NEW DELHI: The number of people infected with COVID-19 in India has still been largely limited and the Union Ministry of Health and Family Welfare has maintained that there is no community transmission of the infection yet.
But if the government has gone a step ahead and declared a three-week lockdown even before an uncontrolled expansion of the outbreak, it is simply because it knows that the health infrastructure in the country is not equipped to deal with the massive surge in cases that would flood the hospitals in the absence of extreme and even coercive social distancing measures.
Picture this: the availability of hospital beds in the country per 1,000 population in the country is just 0.7 -- among the worst globally-- and according to World Bank figures, this is lower than even many Saharan African countries. Japan with the best ratio to boast, has over 13 beds per 1,000 population.
The sad story of the abysmal healthcare scenario in India does not end there. If there are nearly 27 lakh hospital beds in India—nearly 20 lakh of which are in the private sector—the availability of Intensive Care Unit beds, at just 1.32 lakh, is even more worrisome given the fact that the availability of critical care beds, mechanical ventilation, and supported oxygenation is a critical bottleneck in responding to the ongoing pandemic.
“Prevention is our best bet because we don’t have the health infrastructure that can support a huge volume of hospitalization and that too of critical cases,” said Sujatha K Rao, former Union Health Secretary. “As it is, our health systems are already stretched and northern states fare even worse compared to southern ones.”
What she says is supported by data.
As per the National Health Profile, 2019, several states are even below the national level figure (0.55 government hospital beds per 1000 population) which include Bihar, Jharkhand, Gujarat, Uttar Pradesh, Andhra Pradesh, Chhattisgarh, Madhya Pradesh, Haryana, Maharashtra, Odisha, Assam and Manipur.
These states put together account for nearly 70 per cent of the total population in India.
The figures are gloomier when examined from the perspective of ventilators—a crucial machine that is needed by critically ill patients to breathe. The government has not made public the total number of ventilators -- that cost Rs 5-10 lakh each -- but industry estimates that these devices are just about 40,000 in a country of over 1.3 billion.
Of these, nearly 70 per cent are in the private sector while in public sector hospitals, these are limited to medical colleges and a few tertiary care centres. From the experience of COVID 19 outbreaks from other countries so far, World Health Organisation estimates that nearly 5-10 % of total infected patients will require critical care in the form of ventilator support.
The Centre has declared that it intends to procure at least 6,500 more ventilators at the earliest.
Many believe that while it may not be possible to manufacture or import the devices immediately given the situation worldwide, they urge to ensure that at least supply chain of medical devices is not interrupted.
“The Centre is in mission mode to contain the outbreak and deal with it in the best possible way but states have to be as proactive,” said Pavan Choudary, chairman of the Medical Technology Association of India.
“As of now, due to the lockdown, many trucks carrying medical devices and parts are struck and the governments must ensure that the supply chains to the hospitals are not disrupted in any case,” he added.
Dr Dhruva Choudhary, president of the India Society for Critical Care Medicine, meanwhile sounded rather more pragmatic.
“It is a fact that our healthcare infrastructure, whatever may be the situation, will not change overnight but we will have to tackle the situation as it comes,” he said. “The government has done the right thing by declaring a lockdown as it will most likely flatten the graph dramatically.”