Dr. B.D Sharma, Dr.Apeksha Gupta
The COVID-19 Pandemic has been a massive setback to the economy and health status of the developing countries. Rampaging COVID-19 pandemic is an actual realization of difficulties controlling pandemics in highly populated countries like India. As of August 7, 2020, India has reported a total of 2.09 Million confirmed cases and 42,518 deaths from COVID-19, thus making India, the Asian country with the highest number of cases, since its first case on Jan 30, 2020.
Over the initial weeks of the pandemic, India took some expeditious measures to close the international borders and effectuate an immediate lockdown, which were praised by WHO as “prompt and robust”. Aggressive measures adopted to slow the spread of the coronavirus included the national lockdowns, which affected a population of 1.3 billion, closure of all businesses and means of transportation.
The rigorous lockdown approach, lasting for more than two months, has prevented the loss of many lives. As per the Harvard Data Science Review, the eight-week long lockdown had the capacity to prevent around 388,000 cases by May 15 and 7.5 million cases by June 15, 2020. Despite these stringent measures, numerous challenges are imposed by India’s diverse population across states, health inequalities, wide economic and social disparities, and distinct cultural behaviors. COVID- 19 pandemic continues to spread relentlessly. There are several factors contributing to this.
First and foremost, due to the unpreparedness for the immediate lockdown and disruption of services, a large number of people, specifically migrant workers, lost their livelihood. Masses of people, especially those surviving on minimal wages or daily wagers, travelled to their hometowns from big cities, in turn spreading the disease to even smaller towns by compromising “social distancing”. Furthermore, social instability and false-information driven by fear, stigma, myths, misconceptions, and blame was a great setback, which stigmatized people with COVID-19, thus increasing unrest and violence against health-care workers. Indeed, by not restricting travel or socialization due to fear of stigmatization and social pressures, the chances of transmission of the infection has seen a rise. People fear the idea of isolation, rigorous quarantine requirements, and stigma attached by the society to those in quarantine and isolation, thereby avoiding precautionary isolation and running away from the treatment centers. Due to lack of awareness, as well as a scarcity of income and resources, people do not want to be away from family for a prolonged time. To add to the turmoil, people have been hiding their travel history to escape quarantine. Providing fallacious information about travel, even when symptomatic, increases the susceptibility to exposure and infection.
Dismally, India faces a lack of health workers and unavailability of medical protection equipment, due to sudden rise in covid-19 cases. A number of steps have been taken by the Government in this regard, which is evident from the fact that, India is now producing close to 4.5 lakh Personal Protective Units daily. There has been an impending shortage of hospital care, in terms of beds and critical care setups, with data suggesting that there is only one isolation bed per 84,000 people, one quarantine bed per 36,000 people and only one doctor per 11,528 Indians. Likewise, due to the inadequate availability of personal protective equipment like face masks, shields and gowns, medical providers are at maximum risk in this pandemic. Additionally, India’s public health-care
system is chronically underfunded, which eventually drives millions of Indians turning to private health-care sector, which has become the main source of health care in more than 50% of households in urban and rural areas, irrespective of about four times greater cost than the public healthcare. Yet, many private setups have been reluctant to admit COVID-19 patients and currently working on setting up protocols on how to triage COVID-19 patients safely, thus overwhelming the public hospitals with a sudden spike in admissions. Due to all these factors, the rates of testing have been very low in India (0.56 per 1000 people as of June 26), one of the lowest in the world. People with early infections and atypical symptoms are consequently missed, as testing is not readily available. This further creates a large pool of untested but infective patients, largely increasing disease transmission.
Tragically, the problems of job instability and unemployment have worsened the already struggling efforts against COVID-19 in India. A large section of the population in India, like any developing nation, have “Informal jobs” like house helps, garbage collectors, rickshaw pullers and street-side vendors. They lack employment certainties, don’t have the ability to work from home or avoid the use of public transportation and thereby cannot protect themselves and others by observing “social distancing”. This has steeply increased the rate of spread of the disease. The data published by the Centre for Monitoring Indian Economy showed a spike in unemployment to 24 percent by May 17.
Alarmingly, there has been a much larger spread of virus in poor neighborhoods, where already people suffer from illnesses like tuberculosis, with morbidity rates higher than the general population. The spread of the infection is very high in such places due to low socio-economic status, inadequate information and unavailability of means for hygiene, illiteracy, crowdedness and uncertain access to clean water. Implementing adequate public health measures becomes laborious in such unsatisfactory living conditions making these people at the highest risk from COVID-19. Also, a large number of people in India suffer from tuberculosis, diabetes, and hypertension, thus making them especially at risk to COVID-19.
Indian healthcare systems and policymakers so far have achieved some success in slowing down the spread of the virus by increasing the time interval between the doubling rates, thereby ramping up healthcare infrastructure. “But as the pandemic surges, data related to the number of hospitalizations and deaths due to COVID-19 needs to be followed to see the long-term impact of this approach” This economic crisis will be something new for health care policymakers to pay attention to as well, finding a right balance between two will be a challenge the policymakers will have to grapple with for long time to come.
Following are few measures to be prepared for any future recurrences and to help mitigate the disparities in health care among people:
1. Active surveillance and effective data accumulation should be enforced as these are the best guide to target communities which are in most need.
2. The Government should focus on laying the foundation for a stable and sound healthcare system focusing on early and timely primary care to all the people irrespective of socio-economic status. Early detection of comorbidities leads to better health status.
3. Social awareness through various programs, thus promoting mandatory health checkups in underserved areas.
4. Education and information to the people at risk, about unhealthy lifestyle methods, poor housing conditions and assure them about good housing and proper transportation. 5. The medical professional should be able to reach all the sects of the society, irrespective of race, culture and socio-economic status. 6. Adequate personal protective equipment like masks and gloves should be provided to people who are not able work from home.
India’s response to the COVID-19, as the second-most populous country, has had an enormous impact on the world’s ability and approach in dealing with this pandemic. Despite a multipronged strategy by India to contain this contagion, the curve of COVID-19 is still trending up, albeit slowly. Emerging social & economic issues and their impact on disease containment will be keenly watched by the world- especially developing countries.
(The authors are Associate Professor of Medicine Division of Hospital Medicine and Nephorology Division of Vascular Medicine, University of Florida and (MD, Anesthesia) Observer Anesthologist , Washington(DC)
feedbackexcelsior@gmail.com
Trending Now
E-Paper
Follow our WhatsApp channel