital, a private multispecialty hospital in Bhilwara city, tested positive for coronavirus last month. In the weeks before they started to show symptoms, Newslaundry reported late last week, the medical staff had seen over 6,192 patients. The revelation forced the state government to put Bhilwara district on lockdown.

As of April 1, India has 1,637 confirmed coronavirus infections, with 38 deaths.

A doctor at Delhi’s Safdarjung Hospital warned if the current situation continued, all doctors there would likely come in contact with Covid-19 patients. “Nobody in the hospital is complaining about doing their jobs. But it’s true that our own Resident Welfare Association has tried to accommodate a lot of people by temporarily housing them,” the doctor said, speaking on the condition of anonymity. “The bureaucracy handles the healthcare system. If they give us the support, things will go better. There is a lack of masks, sometimes people have to use the same masks over and over again.”

The doctor cautioned that the situation in India “seems to be in control right now” only because enough tests are not being done. “I feel that we haven’t reached our breaking point,” the doctor said. “But we will, soon, if things continue the way they are in the US or Italy.”

Talking about the psychological toll of dealing with the outbreak, the doctor said, “On the outside, you feel in control, but on the inside, you have a lot of stress. I haven’t been living with my parents because I’m concerned that I might be the agent who might spread it to them. I’m staying at a friend’s place. We have to take care that everything is clean and mopped well, which is an added stress.”

Responding to the crisis faced by Delhi’s essential services personnel, Chief Minister Arvind Kejriwal announced that the families of each of those personnel who die from Covid-19 will receive Rs 1 crore. This includes sanitation workers, doctors and nurses in both private and public sectors.

Kejriwal’s announcement comes just days after the Ambulance Employees’ Association in Uttar Pradesh said its members are striking work because of the lack of protective gear and non-payment of their salaries for two months.

India has two weeks of lockdown to go, and experts have warned that the country might be “flying blind” through the outbreak. So, where does our healthcare system stand?

‘Grossly inadequate’

Reports have pointed out that India’s healthcare system is “crumbling”, with “grossly inadequate” testing facilities for the virus. According to data from the Organisation for Economic Cooperation and Development, India has 0.8 doctors, 1.5 nurses, and 0.5 hospital beds for every 1,000 people.

Why are these numbers so low?

According to the National Health Profile data released last October, India spends only 1.28 percent of its Gross Domestic Product on public health, or about Rs 1,657 per person in 2017-18. But treatment costs have risen, leading to inequity in access to healthcare services.

India’s public health expenditure is lower as compared to Nepal, Sri Lanka, Bhutan, Indonesia, Thailand. According to the World Health Organisation, India ranks 184th out of 191 countries in terms of the share of GDP spent on healthcare. The Narendra Modi government aims to raise the expenditure on public health to 2.5 percent of the GDP by 2025.

The country’s health budget for 2019-20 was less than Rs 63,000 crore. In February this year, the outlay for health in the union budget was again criticised as being disappointing. Finance minister Nirmala Sitharaman announced an outlay of Rs 69,000, only a marginal increase from 2019-20.

In a report in The Print, Indian doctors voiced pessimism when asked how the country was tackling the outbreak, saying its “lucky streak” would not last much longer.

Given the absence of robust public healthcare, it’s especially worrying that, as per 2017 estimates, only about 44 percent Indians have health insurance. According to a report in Mint, of the population with health insurance, eight percent is covered by insurers other than the government. The Rashtriya Swasthya Bima Yojana and similar schemes cover around 26 percent of the insured population, Employment State Insurance Scheme covers 10 percent.

Some hope?

Several companies and organisations have stepped forward to help India tide over this crisis.

The Azim Premji foundation, Wipro and Wipro Enterprises collectively committed Rs 1,125 crore to help contain the pandemic. A part of this assistance is specifically for the “dedicated medical and service fraternity in the frontline of the battle”.

The TVS Motor Company has said it is “making and supplying one million protective face masks for essential service providers” in Tamil Nadu. The automaker Ashok Leyland has said it is supplying protective gear such as masks, disposable gloves, and bodysuits to health and sanitation workers.

Zen Technologies has said it’s in the process of developing a “prototype of a ventilator” for India, expected to be “ready soon”.

On Tuesday, the Indian Red Cross Society received the second batch of masks, respirators and ventilators from the Jack Ma Foundation and the Alibaba Foundation.-News Laundry