ICMR model has worrying projections, govt should rope in even final-year medical students to bolster healthcare workforce.
Given how ICMR research shows that strict quarantining of symptomatic and suspected Covid-19 cases could bring down the overall number of cases by 62%, and the peak-number of cases by 89%, the government seems to have got its Covid-19 response right with the 21-day national lockdown, after having missed the bus on wider testing. There will be significant difficulties, no doubt, especially for the economically vulnerable sections of the population. But, if the lockdown is enforced strictly, with the state ensuring supply of essentials and giving monetary aid to the poor, India could successfully ‘flatten the curve’ of transmissions, thereby relieving the potential pressure on its already struggling public health system. Even then, the ICMR model estimates 200,000 SARS CoV-2 infected in Delhi alone, in the best of circumstances (each infected person transmits to just 1.5 other people, much lower than the hitherto global average, the asymptomatic are not infectious at all, and at least 50% of the symptomatic are quarantined safely.) This would be spread over 700 days. A word of caution here, apart from the model’s stated limitations, the study dates back to February, and the government (Centre and states) has undertaken many containment efforts since then.
Given this high pressure on the health system even in the best-case scenario, there is an urgent need for India to quickly ready its public health to respond ably to the crisis, and even to be epidemic-ready in the future. If the lockdown and isolation measures fail, the flood of patients will overwhelm India’s already under-equipped healthcare facilities. For perspective, there are just 100,000 ICU beds in the country, 1 functioning Primary Healthcare Centre for every 64,800 people (much worse in under-developed states like UP), one PHC doctor for every 38,000 people, and 1 doctor (private and public sector included) for every 1,457; India even had a shortage of nearly 25 lakh nurses, renowned cardiologist and founder of Narayana Hrudalaya Dr Devi Shetty had pointed out a couple of years ago. Dr Shetty, in an interview with Mint, estimates just 1,000 ventilators, a key instrument in managing serious Covid-19 cases, in all of Bengaluru! Indeed, Ramanan Laxminarayan of the US-based Center for Disease Dynamics Economics and Policy, who talked of a possible 300 million infections in India without enough testing and isolation measures, called for the government to press industry to produce ventilators on a war footing, and the Mahindra and the Tata groups have already committed to this. But, does India have enough intensivists trained to intubate patients, i.e., manage ventilator functioning? India has under a fifth of its requirement of nearly 50,000-plus critical care specialists.
A meaningful Covid-19 response requires fixing these problems urgently. This would mean the Medical Council of India, the medical education and healthcare sector regulator, must liberalise a lot of its regulations, as Dr Shetty recommends in his interview. The fact is, both Indian medical education, and healthcare suffer as much from over-regulation as from under-regulation. Dr Srinath Reddy of the Public Health Foundation of India has, in the past, advocated the need to train paramedical staff to function as ‘nurse practitioners’ or ‘nurse anaesthetists’. Dr Shetty says, given Covid-19 could become an epidemic and no doctor should deal with Covid cases for more than six hours a day, there would be a massive requirement for medical personnel. He recommends bringing final year medical students on board to bolster resources. Moreover, while training intensivists via video resources may seem unorthodox or even impermissible, with a McKinsey offering to train intensivists, allowing this to happen digitally will help save lives in the Covid-19 crisis. The government must now treat this as a war, and take measures accordingly.