Covid 2.0 lifts lid off India’s health infrastructure system

With daily infections nearing 200,000—many experts say the actual number is higher—hospitals in cities such as Mumbai, Delhi and Ahmedabad are stretched to their limits.

More regions in India are announcing lockdown-like curbs to reduce the stress on hospitals and healthcare workers, raising anxiety about job losses and another slowdown in economic activity just as the nation was emerging from the deepest recession since Independence.

Health experts had for long warned about the consequences of underfunding the country’s health infrastructure. But the recent surge has exposed India’s health preparedness even more than the most pessimistic forecasts. Large and unrestricted religious and political gatherings and open flouting of rules about wearing masks and social distancing have contributed to the current crisis.

“There is no easy solution to address the shortage of health personnel at this stage. This is the result of decades of neglect of public health in the country. There is a shortage of all categories of staff. We need primary care doctors and nurses. We have to re-purpose the existing personnel,” said Lalit Kant, a scientist and former head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR).

Testing capacity, one of the crucial tools to slow the virus’s spread, is facing extreme stress. Although diagnostic capacity was ramped up after the outbreak last year, it still appears inadequate to deal with the soaring demand.

Turnaround time for test results in some states has gone up to more than 48 hours because of the huge backlog of samples, preventing the quick isolation of positive patients and impeding contact tracing as well as the quarantine of suspected cases, said Dr Harsh Mahajan, founder and chief radiologist, Mahajan Imaging, a diagnostics chain.

The total number of labs available in India is 2,449, with roughly half of them run by private operators, according to the Union health ministry.

Private diagnostic companies said they are witnessing a spike in the number of patients who are testing positive. “The requirement of negative RT-PCR reports for interstate travel has led to a surge in requests from travellers,” said Dinesh Chauhan, chief executive of Core Diagnostics.

Experts have urged that only symptomatic patients should get the tests done to reduce the burden on laboratories. “Regulatory approvals that are needed for collection and testing are an added burden and a hurdle to build capacity quickly,” said Ameera Shah, managing director, Metropolis Healthcare. “The demand for home visits has gone up and is difficult to scale up at the moment.”

SRL Diagnostics has been trying to hire people to cope with the surge in testing in the past few weeks. “The focus is currently on hiring more lab professionals and phlebotomists and training them in the process of sample collection and testing to manage the growing demand,” said Anand K., chief executive of SRL Diagnostics.

While the government has claimed that it has used the nationwide lockdown to strengthen the public health system, years of under-funding the healthcare sector has left it grossly ill-prepared for a crisis of this magnitude.

The Union health ministry said the country has substantially ramped up the hospital infrastructure for management of covid-19, with 2,084 dedicated covid hospitals (Centre: 89 and states: 1,995) in the country with 468,974 covid beds.

But the worst-affected states —Maharashtra, Gujarat and Delhi—are facing an acute shortage of beds. Maharashtra deputy chief minister Ajit Pawar said the growing number of infected patients is putting a strain on the health system. “The number of beds required for treatment is being increased. Beds in private hospitals have been acquired by the government. Efforts to improve oxygen supply are underway,” Pawar said.

Gujarat has urged the Centre to start a Defence Research and Development Organisation covid hospital with 900-bed capacity at GMDC community hall in Ahmedabad.