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RSTV: THE BIG PICTURE- PANDEMIC & PUBLIC HEALTH SYSTEM

RSTV

Introduction:

India currently has over 2301 confirmed cases of COVID-19. The government has been quick to adopt a multipronged strategy, including issuance of clear guidelines to ministries for coordinated action, imposition of travel restrictions, suspension of visas, large-scale screening and contact tracing as well as regular dissemination of information to the public. Mounting a swift response involving all stakeholders in a country of India’s scale and diversity is undoubtedly commendable. With these measures in place we can be confident that India will be able to successfully limit the spread of the disease. Meanwhile in Italy, the number of coronavirus cases and deaths continue to surge. Doctors and nurses are under increasing pressure and are calling out for help while medical supplies run out rapidly. In the US, dozens of health-care workers have fallen ill with covid-19, and more are quarantined after exposure to the virus, an expected but worrisome development as the U.S. health system braces for a surge in infections. The need of the hour is to build a resilient public health system that can prevent diseases, promote good health and respond quickly to minimise loss of life when faced with an outbreak of this magnitude

Is COVID 19 threatening our public health system?

  • COVID 19 is a new strain of coronavirus and knowledge regarding it is very limited.
  • The entire world is undertaking research to what kind of vaccine will work against this virus.
  • The government was fast enough to take rapid actions to limit travel by suspending visas and quarantining all incoming travellers has helped. All international passengers entering India undergo Universal Health Screening.
  • According to health officials, more than 1 million passengers have been screened at airports, limiting the entry of coronavirus.
  • The response also mirrors India’s reaction to previous disease outbreaks, including Ebola in 2014 and Nipah in 2018, when people were quickly put into quarantine or under surveillance. Indian citizens have been advised to avoid all travel abroad, and citizens have been evacuated from Iran, Italy, China and Japan.
  • Since the outbreak of the virus in China in late December last year, India has had an advance warning of almost three months to help prepare the country for this public health emergency. India can “flatten the curve” to handle the shock of overwhelming cases (Sharon Begley, 2020) only through social distancing and maintaining hand hygiene by the common populace. 
  • India has implemented screening at airports as per directions from the Directorate General of Civil Aviation (DGCA), Government of India (GoI) which has been taking effective strides to control the spread of pandemic
  • The pandemic has not only stirred India’s humongous healthcare network into action but also sharply brought into focus its shortcomings.
  • Our expenditure on health is low, the facilities and infrastructure in public health hospitals is extremely strain.
  • According to the National Health Profile-2019, released by the Central Bureau of Health Intelligence, India has 7,13,986 beds spread across 25,778 government hospitals. The Railways run 122 hospitals across the country with a cumulative 13,355 beds, while the Employees State Insurance Corporation has 155 hospitals with 21,931 beds.
  • The government placed an order of 40,000 ventilators with public sector undertakings, asking them to ensure supplies by June.
  • On the health infrastructure front, Prime Minister Narendra Modi set aside Rs 15,000 crore as an immediate measure with directions to the state governments to make upgrading healthcare system their topmost priority for the next few months

Third Stage of COVID 19?

  • India has begun preparing for Stage-3 of the outbreak following recommendation from members of the COVID-19 task force, even as Indian Council of Medical Research (ICMR) continues to maintain that there is no evidence of community transmission in the country yet.
  • The preparations have already begun in Delhi, where the government has started scaling up its health infrastructure to handle the evolving situation.
  • According to scientists, three stages for the transmission of covid-19 are being discussed. These can be explained as Stage 1 which is when the country receives imported cases, stage 2 is local transmission when persons can get the infection from known sources.
  • Stage 3 is community transmission, when the source of infection is not known for majority of the infected population and new positive cases can no longer be traced to diagnosed cases. This would mean, the scale of the outbreak increases.
  • According to the government, currently India is largely reporting cases either having a travel history to the virus hit countries or contact history with an infected person.
  • When cases with no travel history or direct contact to diagnosed cases start coming in large numbers, then we take it as a beginning of community spread. Though in that sense, India is not in Stage 3, but it would be better that we do our preparations as if we are in phase-3. In case of community rise, numbers start rising exponentially.
  • According to Indian Council of Medical Research (ICMR), India still remains at Stage 2 (local transmission) and is yet to enter Stage-3 of the disease cycle.
  • India also looks to expand its testing capacity over the next few days, as more private laboratories come on board. Private hospitals, too have begun gearing up to help when there is likely surge in infected cases by creating adequate number of isolation wards.

Public Health System scenario:

  • We have a very strong surveillance system in our country which is called Integrated Surveillance system which has spread out to 700 districts.
  • Our detection system is very good.
  • Rapid Response Team is active in all 700 districts.
  • India’s Public health infrastructure of epidemic front has been very strong because we have repeatedly faced such infection like recent one was swine flu epidemic.
  • ICMR, has immediately acted to create a testing capacity in India which is currently underutilized.
  • The National Health Policy (NHP) 2017 advocated allocating resources of up to two-thirds or more to primary care as it enunciated the goal of achieving “the highest possible level of good health and well-being, through a preventive and promotive healthcare orientation”.
  • The government’s recent steps to incentivise the private sector to open hospitals and testing centers.
  • Individual states are adopting technology to support health-insurance schemes.
  • There is an immediate need to increase the public spending to 2.5% of GDP, despite that being lower than global average of 5.4%.
  • The achievement of a distress-free and comprehensive wellness system for all hinges on the performance of health and wellness centres as they will be instrumental in reducing the greater burden of out-of-pocket expenditure on health.
  • There is a need to depart from the current trend of erratic and insufficient increases in health spending and make substantial and sustained investments in public health over the next decade.
  • Increase the Public-Private Partnerships to increase the last-mile reach of healthcare.
  • India should take cue from other developing countries like Thailand to work towards providing Universal Health Coverage. UHC includes three components: Population coverage, disease coverage and cost coverage.

Conclusion:

  • India needs a holistic approach to tackle problem of his coronavirus pandemic. This includes the active collaboration of all stakeholders public, private sectors, and individuals. Amore dynamic and pro-active approach is needed to handle the dual disease burden.
  • We need to adhere to social distancing which is the best remedy now.
  • This phase requires transforming from government preparedness to community preparedness.