The Covid-19 pandemic has overwhelmed our health infrastructure. India’s coronavirus infections have surged to overtake the U.K, becoming the fourth worst-hit nation, only behind the U.S, Brazil, and Russia.
The situation remains dire, particularly in Delhi and Mumbai where state-run hospitals have run out of beds and are turning patients away. The Delhi High Court on June 11 permitted all the private hospitals in the city, which are equipped with labs to conduct tests and have the sanction of the Indian Council of Medical Research (ICMR). It was imperative to allow private hospitals to conduct tests as there are just 17 labs in the public sector in Delhi, with the capacity to test only 2,900 people per day.
In the private sector, 23 labs have been granted permission, which has a combined capacity of testing 5700 people per day. The decision comes after the Supreme court slammed the Delhi government for a low testing rate in the region which is reporting 1800-2000 cases every day.
On an increase in the number of cases in the capital, Delhi’s Deputy Chief Minister Manish Sisodia shared that by current estimates there would be more than half a million cases by the end of July, requiring more than 80,000 hospital beds. To reduce the burden on public infrastructure, the Delhi government has directed all the private hospitals in the capital to reserve 20% beds for admitting Covid patients.
High Priced Private Hospitals
Adding private hospital beds is a good move but these beds are expensive for the common man. On an average, if a patient was to stay in a private room, including medications, Personal Protective Equipment (PPE) care materials, charges would surge to approximately ₹30,000 to ₹40,000 a day. In an ICU, depending on whether the patient is on a ventilator and other parameters, it would go up to ₹80,000. At a time when people are losing jobs and businesses are shutting down, paying such sums for covid treatment is out of bounds for most pockets. Private hospitals on the other hand have their hands tied due to fixed overheads and mounting losses.
“Although the under-privileged section of the society needs to be protected from the Corona ‘Financial Toxicity’, price capping should be done with due diligence for the extra financial burden on the hospitals in form of PPE, waste disposal, extra human resources and loss of normal revenues antecedent to intake of Covid-19 patients. Fixed costs too need to be monetised and factored in,” shared Dr. O.P Yadava, CEO and Chief Cardiac Surgeon, National Heart Institute, New Delhi with The Blue Circle
Private Hospitals Fight for Survival
Private hospitals have been bleeding money since the crisis broke out in March. N Subramanian, Director (Medical Services), Apollo Hospital, and co-chair, FICCI Health Services Committee told The Hindu Business Line that large private hospitals are staring at a loss of 22,000 crores in the first quarter.
There has been a crippling 90% drop in routine check-ups and non-urgent consultations as people feared to go to the hospital post lockdown. The volume of OPD and non essential surgeries were so low doctors in most hospitals have been coming only on rotation. Moreover, hospitals which are also treating covid patients, require additional staff with the segregation of Covid and non-Covid areas.
For a typical covid patient, four nurses, two on-duty doctors, one primary physician, two wards boys, one lab technician, two security guards at the ward entrance are needed in a single day. The cost of accommodation and missing out on areas that could have been used for treatment has weighed the revenue down further. The price of basic material such as masks and sanitizer bottles have also increased many-fold.
However, Dr. Yadava feels that any hospital should not need any help from financial institutions if the hospitality element – glitz and glamour – is cut and hospitals are run professionally. Adding further, he said, “With the ongoing Covid-19 pandemic, hospitals are overflowing with patients and the extra revenue should make up for the losses of those 6-8 weeks of lockdown. ‘Hospital minus hospitality’ is a viable entity during the Corona pandemic, if only the intent is noble and well-meaning.”
While another leading hospital chain owner, on the condition of anonymity, differs saying that it is difficult to draw a strict line between premium and safe. If you trade down on premiumness you might make your hospital unsafe. As many of the so called frills come with the design of the hospital. That said, in future, we can surely construct more functional hospitals which will be lower in cost.
What Hospitals are doing to Mitigate the Crisis
The hospitals are taking measures to limit the spread of the virus and maintain healthcare services. For instance, training modules have been developed for all categories of staff for teaching personal protection, patient handling, waste disposal, communication skills, etc. Besides, well defined algorithmic protocols have been laid for testing, treatment, discharge planning, and compliance with regulatory norms, including notification.
Hospitals have turned to ‘Skype’ based patient-relative communication systems, as relatives do not have direct access to patients. To ensure the safety of visitors and staff, tiered screening to the hospital has been made mandatory. Additionally, regular (Hourly) disinfection service has been started to reduce fomite based dissemination of the virus.
At the patient level, direct, one-on-one contact has been reduced by launching teleconsultations (Virtual Clinic), remote monitoring, and point-of-care testing for outpatient services. Patients are reassured and educated to the value of compliance with medications, regular exercise, Yoga, and prudence with dietary choices.
Many leading private hospitals like Max, Medanta, and Fortis have introduced home care packages for patients with mild symptoms. The basic home care package starts from about ₹5000 and goes up to ₹22000 in some hospitals. While this could be a good method of treatment to avoid overcrowding at hospitals, there are a few challenges too.
Firstly, the lack of doctors might not permit hospitals to allow their staff to visit home patients regularly. Secondly, if the condition of a patient worsens, it might not be possible to access the doctor or the nursing staff immediately. Additionally, doctors making a trip between patients’ homes and hospitals will put the safety of the entire hospital staff at risk. Dr. Yadava suggests that in any doubt or emergency, one should not hesitate in visiting the hospital, sans any inordinate delay. Hospitals are safe if approached with due precautions. Covid-19 is a self-limiting disease and mild cases need domiciliary care and self-quarantine only.
The Situation is Critical
The number of confirmed cases have crossed the three lakh figure in India. Looking at the country’s healthcare system, the bigger question is where will it stop.
The doctor-population ratio in India is 1:1456 against the WHO recommendation of 1:1000, according to the Economic Survey 2019-20. In small hospitals, if one patient is tested positive, the absence of specialised doctors doesn’t permit them to admit patients further.
The doctors treating the patients don’t have many options either. In the absence of a vaccine, they are treating patients as per the symptoms. The fundamental medicines being Paracetamol, Dolo, and cough syrup for fever, body ache, and cough respectively. Although, India has allowed the emergency use of Remdesivir, sourcing it is a problem for now.
Lack of ventilators in hospitals is another area of concern. As per the norms, the ventilator has to be disinfected and kept for a day but that is difficult to implement due to the rising no. of patients which force doctors to make ethical, and emotionally draining and heart-wrenching decisions – making 2 patients compete for limited resources. The consequent medico-legal issues too are irksome. Even physical effects of the use of personal protection gears and long working hours are showing up now, with burn-outs and rising incidence of depression amongst health-care personnel.
Add to it, the insecurity stemming from the spread of the disease in cities has prompted nurses to leave their jobs and go back to their native places. Hundreds of nurses working in Mumbai hospitals have resigned and gone back to their homes in Kerala, few left without handing over the resignation. There are reports from Kolkata hospitals too regarding the same.
Some doctors turned to the Supreme court over unpaid salaries and lack of proper accommodation facilities. However, the apex court has asked the government to travel the extra mile and channel some extra money to address the grievances of corona soldiers. Contrary to this, Dr. Yadava’s National Heart Institute has increased the salaries of all staff by 20% as part of Covid Allowance with a special life insurance cover; under-taken to provide them totally free health care if anyone contracts disease during this period.
Filling the Missing Gaps
Dr. Guduru, founder of Cureosity, a healthcare consulting and strategic planning company, suggested a few ways which can ease the burden of hospitals. The unused public transport could be used by private hospitals in case of emergencies. The nurses from cities that have fewer cases, could be trained and added to the staff in hotspot cities to increase the bandwidth of the hospitals.
Dr. Yadava stressed on the importance of transparency, sincerity, and accountability. “There are blatant attempts at one-upmanship for nefarious political reasons between the Central and State governments. There is a need for a collaborative spirit between all agencies in this fight,” he said. He further added that epidemiologists and public health experts should be at the center of the task force constituted to fight the virus.
While the situation is worsening day-by-day, the people in white coats are turning up at work every day. Many stay in hospitals to avoid risking their family’s well-being.
We should not forget to thank these warriors for their relentless service during this crucial juncture. There is no denying the fact that people in the health sector and other frontline sectors deserve a round of applause for their dedicated effort.
Reference link : https://thebluecircle.co/2020/06/16/the-business-of-health-in-the-covid-19-era/
National Heart Institute 