Covid-19 strains India's overburdened healthcare system

Staff at a medical college conduct tests for the coronavirus in Kerala on April 6, 2020.
Staff at a medical college conduct tests for the coronavirus in Kerala on April 6, 2020.PHOTO: REUTERS

NEW DELHI - Ms Sheetal Pawar (not her real name) suffers from multi-drug resistant tuberculosis, a highly virulent form of the infectious disease. A daily injection containing amikacin is her lifeline. But even the simple task of having the drug administered became an impossible one for the 36-year-old in Mumbai amid the lockdown this month.

The private clinic she would go to was shut after a case of Covid-19 was reported in the neighbourhood. Ms Pawar offered to walk to the doctor's house so he could inject her with the drug there but he refused to admit her, asking her to go to a government hospital instead.

Once there, she was told the staff at the tuberculosis treatment centre had been sent off on coronavirus-related duties and that no one was around to help her.

It was finally after she reached out to a collective of volunteers who help tuberculosis patients that she was able to find someone to give her the injection at the hospital.

"I could not miss even a single dose, as it would involve the risk of developing resistance to the drug," Ms Pawar said.

The plight of individuals infected with tuberculosis, like Ms Pawar, is indicative of the fallout patients of diseases other than Covid-19 are enduring in India, as the country's overburdened healthcare setup diverts its limited resources to take on the billowing Covid-19 pandemic.

It is a move that some fear could lead to many deaths, especially from diseases such as tuberculosis, one that killed more than 1,230 individuals daily in 2018 in India. On the other hand, the country has reported 824 deaths due to Covid-19 as of Sunday morning (April 26).

"The way other essential health services are being ignored to try and cope with the coronavirus pandemic will create an even greater public health crisis. More people will die because of TB than Covid-19," said Mr Ganesh Acharya, a tuberculosis survivor and volunteer with the Mumbai TB Collective.

He said the lockdown, which was imposed on March 25, has restricted patients' mobility and has diverted government healthcare staff who run a closely monitored therapy for tuberculosis patients to other duties in the fight against the pandemic. That has meant that many fresh cases of tuberculosis have gone undetected.

"They will continue to spread the disease in the community and patients who have missed out on their medicines risk falling prey to multi-drug and extensively-drug resistant forms of the disease," Mr Acharya told The Straits Times.

Official data bear out his argument.The country recorded 207,531 fresh cases of tuberculosis in February. But in March, as the Covid-29 pandemic worsened, the number of cases fell to just 149,109. This number plummeted further to just 25,193 for the period between April 1 and 18.

 
 

India has an overburdened healthcare infrastructure, with a single state-run hospital for every 55,591 individuals on average and a single hospital bed for every 1,844 people. It needs another 500,000 doctors to meet the World Health Organisation's prescribed norm of one doctor for every 1,000 people.

This setup has been further strained after numerous healthcare workers became infected with the coronavirus and many others were quarantined as a precautionary measure.

Earlier this month, India's Ministry of Health and Family Welfare cited "unprecedented demands" on the country's healthcare setup, but included tuberculosis treatment centres in the list of essential services that needed to be maintained while others were deprioritised.

Some private hospitals have even been turning away regular patients because of a fear of handling individuals potentially infected with coronavirus. A top government official of Bihar even went as far as to say that private healthcare institutions in his state were completely withdrawing from their responsibility, following which the government there on Monday issued an order asking them to provide routine as well as emergency medical services.

As the country endeavours to address the Covid-19 pandemic and also maintain general healthcare services as normal, the challenges facing its hospitals are becoming apparent.

This is the case at Kasturba Hospital, a 934-bed not-for-profit hospital in Sevagram in Maharashtra's Wardha district that caters mainly to poor patients.

The hospital management was asked by the state government this month to prepare a 200-bed dedicated unit,with piped oxygen supply for each bed, for the treatment of Covid-19 patients. This came after a government estimate projected the district could see as many as 450 cases of Covid-19 patients in the second half of May.

But Dr S.P. Kalantri, the hospital's medical superintendent, told ST that it is "virtually impossible" to set this up within such a short span as a fortnight or so, especially amid the lockdown that is turning acquiring supplies and manpower into a stiff challenge.

"There is a countrywide phobia that hospitals may require more oxygen beds, which has led to a competition for these limited resources. Hospitals with deeper pockets may not mind spending more money on this, but the problem is that rural and not-for-profit hospitals may be brushed aside," he said.

 
 
 

Dr Kalantri also fears what the impending monsoon season may have in store for the hospital, during which period-surging numbers of malaria, dengue, and scrub typhus patients are brought in.

Around 3,000 patients seek outpatient care in the hospital every day, many of them suffering from these infectious diseases that have certain symptoms in common with Covid-19.

"Between July and October, we find it extremely difficult to find beds for patients who require mechanical ventilation or ICU care. It is a tough time for us. Our OPDs are crowded; our wards are packed.

"If the coronavirus lingers on at that time, we run the risk of being hit by a double whammy this monsoon," he added.