India is ill-prepared to cope with the mysterious coronavirus, should it turn into an epidemic, because of a creaky and overburdened health infrastructure, experts said.
The virus outbreak has not been classified as an epidemic by the World Health Organization (WHO), but the disease has already killed 100 people and infected more than 4,000 since being detected in China’s Wuhan at the end of December.
The virus has spread to 19 countries, including India’s neighbours Sri Lanka and Nepal, and has the potential to spread fast to other countries because of human-to-human transmission, according to WHO.
“India is not prepared to tackle health epidemics, particularly given its urban congestion. In fact, given the city structure and the way the settlements have grown, epidemics, once they occur, will spread at a galloping rate. The slum clusters all around the cities, the unhygienic growth, and poor waste disposal system will only aggravate the situation," said Arup Mitra, professor, health policy research unit (HPRU) at the Institute of Economic Growth.
Health infrastructure is the basic support for the delivery of public health activities, but current facilities in the country paint a dismal picture of the delivery system.
There are 23,582 government hospitals with 710,761 beds in the country, according to the National Health Profile 2018. These comprise 19,810 hospitals in rural areas with 279,588 beds and 3,772 hospitals in urban areas with 431,173 beds.
More than 70% of India’s population lives in rural areas and there are 156,231 sub centres, 25,650 primary health centres and 5,624 community health centres to cater to their needs, according to figures from 31 March 2017. There are a total of 2,903 blood banks, which means less than three blood banks for every 1 million population, as of March 2018, according to the latest government data.
“While our laboratory network has improved after the H1N1 scare, much needs to be done to improve the community facing primary health services and risk communication to the public. In general, hospital services can quickly gear up to treat severe cases in urban areas but rural healthcare needs a step up. Kerala’s success in responding swiftly and smartly to the Nipah outbreak should be a role model to other states," said Prof K. Srinath Reddy, president, Public Health Foundation of India.
“The aerial spread of the newly detected coronavirus poses a threat of rapid dissemination but it can still be contained with an efficient response that combines effective public health, microbiological, clinical and communication responses. Central and state health agencies must act in tandem. The media, too, must help in increasing awareness without triggering panic," he said.
Most countries, including India, are unprepared for outbreaks of major infectious diseases, with Asian countries facing significant risks, according to the Global Health Security Index 2019. Thailand and South Korea were among the best-performing countries in Asia, while India was at 57th rank out of 195 countries with a score of 46.5 out of 100, the report said.
There was little evidence that countries have tested emergency capabilities to show they would be functional in a crisis, the report showed. “Fewer than 5% of countries have a national requirement to test their emergency operations centres to respond to a health emergency on an annual basis," the report said.
The private sector has emerged as a strong force in India’s healthcare service delivery. For health emergencies such as coronavirus, private hospitals have geared themselves up. However, their network in small towns and villages is poor and not many can afford private treatment, experts said.