Covid-19 crisis: Health infra still a fight two months after lockdown

As India approaches two months of nationwide lockdown, among the longest anywhere in the world, administrators as well as medical experts are brainstorming on whether the country is ready to lift the curbs completely. To take a call, they are assessing if the time since the lockdown began on March 25 was used effectively to ramp up the health infrastructure so that the country can cope with the pandemic as it returns to work. 

Noted surgeon Naresh Trehan believes the lockdown has helped the country create infrastructure. “But whether it's sufficient will depend upon the velocity with which the (coronavirus) peak comes,” Trehan, chairman and managing director of Medanta-The Medicity, told Business Standard. 

Rough estimates suggest a spend of around Rs 1,000 crore in Covid-related manufacturing in the country during the last two months. While the government pushed the production capacities of items such as personal protective equipment (coveralls), masks and sanitizers, industry experts say ventilators and ICU beds are far from adequate. It’s a challenge to get enough PPEs too. For each patient, at least three PPEs are required in a day by doctors and paramedics, according to hospital estimates. 

In this backdrop, India’s coronavirus positive cases tally was at 118,447 as of Friday morning. Of this total, 3,583 have died because of a combination of reasons including perhaps lack of right infrastructure, medical staff seem to suggest. However, the Union Health Ministry figures point at a different scenario. Only 6.39 per cent of total active cases require hospital support such as oxygen, ICU or ventilator, according to health ministry data. 

Despite those projections, the government has been ramping up to cope with the increasing number of cases. For instance, it recently ordered procurement of 15,000 ventilators, to add to the 20,000 it had earlier. Out of those 20,000 ventilators, 7,000 were not in good condition, people in the know said.

“About 14,000 ICU beds in India have ventilators attached to them. With new government orders, the capacity is about 30,000 now. This is grossly inadequate,” Vishwaprasad Alva, the founder of Skanray Technologies, India’s largest exporter of ventilators, said. 

Not having enough trained personnel to handle ventilators and other equipment is also a concern. Intensive care units with ventilators, for instance, need specialist doctors and nurses. “A large hospital would have a team of four or five such senior doctors along with junior doctors under them. The nursing staff required to monitor such patients must also be trained differently. This human capital cannot be created overnight,” Dilip Jose, CEO of Manipal Hospitals, said. 

 

 

Moreover, doctors are struggling to man the frontlines with much longer working hours and no breaks or rest. “It is a mental as well as a physical battle. Working for eight to ten hours in PPE suits is a challenge, and doctors definitely need to be rested,” Manjusha Agarwal, consultant, internal medicine, Global Hospital, Mumbai, pointed out. 

The infrastructure in the country’s commercial capital captures the problem. While 25,000 beds would be available for Covid-19 patients in the next few days in Mumbai, it might not be enough. With 20,634 people living in per square km space, the city is struggling to handle the surge in cases. 

But, the CEO of a leading hospital chain hasn’t lost hope.“The issue of bed capacity is largely regional. The healthcare infrastructure in India is not stretched like what we saw in Europe. But some cities and states may have a tough time,” he said. 

Each state is handling Covid differently. While Maharashtra struggles, in Karnataka, where the government had earmarked 2,000 beds for Covid-19 patients, hardly 5 to 10 per cent is being utilised, the CEO said. “Kerala had a policy of treating asymptomatic and mild patients at home from the very beginning.” 

Industry veterans say there are around 850,000 private hospital beds in the country, accounting for over half of India’s hospital beds. Of this, around 100,000-150,000 are tertiary care beds. Roughly, 20 per cent of a tertiary care hospital’s bed capacity are ICU beds. 

The need for infrastructure is even more due to the uncertainty around Covid-19. “We don’t know the animal we are dealing with...There are people who are Covid positive and those who are yet to become Covid positive...If you sit in a room with 10 people, three will be coronavirus positive,” said Alok Roy, Chair-Ficci Health Services Committee & Chairman, Medica Group of Hospitals. 

Explaining the trajectory, Trehan said on one hand, the numbers would keep increasing and on the other, people would keep getting better. ‘’If that balance is maintained and the number of people who are infected peaks around 200-250,000, it is manageable. If it goes to half a million or above, then we will have a problem,” he said. Private hospitals, meanwhile, are gearing for plan B. A senior doctor in a Delhi hospital said, “We know that the numbers are rising and the load will come to private hospitals...Whenever the government tells us, we have to be ready with a dedicated floor for Covid patients.” In Mumbai, 80 per cent of the hospital beds have been earmarked for Covid. “Private hospitals rejecting Covid patients don’t realise the luxury wouldn’t last long,” Roy said. 

While private hospitals are complaining of inadequate support from the government in the form of a stimulus or cash infusion, government funds have gone largely towards Covid-related manufacturing capabilities. “The Prime Minister's Office mandated us to ramp up local manufacturing as dependence on imports was not going to help and suddenly for items where India was self sufficient (like masks and sanitisers), there was an unprecedented demand," said a government official involved with this. 

The official said all departments worked together at a ‘’lightning speed’’ in granting approvals, managing logistics and handholding the industry. “Now every major ventilator or PPE factory in the country has a government deputed scientist and supply chain manager...The pandemic has shown that if the bureaucratic red tape is sidelined, how versatile the industry and the government together can be,” he said.