While medical equipment may be obtained, skilled personnel are required to operate them. However, there is no credible resource that provides segmented data on personnel and infrastructure. In the absence of such data, tackling emergencies such as the COVID-19 pandemic becomes impossible.
In its second wave, the COVID-19 pandemic not only exhibited its virulence in terms of fatalities but also exposed the inadequacies of our system, both with regards to preparedness and planning for exigencies.
In the first wave of the pandemic, when inter-state migrants were desperate to get back to their native villages, there were no reliable statistics on their numbers that could have helped address their plight of desperation and helplessness. In the second wave, we were faced with shortages of oxygen, hospital beds, medicines, healthcare personnel and infrastructure to cope with the rising caseload every day. This pandemic has put stress on our already limited healthcare resources.
While infectivity of COVID-19, during its initial phase, was two for each infected individual, this rate of multiplication has increased multifold (infectivity essentially measures the potential of one infected individual to infect others). It took 67 days to infect the first 100,000 individuals but only four days to infect the next 100,000, and this sequence has brought the world figure to 185 million cases today.
Given this trend of multiplication, healthcare needs outstripped the existing capacity. India’s healthcare personnel are abysmally inadequate, with a single government allopathic doctor catering to the needs of 10,926 persons. But this aggregate does not account for the skewed divide between rural and urban areas, and southern and northern states. The entire public sector health infrastructure consists of 713,986 beds, amounting to 55 beds per 1,000 people, situating India at the 155th position among 167 countries.
This precarious situation, even if complemented with the private sector’s share of facilities, will not go far to address the evolving demand for beds during the pandemic. It is obvious that we have already suffered a stark imbalance between demand and availability of hospital beds, ventilators, personal protective equipment (PPE) kits and trained medical personnel.
A simple back of the envelope calculation says that if 0.1 percent of the population is infected in two months and a meagre 5 percent of them require ICU beds, it would amount to 65,000 ICU beds. Further, if on average, a patient remains on a ventilator for 15 days, it translates to 975,000 ventilator days. These figures are under the assumption of an infection rate of a mere 0.1 percent, and if we assume it to be 1 percent, one can imagine the infrastructure and personnel required.
While medical equipment may still be obtained, skilled personnel are required to operate them – a clear limitation in the existing scheme of operation. Ultimately, everything that is essential for the management of this expected rise in demand for healthcare will be beyond capabilities, and there will be prioritisation and stipulation to ensure that many patients receive home treatment and isolation, so that they do not need hospital care.
This situation of helplessness has emerged because of the lack of data as well as disregard for even the limited data at hand during planning and execution. To cite a few examples, in a large country like India, the government announced vaccination drives in phases, with each phase adding a certain segment of the population based on age. Yet, there was hardly any planning regarding vaccine supply and the result is a shortage of vaccine doses.
Secondly, the ad hoc nature of healthcare planning, with regards to human resources in healthcare, is perhaps solely responsible for the current state of affairs. From time to time, health policy reiterates the need for greater resources and for addressing the disparity in human resources across the country – regional and between public and private providers.
However, this falls on deaf ears, and to our surprise, there is no credible resource that provides data, segmented into categories, such as the number of doctors, nurses, specialists etc. across regions. If such information is gathered at all, it is limited to public sector facilities and is collated based on professional license registration with the Medical Council of India.
In the absence of such vital information and data, tackling any emergencies such as the COVID-19 pandemic becomes next to impossible. Health statistics remain limited to health outcomes, rather than infrastructure and manpower, which are equally important in gauging the healthcare sector and making adequate provisions in times of emergencies.
Under the current circumstances, everyone talks of machines and materials, as if they themselves are sufficient to do the job, when the application of such equipment requires manpower with varying skills and expertise. In the absence of any auditing of such skills and their distribution, alongside the healthcare infrastructure, not merely in terms of hospital beds but their availability for critical care delivery, it is impossible to face any potential exigencies in the future.
We have displayed to the world an example of a callous, complacent and compromised health environment, which does not reflect our potential but rather our negligence in preparing for the unforeseen. Hence, it is rightly said that failing to prepare is preparing to fail.