HC’s criticism reveals its failure in public healthcare; the state also must get testing right.
The Gujarat High Court’s stinging criticism of the state government for its handling of Covid-19 did come in the context of immediate concerns. But, the problems of infrastructure of which the HC took note—it compared the Ahmedabad Civil Hospital with “dungeons”—are probably symptoms of a deeper malaise. With private hospitals refusing to admit Covid-19 patients despite the state government having asked them to reserve 50% of their beds for the pandemic, the HC ordered strict action against them and said, “We do not want the Government to now plead before such private corporate hospitals with folded hands.”
But, what can a state with a lower number of active primary health centres (PHCs) than even Bihar do other than seek the private sector’s favour? Gujarat has just 704 active PHCs against Bihar’s 1,480, as per the Union health ministry’s Rural Health Statistics 2019 data, and the state was short of its required number of urban PHCs by 50%. That missing public healthcare strength surely hobbled Gujarat’s response, given it could have been, at the very least, used as isolation facilities. To be sure, the present government can’t be blamed—the sorry state of public healthcare is a chronic ailment, with successive state and central governments having failed to give it the required attention. But, the present government’s slipshod response is definitely not helping matters.
Noting that government hospitals are now struggling with the increasing number of patients and are “burdened with the lack of PPEs, shortage of ventilators, ICUs and isolating wards for Covid-19 patients”, the HC directed the state government to “initiate appropriate legal proceedings against all those private/corporate hospitals who are not ready and willing to honour the understanding arrived at with regard to treating the COVID19 patients including those who are not agreeable or willing to cooperate and enter into an MoU.”
The state could be empowered to move in this manner—indeed, neighbouring Maharashtra has already commandeered a significant chunk of private healthcare capacity—but, there is no glossing over its failure to create the requisite healthcare capacity, and its failing to maintain existing capacity in an optimal manner. Like the HC has noted, of the 625 deaths in the state, 570 have been recorded in Ahmedabad alone and, of those, 351 at the Civil Hospital—indeed, while patients from the same areas are being brought to the state government-run Civil Hospital and the Ahmedabad municipal corporation-run SVP hospital, the mortality amongst patients in the former is 13% while it stands at 7% for the latter.
The scale of mismanagement at the state-run facility is evident from the HC judgment taking note of a whistleblower complaint that warns that conditions at the hospital are so poor that the doctors themselves might turn super-spreaders.
The High Court was also critical of the state government “gatekeeping” Covid-19 testing and said, “The argument that ‘more number of tests which lead to 70% of the population testing positive for Covid, thereby leading to fear psychosis’ should not be a ground to refuse or restrict the testing.” This is quite telling of the poor response that the Gujarat government could be mounting. If testing is being staggered—during the second lockdown, the state was conducting 2,993 tests per day, which went up to 4,167 per day by the end of the third, and is now at 4,908—it will lead to a much larger problem than the one the state has on it hands right now.