Among the first reports on the government’s management of COVID-19, the parliamentary standing committee on Health & Family Welfare submitted a report recently to the Rajya Sabha chairman. Among other things, it highlighted the underutilization of existing beds and more so the beds created in the railway coaches. Only about 4% of the isolation beds created by the Railways were reportedly utilized by the end of July.
Since the first COVID-19 case was reported on30 January 2020, India has emerged as the country with the second highest number of cases so far with around 93 lakh COVID-19 positive cases. In spite of the high number of COVID-19 cases, the Fatality Rates in India is among the lowest. Even with respect to the high number of cases, the government and others have argued that the high number of cases is due to India’s large population and the country has fared better when the population is taken into consideration. However, few other experts have pointed out the number of tests conducted in India is low when the population is taken into consideration. India currently is second to USA in terms of the total number of tests conducted. Therefore, the opinion is divided on India’s handling the COVID-19 pandemic.
In this context, Parliamentary Standing Committee’s Report on ‘The Outbreak of Pandemic COVID-19 of Pandemic COVID-19 and its Management’ submitted in Rajya Sabha on 21 November 2020, offers a perspective on COVID-19 pandemic management in India. This is the first Parliamentary Standing Committee Report that was presented virtually. We look at the important issues discussed in this report.
Poor contract tracing in the initial stages might have contributed to increase in the number of cases
In the interaction with the Standing Committee, Secretary of the Department of Health Research provided information about the steps taken by the Ministry in containing the Pandemic during the early months.
As per the government’s submission to the committee, one of the initial steps included screening at Airports, Seaports & Land Crossings at borders. Around 5.89 Lakh air passengers and 16 thousand at Shipping ports were screened. The committee was appraised of the advisories issued by the government and the action plan in place to mitigate the spread of COVID-19 cases. The Secretary highlighted that the pre-emptive measures like Lockdown has helped in containing the spread of COVID-19, wherein the growth rate during the initial phases of Lockdown was 36% while during the unlocking period, it was reduced to 3.3%.
The role of the National Center for Disease Control (NCDC) in surveillance and response to epidemic-prone diseases in the country especially through the Integrated Disease Surveillance Programme (IDSP) was also mentioned.
However, the Committee felt that the poor contract tracing and slow testing in the initial phase of the outbreak has led to an increase in the number of infections.
The committee also felt that the IDSP should have been more effectively utilised and that the NCDC-IDSP has failed in generating the required response. It has recommended the government to extend the surveillance under ISDP beyond the current 9 states and also advised to assess the financial needs of NCDP-IDSP for revitalization.
While the Committee did not make any comment on Health Ministry’s claim of reduction in the growth rate of COVID-19 infection, the statement does not present the holistic picture. At the beginning of the Lockdown, there were around 500 total cases in the country with the daily cases being around 100. By the beginning of June, the total number of cases reached 2 lakh with around 8-9 thousand being reported daily. The smaller number during initial days meant that corresponding growth rate would be higher compared to the beginning of the unlock period, where large numbers would ideally mean a larger denominator and hence a reduced growth rate.
These numbers support the Committee’s observation that more effective contact tracing & increased testing during the initial stages could have helped in containing the spread of infection, as the numbers does indicate that in spite of the lockdown, there has been a considerable increase in the number of cases, which has only further increased during the Unlock Phases.
Inadequate number of beds in Government hospitals and underutilization of the available beds
Hospital infrastructure and the accessibility of these Healthcare facilities is another key aspect that the Parliamentary Standing Committee looked into. Government appraised the committee of the 3-tier arrangement of the healthcare facilities –
- Dedicated COVID Care Centers (DCCC)
- Dedicated COVID Health Centre (DCHC) and
- Dedicated COVID Health Hospitals (DCH)
The Government also highlighted the proposal of Prime Minister Atma Nirbhar Swasth Bharath Yojana (PM-ASBY) which is aimed at strengthening public health system. While acknowledging the proposal, the Committee has made some critical observations regarding the availability and accessibility of Hospital beds for COVID-19 patients.
As per the update provided by the Government, there are a total of 220 DCHs, 4153 DCHCs and 8,880 DCHCs across the country i.e. a total of 15,239 dedicated COVID-19 facilities as of 13 October 2020.
The availability of beds across these dedicated facilities is given in the below image.
The government also mentioned that around Rs. 140 crores were allocated for the conversion of Railway coaches to COVID Care Centers. The Railways has provisioned for 813 coaches with 12,472 beds.
Based on this information provided by the Government, the Committee has made the following observations :
- The total number of Government hospital beds available in the country are inadequate. It cites the data from National Health Profile-2019 and states that there is an average of 0.55 government hospital beds per 1000 population. Furthermore, 12 states have a below national average in terms of the number of government beds. This lack of hospital beds, especially those with ventilator facilities has impacted the containment of the pandemic, as per the committee’s observations.
- The Committee further highlighted specific incidences of patients being turned away from the hospitals. Apart from the inadequate availability of beds, it cites the examples of underutilization of available beds. For example, only 242 of the 1572 beds in RML hospital were dedicated to COVID-19 patients. Also, only 289 out of the 2873 beds in Safdar Jung Hospital were reserved for treatment of COVID-19. Committee has asked the ministry to provide the rationale for this underutilization, especially in the context of increased COVID-19 cases in Delhi, where these two hospitals were located.
- The Committee further highlighted the underutilization of the Beds in converted railways coaches, where only 454 patients (as on 21 July 2020) were admitted, in spite of the availability of over 12 thousand beds. The committee said it failed to comprehend the underutilization of the available resources especially at a time when people struggled to find a bed in the hospitals.
While upscaling of the Health Care facilities is a long-term goal which the government should focus on, the underutilization of the available facilities especially during the time of pandemic points to serious lapses in dealing with the pandemic.
In relation to COVID-19 treatment, the Committee made two more key observations. The first one relating to the inadequate budgetary allocation on developing Healthcare facilities in the country. It highlighted that the Government can take the COVID-19 situation as a window of opportunity and increase the spending on Health Infrastructure. The second one was regarding the financial burden of COVID-19 treatment, especially with the lack of specific guidelines on COVID-19 treatment in private hospitals, making this a challenge to the financially weaker sections of society.
We would look at these observations in further detail along with the Committee’s observation on the Testing Strategy, Healthcare workers, Educational Institutions, Mental Health etc. in the next part of the story.
Featured Image: Parliamentary Standing Committee Report on COVID-19