By Dr. Oishee & Dhurjati Mukherjee
India has overtaken Russia to take the third position in the world with corona infections rising at a galloping rate. The complacency that was manifest a month ago has now raised concerns, not just amongst the medical fraternity but also the general public. However, most believe that testing being way below the western nations India witnessed lower cases being detected, though recovery rate has been satisfactory.
According to projections by Indian Institute of Science, India will have 35 lakh COVID-19 cases by September in a worst-case scenario and in any case in a better than current scenario, it may hit a peak of 20 lakh cases, 4.75 lakh active and 88,000 deaths by September1. The grim scenario is manifest in the daily nationwide testing of 27 lakh proving to be inadequate with positivity rate – total confirmed cases per 100 tests — reaching the double digit mark for the first time at 10% in the first two weeks of July. Maharashtra was on top with a positivity rate of 23% followed by Telangana 19%, Delhi 15% and Karnataka 12%, whereas Gujarat, Tamil Nadu and Bengal crossed the 10% mark.
Adding to the research into the pandemic, around 239 scientists from 32 nations wrote to the WHO, saying there is evidence that the corona virus is airborne and even smaller particles can infect people– a significant departure from its claim so far that it is spread primarily through cough and sneezes. A report in The New York Times stated that clusters of infections are rising globally as people go to bars, restaurants, offices and markets, a trend that increasingly confirms that the virus lingers in the air indoors, infecting those nearby. In the open letter, these scientists outlined evidence showing that smaller particles can infect people, and are calling for the UN agency to revise its recommendations, adding they plan to publish their letter in a scientific journal.
In such a situation, when the pandemic and resultant lockdown in India has severely affected social and economic situation, and studies reveal the trend will continue at least for another 2-3 months, an avoidable controversy emerged. Last month, ICMR Director General’s stating a 15 August vaccine launch eroded the agency’s credibility and experts questioned the validity of the date, making him retract. As per WHO report, 18 candidate vaccines against COVID-19 are in clinical trials while over 120 others are undergoing lab or animal studies.
The Indian Academy of Sciences, a body of 1100-odd scientists, stated that while administrative approvals could be expedited, clinical trials process and data analysis have a natural time span that cannot be hastened without compromising scientific rigour. In fact, scientists across the globe believe a vaccine is unlikely to be made available by early 2021.
IASc President Dr. Partha Majumder observed: “Scientifically unreasonable demands and claims lower the hard earned international renown of our biomedical research institutions and pharmaceutical industry”. Even Prof. Francis Collins, a top American biomedical researcher testifying before the US Senate, stated: “We’re optimistic that the goal we have set to have a vaccine that works and is safe by the end of 2020 will be met by one of the vaccines…and that we would have by early 2021, 300 million doses of a safe and effective vaccine”.
Independent researchers have pointed out, “no one expects a vaccine to become available for routine public use anywhere before at least the end of 2020 or early 2021”. Obviously, they found the letter surprising because as a doctor-researcher involved in past clinical trials, the ICMR authorities should be expected to grasp the complexity of assessing a brand new medicine or vaccine – something that typically takes years. Thus, it naturally follows there may have been pressure from the political class, who have no understanding of how a vaccine emerges, and as known are in the habit of hoodwinking people.
The neglect of health infrastructure over the years has been the reason successive governments have done little to ensure the barest minimum health facilities for the poor and economically weaker sections. The situation has become worse with the invisible enemy. While the metros and cities, where cases are more, have some health facilities, a lot many more districts are now being affected and the situation is indeed turning quite grave. This has emerged during the past three weeks or so with testing being scaled up in most States.
India has 519 medical colleges that can admit over 80,000 MBBS students a year, as mentioned by MoS Health in the Lok Sabha on November 29, 2019. But the requirement of doctors in the country is several times more, specially in sub-divisions and blocks. Moreover, the number of beds that is being reported almost every day is much less, at least 40% than required. As a result many patients are dying without getting admission in government hospitals.
As regards doctors’ strength there is a growing concern and it needs to be enhanced. These could be specialists who have completed or are on the verge of completing training in clinical specialities in teaching hospitals. Also those who have undergone a fellowship programme for 2-3 years after internship could too be requisitioned, besides those who are trained in Russia and China but couldn’t clear the Indian exit exam too could be considered. Final year nursing students, who finished training and are set to appear for the final exam, is another area that could be looked into.
On another front, there are reports that the Centre is not extending adequate financial help to States, some of whom are fighting the pandemic with scarce resources. As the situation is expected to deteriorate till August-end, the health infrastructure needs to be scaled up, at least in the metros that are severely affected like Mumbai, Delhi, Chennai, Kolkata, Ahmadabad and Pune, other than the districts. Thus, requirement of beds, ventilators, ICU beds etc. need to be beefed up. With accommodation in government hospitals bursting out of seams, there is need for strict vigilance of private nursing homes to ensure they don’t charge the common man in access for beds, ventilator or medicines.
While there is no denying that doctors and nurses in States are doing a splendid job, inadequate health infrastructure is putting them at greater risk and a number of them have succumbed to the virus in line of duty. It’s critical to give them the additional support.
With the challenge undoubtedly quite daunting, the Central political leadership instead of seeking mileage for an early discovery of a vaccine should immediately assist States by setting up 150-bed Covid hospitals for say six months under the Central Govt. Health Scheme (CGHS) in affected metros. Why this hasn’t been done so far requires an answer.
At the same time, the nagging question persists—whether the situation shall improve, how soon and will health infrastructure be given the requisite boost? Will the growing number of patients get adequate treatment in a country like India, which is aiming to be a super power? The Union Health Ministry needs to extend infrastructural support to the States at the earliest and not leave it to them saying it has done its job and now they need to do theirs!