The Dangerous Proportions of Covid19 in India
Covid 19 has acquired a dangerous proportion in India. From what it was merely 16,000 per day in the mid of March, it is now nearing 180, 000 now…a jump of almost 18 times. Although this is a trend the world over, India has reasons to be worried. Among the 10 most populous countries in the world, Bangladesh has the highest density (1265 persons/Sq Km) followed by India (464), Pakistan (286) and Nigeria (226). Indian population today is believed to be at par with China’s ~143 Cr (138 Cr Indian +5 Cr Illegal migrants). However, the population density of China is ~1/3rd of India. Hence, any uncontrolled communicable epidemic or pandemic is likely to adversely affect the densely populous nations more than the others. Further, the number of Covid19 cases depend upon the number of tests done. Since the percentage population having undergone Corona tests in Bangladesh, Pakistan and Nigeria are <25% of India, the comparison with India will be illogical.
However, India claiming to be economically superior to the other densely populous state, we should not compare ourselves with them. For India, the fact sheet is not too bad among the developed nations. However, Indian govt cannot take solace from the sufferings of the other developed nations. It is a fact of the day that our daily new Covid cases are maximum in the world since the pandemic struck. In spite of this, the larger populace seems to be ignoring Corona Compliant behaviors. It is not the public alone, even the constitutional bodies are apparently erring. Under the renewed second wave of Covid starting in the mid of March 2021, there was hardly any justification for the Election Commission to have pursued the Election schedules in the 5 states.
It is true that when EC announced the poll schedules on 26 Feb 21, the 2nd wave had not started. It is also true that had the EC cancelled the polls on its own, it would have been under severe criticism of the political parties of siding with the union govt. All the same, the State Govts too are equally responsible in not asking the CEC to postpone the polls owing to the Covid fears. They were possibly under the apprehensions that the day their tenure came to end; President’s rule would have been imposed that they did not want. This apprehension could have been allayed by the CEC through the concurrence of the Supreme Court. However, that did not happen. All public gatherings and events continued flouting all Covid norms. The leaders of all political parties broke the rules and so did the larger populace who ignored the Covid-compliant behavior. The result of all these are before us.
Lockdown in the nation was very essential in March 2020 as India was unable to cope-up with lack of testing facilities, PPE Kits for the hospitals, masks for the citizen, hand-sanitisers, hospital beds for the patients, life-saving facilities and the lifesaving drugs and Oxygen Gas supply. The lockdown really saved numerous lives. A timely constitutes Covid19 Task Force under the PM really changed the scenario. The pandemic provided opportunities. We are proud to have our own vaccines developed under the task force. However, the situation now is grim on the patient management…a glaring shortage of Hosp Facilities.
No one is sure as to the reason for this second wave. Is it purely due to lack of Covid19 appropriate behavior among the citizen or is it the new mutant variants of Corona? By now numerous strains of the nCoV2 have been identified in India incl those of UK, African and other mutants…as well as the new B1617 of Maharashtra. A new double mutant has also been identified in Maharashtra…the E484Q and L452R. It is believed that some of these variants can evade detections on the RT-PCR test but of late, testing authorities have denied it. It is possibly a flawed sample collection. Some are believed to be more contagious and virulent and infecting the younger population more. The second wave unlike the first one, is infecting many or even all in a family. Even the symptoms seem to be more. Instances of lung involvements and depleted blood oxygen saturation seem to be more. However, a recent limited TNN analysis proves that the trend of infection is similar to the 1st wave but younger patients are comparatively landing more to hospitals with higher severity. It is widely believed that we have a long wave to go before fully understanding the virus that Wuhan, China has given a gift to the world.
Today when there is no shortage of testing kits and facilities, a sheer mismanagement by various State Govts are making hundreds of ill citizens, some critically too, to stand in the queues for hours to get their turn for the Covid tests. India had ramped up the Covid tests to few millions a day but today when there are 17-18 million infections detected daily, it is believed that there are far too many who are not being tested. There are long queues of mostly symptomatic individuals in many states of India who are not being tested owing to shortage of testing facilities. Even RAT results intimated after several hours of patient’s anxious weight in Delhi hosp, leave alone the other cities. The situation is fast getting out of control. Shameful scenes are emerging almost in all states with Maharashtra, Gujarat, Rajasthan, UP, MP, Chhattisgarh and Bihar being the worst as far as the availability of the hospital beds are concerned.
There is mismanagement in the patient care too. ICMR has clearly given the guidelines for the mild cases to be treated under Home Isolation or at the makeshift arrangements of the Corona Care Centres. However, several reports are coming that many influential people having mild symptoms are occupying the hospital beds. As a result, the serious cases are unable to get admission in the hospitals.
As on now, the majority of the new cases are coming from the five states of Maharashtra, UP, Chhattisgarh, Delhi and Karnataka as shown in the pie-chart opposite. Numerous holes have been dug in to Delhi CM’s propaganda claims of Delhi excelling in Covid cares. With numerous testing facilities, numerous makeshift CCCs, many new Covid Hospitals raised by various groups incl DRDO. The NGOs (ASHA) rendering immense assistance with supply of medicines to most of the patients in Home Isolation. Many patients also received an Oximeter through Delhi govt, the only small portable gadget to monitor the patients esp under Home Isolation. There is also an effective Telemedicine centre being run by the Step1 group with the doctors calling up the patients, rendering monitoring and advise to them. Delhi was expected to do much better. Patients are running from pillar to post to find oxygen supply and Covid hosp bed.
With the new spike in the new Covid19 case numbers reaching 3.5 lakh per day, the hospital facilities are running short in all major cities. This is a sure justification for a limited lockdown to prepare make-shift hospitals for moderate cases utilizing the existing infrastructures. Delhi administration has already announced a 7-day lock down since 20 Apr 21. Karnataka is following the suit from 27 Apr 21 but they are missing the larger point…there is hardly any justification in locking down the entire state. All major cities in the state that are having shortage of the healthcare facilities, could have been locked down till some makeshift hosp facilities could have been created. The same should be the objective of all State govts…to plan a micro-lockdown.
The makeshift hospitals need not have all facilities of a hospital such as a full-fledged lab, the catering, the laundry, the full medical stores and so on. Lal Path lab or any other group could be contracted to extend their collection centres and forward the online report the same day. All essential drugs, a piped oxygen supply through Oxygen Concentrators / LOX or PSA technologies could have been provided. The nearby medical stores could have been requisitioned to supplement the drugs. A nursing care with a few doctors pooled from the nearest specialist centre could have been adequate. All retired health personnel could have been requested to render a helping hand…not requisitioned thus far. Only Armed Forces have taken the lead so far. All the closed temporary / make-shift Covid Hospitals / facilities all over India should have been re-opened by the State Govts with due assistance from the Union Govt.
By now, DRDO Covid facility has been opened in the morning of 19 Apr 21 and it was almost full by afternoon except few ICU beds. Since then many additional make-shift hospitals/Covid care facilities have come up in several states but unable to meet the huge requirements. The healthcare facilities in the most states are overwhelmed. DRDO has also set up COVID-19 hospitals in Awadh Shilp Gram Lucknow (450 beds), Varanasi (750 beds) and Ahmedabad (900 beds). These hospitals will have LCA technology based Oxygen facilities, ICU beds and the ventilators in logical proportions. It is expected that many such facilities will be opened in near future.