At first it seemed that India had been sheltered from the Covid-19 pandemic. Early action to restrict international travel by the government and state level precautions seemed to be holding back the floodgates of widespread infections.
But in the last month, number of cases have been ticking upwards. While India is technically behind the US in Covid-19 infections, numbers from rural communities may be severely underreported. Testing has recently been ramped up, with over a million tests a day, but this is only on par with the number of tests currently being done in the US (which has one fourth the population). Meanwhile, lack of access to healthcare has been compounding the impact of loss of livelihoods for vulnerable communities.
Covid-19 Impact on Healthcare System
Over the last six months of lockdown, healthcare access has been limited across the country. Dr. Shenoy, who has created a video series on medical topics for the public, divides the healthcare access problems into Covid care and non-Covid care issues.
In terms of Covid care, many states in India do not have a tiered healthcare infrastructure in place to refer patients from local clinics up to hospitals. A recent study of 85,000 patients showed less time in hospitals per person than in the US possibly because of capacity concerns. However, there were lower mortality rates for those above 65 than those in middle age because older patients were likely to be wealthier and likely had access to be better care.
Under non-Covid care, he cited late detection of cancer and uncontrolled diabetes as some of possible outcomes from curtailed access. There have also been heart-wrenching reports of people, including a pregnant woman in Delhi, being turned away for basic medical treatment due to fears over the virus. Disadvantaged communities, especially the elderly working in unofficial jobs, are further affected by loss of livelihood.
The Impact India Foundation, a nonprofit working to improve conditions for disabled individuals in rural India, re-opened their Lifeline Express Hospital Train while following government approved safety regulations. Now stopped at Sabroom Railway station in Tripura in North East India, onboard staff are providing surgeries for restoration of hearing and sight as well as treating problems ranging from epilepsy to clefts and orthopedic impairments. They also provide assistive devices including hearing aids or spectacles and provide screening for diseases including oral, breast and cervical cancer.
At each destination, the train serves over 5,000 people, free of cost, every month. In addition, there are many others working to mitigate the healthcare burden during the pandemic, including HelpAge India (which specifically supports older populations) and Udaan Welfare Foundation (which is focused on preventative healthcare).
Public perception and government response
In addition to the infrastructure challenges, mass hysteria has caused further issues to arise. Panic buying of hydroxychloroquine early on during the pandemic caused real shortages for people with chronic conditions like lupus and arthritis who depended on the medication.
At the same time, misinformation spread by irresponsible media outlets regarding the origin of the virus has led to 3 out of 10 people believing that the SARS-CoV virus behind Covid-19 is manmade, according to The Hindu, despite scientific evidence that it evolved naturally.
While there has been harsh critique of government, with some lockdowns seen as being uncoordinated and caste-biased, while also providing inadequate demand stimulus, the same poll by The Hindu showed public support for the lockdown remains strong at 50%.
The pandemic has also forced the central government to invest in health infrastructure, including adding more hospital beds and medical equipment. Meanwhile the national health insurance plan or Pradhan Mantri Jan Arogya Yojana, meant to provide healthcare access to 40% of the country when it was launched in 2018, recently increased coverage for healthcare workers.
While this a temporary solution for a limited group, it is establishing precedent for healthcare access to be further extended in India. And though private sector health care is growing and making sizable profits, it also needs regulation. The government could also partner with the private sector to meet the healthcare needs of India’s public as it has done previously for renal disease through the National Dialysis Program.
The long-term effects of the virus on populations around the world are unknown, but policy makers should take these sentiments towards the crisis as an opportunity to truly expand healthcare access in India.