Covid-19
Surge –
Call by few
for National Emergency?
Covid-19 surge threatens to engulf India. Despite various control measures – nationwide lockdown in 2020, Containment Zones, Quarantine measures and Face masks etc - the second wave the Covid-19 surge - from 2 lakhs in the first week of April 2021 to over 2.84 lakhs on 18 April 2021 continues to threaten life styles and restoration of normal activities to include economic revival.
In particular, the surge in the states of Maharashtra, Delhi, Gujarat, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, Delhi, Chhattisgarh, Punjab and Rajasthan appears quite alarming.
Few vested political interests are demanding imposition of National Emergency. Is it a rational decision? Criticism is galore by experts and pseudo intellectuals in social media, visual and print media. Hardly anyone is reviewing the growth of health infrastructure in the country since independence. Time is ripe to expose fake and fraud coverage of the past blunders. .
Medical experts have already identified a third mutation that has overtaken Indian-origin double mutant strain of the coronavirus, B.1.167, as the cause for the rapid climb of the second Covid wave, which was first detected in October 2020 through genome sequencing of a virus sample. They have already sounded the alarm bells for the follow through surge of Covid-19 – third wave in posterity.
However, the genome sequencing exercise, which was running at a snail’s pace, further slowed down between November and January due to lack of funds, absence of clear directives, and, possibly, also disinterest because of the steadily falling Covid curve.
Considering the “Himalayan Challenge” faced the country, excessive politicization of the issue to score brownie points mercilessly exposes the fraud played out by political parties and leaders.
Let me highlight that Modi led BJP government has no “MAGIC WAND” to make up the shortfalls cumulatively piled up due to past thoughtless, unimaginative and bankrupt policies between 1951 and 2014 both by the Central and State governments respectively.
Thoughtless it is for media to compound persisting scaremongering by endless cacophony borne out of sensational breaking new obsession and providing platform for blame game vicious politics by po9litical parties for the abject failure to wage the war against in their respective backyards.
“TEST, TRACK and TREAT” strategy is one strategy only. Social distancing and quarantine are yet another means to fight the Covid-19. Also, “Double Mask” is another means. People must strictly follow and implement them.
Let me reiterate and highlight that as per the separation of powers enshrined in the Constitution of India, Medical and Health is the responsibility and accountability of the State Governments. For the shortage of Hospitals, Beds, Ventilators, Oxygen Cylinders and medicines to include vaccines, the State Governments are responsible and accountable for the ongoing fiasco to wage war against Covid-19 Pandemic. And, the Central Government is accountable for shortfalls in policies, formulating strategies, financial allocation and collaborating and coordinating implementation at the delivery end. The Medical Council of India is equally responsible for the present mess.
Consensus and Unity of effort is an imperative which is anathema in today’s vicious politics perpetrated in the name of democracy – mutilated beyond recognition by original conception.
Review of inherited mess/crisis in five areas of growth of medical and health infrastructure during the past 74-years are reviewed is vital for gaining insights into balanced “Holistic Perspective” for of the current woefully pathetic state to wage war against the Covid-19 pandemic surge to include: growth state of medical colleges and PG Institutes since 1951; Sub Centers/PHC/CHCs, Dispensaries, Hospitals, Beds and Doctors; management/supply of Oxygen and Ventilators; Vaccines, Remdesivir and allied medicines; and effective implementation of control measures at local levels.
Suffice to sum up that both the ruling parties at the Center and the States are to be blamed squarely for neglecting creation of medical and health medical infrastructure to include education from 1951 till 2000.
In 1950-51, there were only 28 medical colleges. By 1999-2000, their numbers increased to 167. In the academic year 2014-15, there were total of 404 (215 private and 189 government) medical colleges in India.
As per latest data on medical college with the Medical Council of India (MCI), the regulator for medical education and doctors, there are 542 medical colleges and 64 standalone PG Institutes – increase of nearly 200 medical colleges in the last 7-years. In retrospect, the real growth started only after 2000 and galloped after 2014 with the entry of private sector despite all alike were aware of population explosion – the mother of all strategic challenges faced by India .
Most important to appreciate is the skewed growth story. As on date, the top 10 states of medical colleges and PG Institutes include: 1) Karnataka with 60 and 9; 2) Maharashtra with 56 and 11; 3) UP with 55 and 5; 4) Tamil Nadu with 50 and 5; 5) Telangana with 33 and 1; 6) Kerala with 32 and 2; 7) Andhra Pradesh with 31 and 1; 8) Gujarat with 29 and 2; 9) West Bengal with 25 and 8; and 10) Rajasthan with 23.
Follow Delhi with 10 and 11; Madhya Pradesh with 22; Bihar with 16; Odisha with 12 and 1; Haryana with 12 and 1; Punjab with 10 and 2; Chhattisgarh with 10; Puducherry with 9; Jharkhand with 7 and 2; Assam with 7 and 2; J & K with 8; Himachal Pradesh with 7; and Uttarkhand with 6.
Chandigarh with 1 and 1, Manipur with 2, Tripura with 2 and Sikkim with 1 and 1 are followed by one medical college each in Andaman & Nicobar Islands, Arunachal Pradesh, Dadra and Nagar Haveli, Meghalaya, Mizoram and Goa.
No medical colleges in states include; Nagaland, Daman and Diu, Ladakh and Lakshadweep.
The skewed growth of health infrastructure can be easily identified when one takes into consideration the population profile of India (2020) to include: 1) UP with 23.15 crores; 2) Bihar 12.85 Crores; 3) Maharashtra 12.49 Crores; 4) West Bengal 10.29 (2021) crores; 5) Madhya Pradesh 8.50 Crores; 6) Rajasthan 8.10 Crores; 7) Tamil Nadu 7.78 Crores; and 8) Gujarat 7.04 Crores.
For example, Karnataka with population of 6.96 Crores tops the list of medical colleges with 69 and 9 PG Institutes followed by Maharashtra with population of 12.49 crores having 56 medical colleges and 11 PG Institutes. UP with population of 23.15 crores has 55 medical colleges and 5 PG Institutes only. Bihar at the second position in population with 12.85 crores lags behind woefully other states with 16 medical colleges only. De facto, there is skewed growth of medical colleges and PG Institutes.
Most important is the doctor-population ratio in India - 1:1456 against the WHO recommendation of 1:1000. In retrospect, the medical and health care workers (fighters), grossly inadequate, are waging a grim battle of Covid-19 what with some not going to their homes for months.
Next, the review of growth story of Sub Centers/PHC/CHCs, Dispensaries, Hospitals, Beds and Doctors given below clearly exposes the lackadaisical approach of successive ruling regimes at both the Central and State Governments level.
|
|
1951 |
1981 |
2001 |
2021 |
|
SC/PHC/CHC |
7 25 |
57,363 |
1,63,181 |
37,725 |
|
Dispensaries and Hospitals |
9,209 |
23,555 |
43,322 |
69,000? |
|
Doctors (Allopath) |
61,800 |
2,68,700 |
5,03,900 |
11,59,309 |
Number of Primary Health Centers (PHCs), Community Health Centers (CHCs), Sub-District/Divisional Hospitals(SDHs), District Hospitals(DHs) and beds, India, State/UT wise as uploaded by the State/UTs on the Health Management Information System (HMIS) portal of the Ministry - Total 7,39,024 beds in 37,725 facilities.
As per data in public domain in 2020, India has a total of 43,486 private hospitals, 1.18 million beds, 59,264 ICUs, and 29,631 ventilators. On the other hand, there are 25,778 public hospitals, 713,986 beds, 35,700 ICUs, and 17,850 ventilators. Total private infrastructure accounts for nearly 62% of India's health infrastructure.
Surely, the responsibility for the creation of additional beds rests with the local authorities under the control of State Governments. In 2020, the idea of converting a plethora of air-conditioned convention and marriage halls was mooted, but hardly any takers. Instead, State governments opted for requisitioning 5-star Hotels.
Yet another issue that has been politicized (blame games) concerns the availability and supply of Oxygen. An inter-ministerial Empowered Group (EG2) the daily consumption (3842 MT) at present is 54% of daily production capacity (7287 MT) besides stock (~50,000 MT) of medical oxygen.
Key measures initiated by the EG2 are as follows.
• Increase oxygen production capacity of each oxygen manufacturing plant to increase 100 percent production in the oxygen manufacturing units, ramping up availability of oxygen.
• Utilize surplus stocks available with Steel Plants - 14,000 MTs out of CPSUs Steel Plants alone.
• Maharashtra has been able to lift surplus medical oxygen on daily basis from Steel plants like JSW in Dolvi (Maharashtra), SAIL in Bhilai (Chhattisgarh) and from JSW in Bellary (Karnataka). Similarly, Madhya Pradesh is able to supplement its oxygen supply from the Steel plant in Bhilai (Chhattisgarh).
• Move oxygen from States with less necessity to States with increased necessity.
• Facilitate movement of Liquid Medical Oxygen (LMO) tankers. Moving of oxygen by rail.
• Placing of orders for purchase of other one lakh oxygen cylinders is also being undertaken.
• Early completion of 100 percent of the PSA plants sanctioned under PM-cares to enhance self-generation of oxygen in hospitals.
• Daily reviews with the high burden states are being jointly done by DPIIT with MoHFW and Steel Ministry. Oxygen manufacturers are also present in these meetings, as are the Steel units
• Orders have been given by PESO (Petroleum and Safety Organization) for conversion of argon and nitrogen tankers for use as oxygen tankers; thereby the fleet available for transportation of tankers has been enhanced;
· Free movement of oxygen tankers inter-state has been facilitated through MoRTH without registration in the other states.
The maximum consumption of medical oxygen in the country is by states of Maharashtra, Delhi, Gujarat, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, and Delhi, followed by Chhattisgarh, Punjab and Rajasthan.
In retrospect, it is the management of supply of medical oxygen to hospitals and to ensure there is no wastage of oxygen. States have been advised to set up control rooms to ensure a smooth supply of oxygen to the districts as per need, review requirement of cylinders, tankers etc.
Next, the ruling government has issued orders for enhancing the production capacities of Covid-19 Vaccines and Remdesivir medicine vials and also has set target 01 May 2021 for vaccination of all those above 18-years of age. And, financial support has been allocated to private firms.
In sum, the present “Total Mess” in the “Health Sector” as well as the “Education” sector has been created by the past ruling regime over seven decades. To clean up the above mess is most vexatious. If the war on the Covid-19 Pandemic front has to be successfully waged, political parties and leaders must first unite. No useful purpose is served by the TRIOKA of Dynasty and its sycophants responsible and accountable for creating the sordid mess in the medical and health sectors to endlessly criticizing the current ruling regime particularly whilst enjoying “Freebies” at tax payers cost in New Delhi. Merely invoking National Emergency – scaremongering - serves no purpose.
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