India says set to confront COVID-19 but time is running out, say doctors

More than two weeks into the world’s biggest ever lockdown involving 1.3 billion people has seen India face the challenge of the COVID-19 spread. Efforts to keep the virus at bay by social distancing and preventive measures seemed to have met with reasonable success going by the numbers of infected cases reported by the official agencies.

But examine these reports: About 26 nurses and 3 doctors test positive in one of Mumbai’s top Hospitals. The Brihanmumbai Municipal Corporation (BMC) has declared it as containment zone.

** The Union Ministry of Health says, the Tablighi Jamaat meetings in Delhi in March have pushed up the doubling rate of cases in India to 4.1 days from 7.4 days.

** The 40-year-old man, who returned from Dubai to perform the tervi ceremony in memory of his mother with 1,500 attending in Madhya Pradesh, tested positive along with his wife. Ten others who took part too tested positive.

There are many more such ‘Hot Spots’ in the country coming to light as the cases are climbing with ominous signs of striking a larger swathe of the county. The official data points to 62 locations in the country where 75 per cent of the present number of 6,500-plus cases 220 deaths reported can be traced.

The joint secretary in the Union Health Ministry, Luv Agarwal, claimed “We are chasing the virus rather than the other way around and India’s strategy continues to be preventive. We rather be over prepared”.

Implicit in his statement is that the government now has taken a proactive role in confronting the gigantic problem and the ‘wait and avoid’ phase is getting behind us. That brings us to the question of how equipped are we to fight this battle on the healthcare front?

It’s no secret that India’s healthcare infrastructure is woefully inadequate for the demands of its 1.3 billion population by any indicator, starting from doctors to beds and critical care facilities to technical support staff. The disparity becomes starker in rural areas. The Telangana Chief Minister, K Chandrasekhar Rao, stated that the country’s healthcare infrastructure is inadequate and cited it as one reason for favouring extension of lockdown beyond April 14.

Except for Kerala as a state with a long-term policy of improving healthcare on a sustained basis, cities like Delhi, Hyderabad, Bengaluru, Chennai perhaps have corporate and private sector medical facilities to boast of to an extent. The task would be ‘Herculean’ to create temporary COVID special hospitals and galvanise medical professionals in rural areas. But it’s a Hobson’s choice at present for many states.

The foremost question is: Are we ready to fully arm our medical fraternity with the wherewithal and safety measures to take on this battle?

A Union Govt exercise with the concerned industry leaders recently threw up the demand projections for the next two months. As per reports India will require roughly 27 million N95 masks, 15 million PPEs, 1.6 million diagnostic kits, and 50,000 ventilators.

The Centre has stepped on the gas in this direction. However, the reality’s that only a couple of companies like Magnum Medicare and Venus Safety have been manufacturing N95 masks and predominantly exporting to the Middle East, US, Europe and some other Asian nations. Recently, they even shipped to China during the crisis.

As far as disposable masks are concerned, Indian manufacturers produce 240 million every year, primarily for domestic use, as per the estimates of the Association of Indian Medical Device Industry. Surgical masks are made by small industries with a maximum capacity to scale up to a lakh per day.

Finally, coming to the critical ventilators, the projected demand by the end of June is around 50,000. Out of these, 16,000 are already available and orders have been placed for 34,000 ventilators. To facilitate procurement of ventilators and other PPEs from abroad, MEA (Ministry of External Affairs) has been taken on board, according to officials.

It’s clear that a combination of urgent scale up of manufacturing capacities and select import is needed to meet the demands. Can we do it? Yes, says the industry. But, the key impediments are funds to increase capacity, buy back guarantee and protection from dumping or external competition in case of bidding process.

A host of innovators from the IITs, CSIR, Defence Labs, biotech companies, universities, etc too are coming up with affordable designs and products ranging from sanitisers to ventilators. Perhaps, ‘Make in India’ has to be effectively tweaked in favour of domestic makers. These will help producers to plan and quickly make investments, the industries say.

The Union government is stating that it is coordinating with the state governments to ensure a steady flow of the supplies of these equipment. The suppliers have also been given adequate instructions to keep increasing production and supply. In the next few weeks, the supply position should improve substantially, says Luv Agarwal.

Meanwhile, hospitals and medical professionals, from doctors to the lowest support staff, who are the frontline warriors at present, are facing difficult times. As the Mumbai Hospital case points out, they are exposed as the first point of fresh infection too. A top doctor in Andhra Pradesh, where cases started shooting up in the last week, lamented: “There is talk from govts but little action, hospitals are not in a position to procure in adequate numbers and the media/TV does not feature any medical voice on this most important need.” At another top corporate hospital, a doctor said there were very few protection equipment. The interventionists, nurses and critical care staff face grave risk. Interestingly, the AIIMS Resident Doctors Association, in a letter to the Prime Minister, said doctors who highlighted the issues related to shortages of PPE, testing and other COVID-related equipment and quarantine facilities on social media were being targeted. They urged the PM to view them as constructive suggestions.

The Prime Minister initially announced a Rs-15,000-crore fund to fight COVID-19. Funds through donations from corporates to citizens under PMCares, the Prime Ministers Disaster Relief Fund and CM relief funds are being collected. Cuts in MPs salaries and other drastic measures have been taken. Meanwhile, the flow of funds from states or the Centre to the healthcare sector is percolating slowly. Most states are facing a financial crisis and also staring at drastic fall in revenues. New hospitals are being created, trains are being converted, etc., but a good number of healthcare professionals at the battlefront are still waiting for full protection.

Bowing to criticism of grossly inadequate testing, the Union Ministry of Health finally announced that it would be stepped up from April 9 in clusters where numbers are rising fast. So far just 1,70,000 tests have been done, which is very low compared to Asian nations like South Korea, Japan and Taiwan. These nations with experience in tackling SARS and MERS earlier have been doing well in managing COVID-19 in the last two months.

Raman Gangakhedkar, Head of Infectious Diseases at the ICMR, said it has validated antibody kits developed by half a dozen Indian and global firms and awaiting Drug Controller nod. So far imported kits, which were expensive and by a couple of Indian firms in small numbers were used. The government put a cap of Rs 4500 per test which drew flak. It quickly intervened to create more testing centres and subsidise the price. Now, the government says, it will cover the test under the Ayushman Bharat insurance scheme, thus extending it to millions of families.

Devi Shetty, the renowned cardiologist and director of Narayana Hrudayalaya, says the most difficult phase of the virus impact would come towards the end of April and early May. “Time is running out for us to prepare more seriously, tougher and effectively to flatten the curve,” is the common refrain from medical professionals.

The ICMR and Ministry of Health declared that the virus is not airborne. Now is the time to ensure delivery of tools to fight the virus that is knocking at our doorstep.

We cannot allow the poet T S Elliot to be true with his famous lines: “April is the cruelest month”.

(The Author is a senior journalist and science writer based in Hyderabad)