Reasons for India’s Current state of Crisis:
- Though the second wave expected & prepared by the planning was confounded by two factors:
- A more infectious mutation of the virus
- The people became ignorant & stopped following COVID discipline & guidelines.
- The cases surge were inflated due to the untimed elections & their rallies and also religious mass congruence.
- But most of it, the recurrent failure of India’s Centralized scientific & administrative bureaucracy.
- In most cities, the great demand for ICUs & critical care beds, shortage of oxygen & hoarding of key medicines have been aggravated the situation further.
- In India, scientific agencies failed to come out with key parameters & a planning approach that reveal the geography of the epidemic & helps predict shortage.
- It also failed to come up with any quantitative norm for state-specific preparedness or guidelines to follow.
- The usual problem of poor design of empirical & scientific systems.
- Excessive centralization & a failure of execution, which is compounded with the absence of research.
Case Study of Maharashtra:
- Reference for Comparison: Centre for Disease Control (CDC), US.
- It developed a system that provides the public & states with
- State-wise facts about the epidemic spread.
- Current Hospitalization demand= 15/1Lakh Population
- Mortality = 6%
- Median hospital Stay = 5 days.
Different Factors in Maharashtra Case:
- Though India lacks the above clinical facts based that is crucial for managing the epidemic, the authors made up a study to analyze the Maharashtra case;
- In Maharashtra, the hierarchy of hospitals in dealing COVID as follows:
- Tier 1 consists of large private hospitals & well-equipped public hospitals in main cities that are used for only critical care.
- Tier 2 consists of Smaller Private & Public hospitals dotted across the state used for mild care & to some extent critical care.
- Tier 3 is Community or Home Care.
Quality-of-Care Multiplier to find the relation of mortality with the availability of critical care beds.
- A 250-bed tier 1 critical care hospital should expect 1 death/ day.
- A 250-bed tier 2 hospital should expect 3 deaths/ day.
- Tier 3 is essentially a denial of service for a severe COVID patient.
- For any hospital/state, recording the mortality & duration of care along with the number of beds in each tier defines the preparedness of the district/state.
- In this respect, Maharashtra has been both transparent about preparedness & responsive to rising demand.
- Daily Death Rate (DDR) to estimate hospital utilization & classify the stress levels in a district.
- The districts as the virus spread progressed, degraded from Tier 1 critical service to Tier 3 denial service to the critical patients.
- Though Maharashtra dis increase tier 1 & tier 2 capacities by 18% & 24% respectively, but the faster epidemic spread resulted in more deaths even in advantaged Pune & Mumbai.
- Rural districts are continued to be poorly provisioned.
- The current state of Maharashtra is:
- Tier 1 capacity is exhausted & increases anxiety as only poorer quality tier 2 hospitals available.
- Supply chains of tier 2 hospitals are weak leading to oxygen & drugs shortage.
- Hoarding of services becomes endemic & mortality rises.
- In the case of oxygen availability, at a peak rate of 5 deaths/ million/ day needs more than 7000 MT oxygen/day nationwide.
- India needs a National Plan for the epidemic.
- India needs to have comprehensive research on the lines of Oxford University.
- India has to focus more and more on micro-containment zones strategy.
- India taking a cue from Kerala’s approach of managing a low death rate, it needs to be emulate throughout the country.
- India needs to develop a vibrant administrative system that is decentralized & responsive to any crisis.
- It also needs to focus on better & workable empirical & scientific systems.
- The need of the hour is not to play a blame game on people’s anxieties or solely politicians.
- The current situation is the manifestation of ignorance &failure of all stakeholders.
- The actual need of the hour is to decentralize the COVID tackling strategies with only effective monitoring at the top.
- To overcome a crisis like COVID, the approach has to be organic & dynamic moreover it has to be transparent & responsive. Discuss.