As the number of COVID-19 patients in India rises to 84, and the World Health Organization (WHO) declares it a pandemic, is India prepared to prevent the spread and deal with a severe outbreak?
Chennai:
As of March 14, 84 cases have been confirmed, including 17 foreign nationals. The scare has spread and people across the country are restricting exposure to public places and travel. At this juncture, the question lingering in the minds of people is if India is prepared to handle the impending crisis given peoples habit of spitting on the streets, not washing their hands with soap water and poor hygiene all over? Are the hospitals equipped to deal with the evolving situation? Do we have enough isolation hospital beds and ICUs to contain the spread with speed? Are we disciplined enough as a nation to follow a regimen?
Health infrastructure
“In order to prevent widespread outbreak of COVID-19 in India, we need to take extraordinary measures to test or quarantine all suspected individuals and isolate all the diagnosed individuals,” says Dr Giridhara R Babu, professor and head, Lifecourse Epidemiology, PHFI, Indian Institute of Public Health, Bangalore. “If we miss this golden window of opportunity, our system is simply not capable of handling the load of patients. This is mainly because these complicated cases require ventilators and ICU admissions. We don’t have those kinds of numbers to cater to,” he says.
Provisional data provided in the National Health Profile 2019 report by the Central Bureau of Health Intelligence, shows India has 21,403 government hospitals with 2,65,275 beds in rural areas and 4,375 government hospitals with 4,48,711 beds in urban areas.
Tamil Nadu has 692 government hospitals with 40,179 beds in rural areas and 525 government hospitals with 37,353 beds in urban areas. These numbers include hospitals of the Central government, State government and local government bodies.
There is shortage of critical care facilities in public hospitals in the country. The number of ICU (Intensive Care Units) beds in a hospital depends on the capacity and the type of specialty that hospital deals with. The Parliamentary Standing Committee on Health and Family Welfare in its report (2006-2007) says there are 70,000 ICU beds in public hospitals across India, of which only 8,000 could be considered good.
A 2019 study on healthcare associated infections in ICU’s in public hospitals in India published in the Journal of Prevention and Infection Control found that ventilator associated pneumonia was the most prevalent healthcare associated infection among patients in respiratory ICUs.
India’s public health sector does not have adequate number of doctors and a 2019 report by the Centre for Disease Dynamics, Economics and Policy, says India only has one government doctor for every 10,189 people. The World Health Organization recommends a ratio of 1: 1,000. This means that India has a deficit of six lakh doctors. The nurse patient ratio is 1:483, which implies that India has a shortage of nearly 20 lakh nurses. In 2020, public health expenditure, of both central and state governments would be around 1.6% of our GDP, which is less than the global average of 6%.
Given the rapid spread of the disease and the rise in cases in India, there is a general concern over the adequacy of medical infrastructure in the country.
“At present we have 255 bed capacity isolation facilities in place in Tamil Nadu to handle COVID-19 patients and we are also in the process of identifying more locations to expand. We have also roped in leading private hospitals for isolation facilities. We are fully equipped to handle COVID-19,” says Dr K Kolandaswamy, Director of Public Health and Preventative Medicine, Tamil Nadu.
“Responsibility of people is also very important to control the disease. People should wash their hands at least 10-15 times a day, cover their mouths during coughing and sneezing and clean all surfaces and not just the floors. Unnecessary travel should be avoided.” he says.
Testing laboratories
The Indian Council for Medical Research (ICMR) – National Institute of Virology, Pune, is the apex laboratory for reconfirmation testing of positive COVID-19 samples and it also deals with quality assurance for sample testing and technical training. It is equipped to handle Biosafety Level 4 (highest level of biosafety) contagious pathogens like Ebola.
ICMR records say India currently has 52 testing labs for COVID-19 and 57 laboratories for helping with sample collection. One of India’s COVID-19 testing centres is at the King Institute of Preventative Medicine and Research (KIPMR), Chennai. ICMR has said as on March 9, 2020, a total of 5,255 samples have been tested across the country. These testing facilities have the capacity to test up to 25,000 samples said Minister of State for Health and Family Welfare Ashwini Kumar Choubey in response to a question raised in the Rajya Sabha on March 3, 2020.
Medicines for treatment
Treatment for COVID-19 diagnosed patients is currently supportive and symptomatic as there is no specific treatment drug for the disease. In March 2019, the new drugs and clinical trial rules (NDCT) which comes under the Drugs and Cosmetic Acts was notified which includes provisions to fast track approval processes for usage of unapproved drugs during public health emergencies. Hence, permission can be sought for the restricted use of combination drugs during emergency situations.
Many drugs are being investigated for treating COVID-19 patients by various organizations around the world. “The regulatory framework is now in place for rapid conduct of clinical drug trials as required in an emergency such as COVID-19. There is a network of registered ethics committees across the country to conduct ethics review and monitoring. This system will support conducting trials on not just one but many different drugs as may be required. Decisions about protocols, drugs to be tried, will be taken by regulators on the recommendations of the expert groups that are closely reviewing and ensuring fast track clinical trials,” says Dr Roli Mathur, ICMR – National Centre for Disease Informatics and Research.
Union Minister of Chemicals and Fertilizers D V Sadananda Gowda, in response to a question in Lok Sabha, said that at present India had ‘sufficient stock of medicines’ but he also added that if COVID-19 continued to disrupt manufacture of drugs in China, the apprehension is that that drug supplies from China might be disrupted. Nearly two-thirds of India’s total import of drugs is from China.
The Ministry of Commerce and Industry says India majorly exports drugs to USA and on March 3, 2020, India restricted the export of 26 key drug ingredients and medicines, including Paracetamol. In 2018-19, India exported medicines worth $ 14,389 million. Panic buying of medical supplies, hand sanitizers and face masks has become widespread in many shops and online shopping platforms. The cost of these products has risen exponentially. Earlier, the price of a face mask was less than a Rupee but now it is around Rs 18.
Many drugs are being investigated for treating COVID-19 patients by various organizations around the world. “If everything goes well, there is a possibility that treatment drugs for COVID-19 could be developed and deployed by 2021. Clinical trials for a vaccine could also start within the next few weeks,” says Dr Giridhara R Babu.
Vaccine development
Research organisations, including ones in Israel and Canada, are claiming to have made significant progress with the COVID-19 vaccine but the process of developing a vaccine is time consuming as it involves pre-clinical trials on animals followed by clinical trials on humans before it can be deployed for widespread usage. Israeli scientists are quoted as saying that they are close to developing a vaccine, but that they will need another 90 days to complete the testing. It may take a few months for the COVID-19 vaccine to materialise
Face Masks
- Healthy people DO NOT need masks
- People showing some sign of infection may wear them so that they don’t spread it to others
- The N-95 mask is specifically designed for pollution and may also be used for protection from COVID, but doctors recommend that a simple surgical mask. For patients, and care givers in close contact, a three layer mask may also be used
Containing the damage
“India is in the containment phase to keep the numbers within the capacity of our healthcare system. This is called ‘flattening the curve’. We can do that by social distancing, expanding testing facilities, increasing surveillance systems, transmission control measures like travel restrictions and preventing mass gatherings, providing adequate safety for frontline healthcare workers, infection control in health care facilities, resource sharing and collaboration between private and public health care systems, providing more ventilators and oxygen support, risk communication and public engagement,” says Dr Priya Balasubramaniam, senior public health scientist, PHFI and director, Institute of Sustainable Health Innovations, Singapore. “The elderly, people with pre-existing conditions like chronic diseases or immune compromised individuals, people working in airports, bus, auto and cab drivers, construction workers, people living in vulnerable communities like slums, homeless people should be offered more protection. This is a wakeup call to increase funding to public hospitals and have better quality controls in place for health care systems,” she says.
States and their contingency measures
Tamil Nadu
- 300 isolation wards in Madurai, Tiruchy and Chennai and isolation wards in every district
- To make available sanitisers in all public spaces, schools and colleges
Kerala
- Declared health emergency in 4 districts
- Has mandated 28 days of home quarantine
- Systematically tracking people who have had contact with infected patients
Maharashtra
- State government directs chemists to sell COVID kits only on doctor prescriptions
- 700 beds readied in Mumbai
- Seeking more testing centres
Karnataka
- Reserved 630 beds in government hospitals; 1,689 beds in private hospitals for isolation wards
- 400-bed isolation ward set up at Kalburgi
Delhi
- Nodal hospitals Safdarjung & Ram Manohar Lohia with isolation wards
- 19 government and six private hospitals that treat swine flu asked to set up isolation wards and add 230 beds
Homecoming
- As on March 14, the Indian government has evacuated over 1031 Indian citizens along with 48 people from Maldives, Myanmar, Bangladesh, China, US, Madagascar, Sri Lanka, Nepal, South Africa and Peru.
- 322 evacuated from Italy so far; quarantined at Manesar (near Delhi)
- 234 Indians have been evacuated from Iran
- 654 evacuees from Wuhan (batch 1)
- 236 evacuees from Wuhan (batch 2- currently under quarantine)
How other countries are tackling the outbreak
China
- Confined people to their homes
- Enforced round-the-clock "closed management" of all residential complexes
- Groceries, medication delivered home
- Built over 20 mass quarantine centres
Italy
- Declared "red zone" — meaning people should stay home except for work and other emergencies
- Public gatherings banned
- Domestic sporting events suspended until April 3
Iran
- Public gatherings, including Friday prayers in Tehran and other major cities cancelled
- Schools closed and crews of cleaners dispatched to disinfect trains, buses and places of mass gathering
India
- All existing visas issued to a national of any country except to International Organisations like the UN, diplomats, employment and project visas have been suspended till April 15. Visas of all foreigners already in India remain valid
- All incoming travellers, arriving on or after February 15, quarantined for a minimum of 14 days from March 13.
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