In the collective memory of the nation, few times would come close to the shared despair, fear and gloom that is prevalent all across now. Certain parts of the country have been reeling under loss, with people losing their lives not just because of the virus but because of the failure of the system to be prepared. Lack of beds, ventilators, life saving medicines and importantly oxygen points to the complacency and the lack of planning that had set in sometime after November 2020, when cases started to dwindle in the country. 70 years of slack in focusing on the health infrastructure could not be addressed in a few months, but the confidence of both the political and administrative class as well as of the common people, betrayed that feeling of urgency.
"In the collective memory of the nation, few times would come close to the shared despair, fear and gloom that is prevalent all across now. Certain parts of the country…"
While states like Maharashtra, Delhi, Uttar Pradesh among others fight out the steeply rising infection and death curve, others like Odisha await their turn. We have already surpassed the disease burden of the previous year and as of today morning, there is a rise of more than 8000 cases. In perspective, it does not seem like much considering the disease burden in other states, but the ramifications of this will be steep considering the health infrastructure of Odisha.
The urgency in the other states has placed Odisha and a few other lower burden states to be in a position where they could learn from the mistakes committed by other states and prepare themselves for the potential upsurge in the cases. There are many things about the health infrastructure which cannot be fixed in this short amount of time. Lower number of health care providers particularly in the rural and tribal districts and the huge district level disparity in health care infrastructure cannot be remedied in the time frame of a few weeks. So, we need to be realistic in our assessment of what can be augmented and by how much, within the time and resources we have at hand.
While the state government has ramped up efforts on increasing the number of beds in both government and private hospitals, there has been some focus on ramping up the health infrastructure in time. But, there could be some quick learnings taken from the events of the past few weeks which could help build up the confidence of people and prevent some of the chaos that we have been seeing around us.
Timely Information To Instill Confidence
One of the signs of the time has been the desperate cries of help on social media to access beds, medicines and oxygen cylinders for critical patients. While, there must be an informal system in place beyond social media, it is difficult to access and be confident around. The helplessness that people face due to lack of information and the resulting chaos can be easily avoided.
There have been reports of the state government working on an online portal to share information on the real-time availability of beds and ICUs in different districts. Keeping the rising caseload in mind, this portal should be made active as soon as possible for the benefit of the people and to avoid the ensuing chaos.
Ease Burden On Care-Givers Dealing With Artificial Shortage
There is no dearth of information and opinions around Remdesivir and the apparent indiscriminate usage that is being seen. But despite this information, it is well established that the medical fraternity at this point is not going to go too far from the drug, due to both familiarity and lack of options. The SOS calls from multiple states for the drug indicate a supply block which is perhaps going to be remedied in the coming weeks as the local production is going to be jacked up. But, there is also enough evidence of artificial shortage being created through panic buying, hoarding and stock piling.
A remedy for this has been stop hospitals from procuring the medicine from stockists directly, and instead routing it through the DCs office or the CMO. This is meant to solve ‘indiscriminate usage’ of the drug and prevent stock piling, there is a lot of discretionary allocation being reported across states. Between hoarding by stockists and lack of transparency by the government officials, the hospitals and caregivers are the ones running from pillar to post.
This artificial shortage being created is leading to longer duration of stay in hospitals for many, at a time when beds are in short supply. The government must streamline this process of allocation and build in absolute transparency, so that the long queues in front of distributor offices can be avoided.
A district level helpline number just for Remdesivir usage is highly needed till the supply situation is addressed. This will at the least put some functionaries through an institutional line between the care-givers and the authorities.
Reduce Effort For People To Motivate Them For Vaccination
The biggest tool in the hands of the state at this point is to vaccinate the population as soon as possible, because despite all efforts it will be impossible to be fully prepared in terms of public vigilance or health infrastructure. With the new policy in place, the state has also declared that it will provide vaccines free of cost through government channels, for the 18-44 year old population. While the government has already placed the orders for the vaccine, the supply pipeline is unlikely to be cleared before mid-May.
Even in the above 45 year old age cohort, there are repeated cases of centres running out of vaccines and people having to make multiple trips. There is also an increased fear of getting vaccinated at hospitals, due to the fear of getting infected. Vaccine hesitancy continues to be under-reported, with even health care workers delaying doses due to fear of adverse effects and low risk perception.
With the supply concern, being beyond the scope of the state government, there is still a lot that can be done to reduce the physical and cognitive burden of the people to motivate them further for vaccines. Timely information on dosage dates, moving vaccination centres away from Covid designated hospitals, clarifying misconceptions around adverse events could be some of the things focused on.
Better To Be Paranoid, Than Complacent
Even with all these learnings, a critical point that remains is increasing the testing in the state so that a false sense of complacency does not set in. Currently, the number of active cases seem to be not growing as steeply due to surprising reduction in the number of tests being administered. With multiple districts registering a significantly high TFR, it makes no sense whatsoever to see the number of tests going down. It is also particularly crucial keeping in mind, the return of migrant workers and the increase in cases in the neighbouring states of West Bengal and Chhattisgarh. While the government has refuted claims of the lack of testing kits, there needs to be clarity on the reasons behind the drop in testing rates and a clear intention to aggressively test more people in high-risk zones in order to contain the spread.
The past few weeks have shown the amount of preparedness that was needed in a country, with limited resources and a history of inadequate health care infrastructure. With the rising number of cases in Odisha, the return of our migrant workers, the slack in temporary medical centres which were extremely effective the previous year and the pervasive sense of panic and fear all around, we can never have enough tools in our toolkit to ride the wave.
(DISCLAIMER: This is an opinion piece. The views expressed are the author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same.)
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