Private hospitals must be brought into the coronavirus fight

Has community transmission of the COVID-19 virus begun in India? There is no clarity on this score. The Indian Council of Medical Research (ICMR) in its daily briefing insists the disease is largely confined to six cities and is not as widespread as ‘community transmission’ would suggest. Public Healthcare Foundation of India’s president Dr K Srinath Reddy says that “community spread is inevitable” and must be tackled in a calibrated manner.

A study conducted by ICMR, whose findings have not been made public, warns about the inevitability of community transmission and the need to set up medical facilities keeping this reality in mind. Daily infection spikes would require an exponential increase in ventilators, intensive care beds and general care beds.

On April 23, Ministry of Health officials led by bureaucrat Luv Aggarwal said that India has 3,770 dedicated COVID-19 facilities. These together have 24,644 ICU beds, 12,371 ventilators and 1,66,960 isolation beds.

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The question is, why are the private health providers not being roped in more actively given the shortage of critical care specialists in the country?

During the last four decades, the focus of the government has been on facilitating private healthcare at the cost of the public health system. A survey conducted by FICCI shows that private hospitals and nursing homes comprise 60% of the beds in India at 8.5-9 lakh and 80% of the doctors in India, and cater to 60% of the in-patients.

As per the study, this vast network of private nursing homes and hospitals have largely shut shop during the lockdown and are incurring losses to the tune of between Rs 14,000-24,000 crore. By doing so, they have placed the onus of providing medical care on our beleaguered government hospitals which often do not possess the equipment or the staff to handle this medical calamity.

Of course, part of the problem, corporate medical officers say, is that the cost of acquiring and maintaining personal protective equipment (PPE) stocks, putting in place separate air conditioning ducts for COVID-19 patients and acquiring ventilators will run into several crores for each hospital.

Some corporate hospitals, including Max Healthcare, Sir Ganga Ram and BLK Hospital to name a few in the capital, have set up separate COVID-19 wards. The cost of a 12-day stay in a private hospital has been calculated at around Rs 6 lakh, which will go up if the patient is shifted to an ICU or put on ventilator support.

The state of treatment available in public hospitals for COVID-19 patients leaves much to be desired. This was brought home a few days ago when a teenage resident of Jehangirpuri, Pratibha Gupta, took to social media to highlight the plight of her father who had tested COVID-19-positive and had been admitted to Lok Nayak Hospital in Delhi. During his two-day stay there, he had complained to his daughter that despite running 102 degree temperature, he had not been attended to by any doctor or been given anything to eat for 12 hours.

Gupta’s tweet evoked an immediate response from the Minister of Health, Harsh Vardhan, but not every suffering patient is so lucky.

The immense focus on COVID-19 seems to have brought a halt to the functioning of other key departments in our hospitals. Even those suffering from health emergencies are being turned down. The recent death of 56-year-old Mumbai lawyer Jaideep Jaywant is one such example. Despite suffering a heart attack, he was turned down by two Mumbai hospitals. His wife finally took him to DY Patel hospital in Nerul, but he died en route.

With general practitioners closed down and OPDs in hospitals not functioning, where do patients suffering from health issues go?

Aflatu, a Varanasi-based social activist, cites the example of his own wife, who is suffering from blood cancer. She needs to go twice a week to Sir Sunderlal Hospital in the Benares Hindu University (BHU) campus for dialysis.

Aflatu complains that despite the Varanasi District Magistrate’s order stating that the OPD of the hospital must function, this has not been the case. The OPD dealt with a minimum of 5,000 patients every day. A simple procedure for his wife has been delayed, he said.

Governments around the world are rapidly expanding their healthcare capacity in response to this pandemic. In India, there is little regulatory control over the private healthcare system.

Of course, some states have moved in to use this private pool of hospitals. Uttarakhand has allotted 25% of beds for COVID-19 patients in private hospitals. In the Bhilwara district, the Rajasthan government took over five private hospitals for treatment of patients. In Andhra Pradesh, the state government requisitioned 58 private hospitals. The Agra district authorities have warned of strict action if patients are turned down.

But by and large, this large pool has not been utilised. Chhattisgarh ordered the takeover of all private hospitals in the state to fight COVID-19 but rescinded the order a few hours later.

The Bihar state government has expressed anger at how private hospitals have simply shut shop, with principal secretary Sanjay Kumar tweeting that regular services available prior to the pandemic are now unavailable.

The situation is the same in West Bengal and UP. The city of Mumbai has seen several large hospitals close down because their own doctors and nursing staff tested positive due to shortage of PPE kits and testing equipment.

Shutting down of hospitals is no solution. Proper nursing protocols, genuine PPE kits and dependable rapid tests are the urgent need of the hour. Is the Union Health Ministry listening?

(The writer is a New Delhi-based senior journalist and author)