With only five positive test cases, India has so far escaped the rash of infections being reported from countries as far afield as South Korea, Iran and Italy. Now, experts warn that India, which spends a mere 1.3% of its GDP on health, could face some serious challenges.
“Any shock to the health system triggered by a virus has the potential to fill up hospital beds, overwhelm the crowded public health infrastructure, drain healthcare workforce capacity and increase out-of-pocket expenditure," said Siddhartha Bhattacharya, secretary general of Healthcare Federation of India, a forum of healthcare stakeholders.
Experts say India is yet to develop a robust primary healthcare, quality emergency response infrastructure and a surveillance system that can easily detect infections. There is also a lack of strong case record management and care continuum integration backed by universal financing.
They doubted India’s ability to ramp up healthcare facilities swiftly if needed, unlike, say, China, which built two hospitals in 15 days. According to the National Health Profile 2018 report, there are 23,582 government hospitals with 710,761 beds in the country. 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, where there are 25,650 primary health centres, 156,231 sub-centres and 5,624 community health centres.
There are a total of 2,903 blood banks—less than three for every 1 million population, according to government data.
“Given the density of population in the metropolitan cities, the rate at which the virus can spread is going to be very high. Secondly, our hospitals are usually overused, with very little capacity to handle new casualties," said Arup Mitra, professor of health policy research unit at the Institute of Economic Growth.
On Monday, the government said it is preparing 19 more laboratories in addition to the existing 15 for testing samples of suspected Covid-19 patients.
“We can increase the number to 50 laboratories as and when we need," health minister Harsh Vardhan told reporters at a press conference. No private healthcare companies have been roped in yet, he added.
As and when private hospitals suspect a Covid-19 infection, doctors send samples to government-run facilities such as the National Institute of Virology in Pune.
Ritu Garg, zonal director for Fortis Memorial Research Institute (FMRI) in Gurugram, said the institute has temperature screening at its emergency room for all patients, and is quarantining anybody with symptoms of fever, cough and breathing difficulties and a travel history in China, Italy or South Korea.
Since the outbreak in Wuhan, China, in December, the government has increased its vigilance and screened more than 500,000 people at airports, an additional 12,431 at the 77 seaports, and around a million people in border areas.
After this, samples of people showing symptoms such as cold, fever and breathing difficulty were tested. Around 3,217 have come out negative, and five have tested positive—three in Kerala earlier and the two new ones. Results of another 23 are awaited.
India’s greater vulnerability to the disease is also because of the county’s historically poor hygiene standards, though things have improved with the government’s Swachh Bharat Mission.
The World Health Organization has emphasized the need for measures such as maintaining at least 1 metre (3 feet) distance from anyone who is coughing or sneezing, and thorough cleaning of hands with an alcohol-based solution or washing them with soap and water.
“Factors such as a high rate of migration, low literacy rates, lack of general hygiene awareness and access to clean water and sanitation make India vulnerable to the spread of outbreaks such as the coronavirus," said Himanshu Sikka, chief strategy and diversification officer and lead-health, nutrition and wash at IPE Global, an international development consulting company.
“We have already suspended existing e-visas for China and Iran, and today at the group of ministers meeting we decided to extend travel restrictions to other countries also if the situation worsens," said Harsh Vardhan.
Aviation authorities on Monday said universal screening has been extended to passengers coming on flights from Italy and Iran too.