Having ‘overtaken’ Russia, India is currently on track to become the second worst affected country in the world from COVID-19, courtesy the gross incompetence and indifference of the Central and state governments.
The ICMR’s testing strategy during the initial days of the pandemic, the state governments’ unofficial policy to underreport rather than contain cases, under procurement of PPE for health care workers, an unnecessary and harsh and unplanned countrywide lockdown when there were less than 100 new cases per day, failure to respond to the migrant workers’ crisis, failure of states to scale up testing and failure to ensure, at the very minimum, that people don’t starve to death has resulted in a surge of new cases despite what was dubbed as the world’s strictest lockdown.
This is in sharp contrast to many countries where the lockdown resulted in a decrease in new cases to the point that many are now relaxing restrictions or planning to do so. But in India, despite increasing cases, the central and state governments have simply given up and commenced ‘Unlock 1 and 2’ – as if the lockdown was successful and as if there are less active cases now than at the start of the process.
The least one expected governments to have achieved during the lockdown was an adequate increase in testing capabilities, institutional quarantine facilities, hospital and ICU beds, ventilators and other infrastructural needs.
Instead, what we are witnessing in Mumbai, Delhi and Chennai is sick patients – in need of testing and treatment – being turned away from hospitals, with some even dying as a result of not finding any hospital to take them in. Besides unspeakable suffering, this also inevitably results in the failure to contain the disease since infected patients cannot access health care and are not isolated from the rest of the population, including their family members.
In Chennai, government hospitals are running out of beds. Only a fraction of private hospitals in the city – a total of just 61 to be precise – have agreed to treat COVID-19 patients. Even these private hospitals are running out of beds. Most private hospitals have actually withdrawn themselves from treating both COVID-19 and other patients.
So we have a situation where sick people are dying without hospital care and most of the hospital capacity is with the private sector and locked away. This alarming situation shouldn’t fool us into thinking we are seeing the worst or that we are near the peak of the epidemic. In fact, there are only 22,375 active cases in Chennai at the time of this article’s writing.
Only a few thousand of them require hospitalisation. Then how is that a few thousand more patients in a city with a population of over 70 lakh and one which boasts of a private healthcare system that caters to the needs of international medical tourism is nearing a health care collapse?
As per official government data, in Chennai, there are 4,145 beds in private hospitals designated for the treatment of COVID-19 patients out of which 2,258 were occupied as of June 28, 2020. Why are patients being turned away from designated hospitals when there are 1,887 unoccupied beds remains a mystery.
A vast majority of the population cannot afford the cost of private hospitals even if they do manage to find a bed. The Tamil Nadu government has fixed upper limits for hospital bills and included COVID-19 treatment under its insurance scheme (CMCHIS). This essentially implies that the state government has washed its hands of any responsibility for care of the majority of the population knowing very well that the upper limits of the tariff will not be enforceable.
While the affordability of private health care is a major issue, there is also another question – how long before the remaining 1,887 beds are occupied? At the current viral transmission rate (Rt = 1.35), Tamil Nadu would see 25,000 new cases every day by the end of July. Chennai would completely run out of both government and private hospital beds in a matter of a few weeks.
This will not resolve soon either; if the transmission rate remains above 1 as it has been even during the lockdown, a majority of the population, somewhere between 50 to 70% (40 to 56 million people in Tamil Nadu) will eventually be infected unless an effective vaccine is available before the epidemic runs its course.
For governments to let citizens die because they can’t afford private healthcare was not justifiable even before COVID-19, but more so now. The hospitals that remain shut today, that have chased away both COVID-19 and other patients are stark reminders about the failure of decades of governmental policy on the privatisation of health care. Successive Central governments have promoted privatisation of health care and chronically underfunded public health. This has now earned us the dubious distinction of being a major country with the worst public health care spending.
Three decades of this policy is responsible for the crisis we currently are in. State governments must nationalise private hospitals instead of meting out unenforceable orders and guidelines for private hospitals or morally repugnant and self-defeating orders like not allowing other state patients to get treatment. This would mean that the government must take care of the expenses of the hospitals including retaining the staff and paying them wages.
Governments can and must find ways to spend significantly more money in health care for this and this must be enforced now before more suffering and loss of lives. Apart from making sure that people don’t suffer because they can’t afford private hospitals, the nationalisation of private hospitals will bring in far more hospital beds than are made currently available. For example in the case of Chennai, an estimated total of 84,210 hospital beds are available, all of which should be utilised by the government to treat both COVID-19 and other patients.
Government undertaking of all private hospitals opens up the possibility for cities such as Chennai to form a network of healthcare infrastructure that will be centrally managed and will be more efficient and allow for the free use of staff, equipments, laboratory and other infrastructure within the network. One of the reasons often cited by listed private hospitals for turning away patients is that they cannot provide ICU care to patients should they require it later.
Under a centrally managed system, patients could be transported seamlessly from one centre to another without any hurdles like bureaucratic inefficiency or settling of bills. Besides it being the morally right thing to do, nationalisation of private hospitals will bring down mortality, reduce suffering but more pertinently scaling up access to health care will go a long way in containing the spread of the disease by better case identification and early isolation of infected people.
The world’s strictest lockdown having already failed, perhaps this is the only thing that could still save the severely affected cities from a complete disaster.
Calls for the nationalisation of private hospitals have been growing. In Tamil Nadu, MP and president of VCK, Thol. Thirumavalavan has urged the government to take over private hospitals. Not surprisingly, a Twitter poll run by a Tamil news channel showed overwhelming support for the demand.
Ultimately the choice before governments is clear and simple: Do they let a majority of the population suffer in silence or employ every resource available to reduce the suffering of people as much as possible?
Asura is the pseudonym of an assistant professor of biochemistry in a medical college.