Updates from India: COVID-19 Resurgence
Image from The Guardian
Health emergency in India - more than what meets the eye!
The COVID-19 pandemic has hit India again this March and this extreme second wave has brought out a state of healthcare havoc hitherto unseen. Covid cases in India have crossed the 25 million mark. (28.17 million as of date) with almost half a million cases and 4000 covid deaths reported daily, despite controversies regarding the numbers.
Ministry of Health and Family Welfare COVID-19 UPDATE
CNN: As Covid sweeps India, experts say cases and deaths are going unreported
Lacunae uncovered by the pandemic:
Inadequacies of India’s healthcare sector include the severe lack of: a well-functioning preventive healthcare system to address inequities in the social determinants of health, robust primary and emergency care systems, proportionate numbers of ICUs, sufficient oxygen, and affordable drugs and ventilators. These gaps were on display during the peak of the pandemic in India. With governments and courts intervening and allocating funds and grants to the health sector more than ever, the peak seems to be plateaued now.
The Times of India: Exhaustion and fear for India's frontline doctors in Covid battle
Traffic jam in Emergency Departments:
Overflowing ICUs, incessant referrals from rural areas, along with a lack of beds and staff to care for both COVID and non-COVID patients separately choked most higher level centres. Every emergency department had to bear the brunt of it by witnessing daily disasters due to surge beyond capacity, oxygen or ventilatory requirements exceeding availability and resuscitations withheld midway due to the mayhem. A practical solution was to adopt more generic resource-poor methods and innovations like war room triage principles, a liberal DNR code and empirical care without usual personalised care, as the alternative was to perish. Hospitals with established Emergency Medicine departments have not bowed to pressures, but most others without departments have broken down due to the challenges faced by a multitude of compartmentalized specialists providing holistic care for a plethora of patients amidst the pandemic.
BBC: India coronavirus: Over-18s vaccination drive hit by shortages
NPR: Doctor In India: Emergency Room Is So Crowded, 'It's Nearly Impossible To Walk'
Clinical manpower in huts:
An inherent lack of primary care and emergency care hit the system badly. The primary and emergency care in India relies heavily on newly graduated medical personnel to cater to a vast population. It is a sad reality that as many as a million young medical graduates do not practice and are in a dormant state best described as "neither residents nor doctors" as they remain out of practice, preparing for exams to seek specializations of their choice. The government postponed such exams and has incentivized medical students and doctors serving COVID areas with preference for jobs in the future. Despite this stopgap arrangement, recruitment of physicians has still been a challenge in most parts of the country.
University World News: Medical students suspend studies to help in COVID crisis
Burnout amidst pandemic:
The morales of young Emergency physicians and residents are left untended, as they end up being caught into a vicious cycle of tumultuous duties. They are being painted as forefront health workers, exposing them to hazmat hours beyond comprehension. Their thoughts of getting infected amidst resuscitative procedures, feeling for their patients, quick decisions amidst ever changing protocols, sleeplessness and work pressures ultimately burn them out or get them diseased and down. Unattended, this system results in what operates like a bicycle forced to run without pedals.
Bloomberg: Doctors on 48-Hour Shifts as India’s Hospitals Pushed to Brink
Silver lining in sight?
Through more liberal vaccine exports, vaccination drives and lockdown has had some impact, even if not much. Despite this, any potential silver lining seems to be far in the distant future. However, data from governments and the World Health Organization shows that the peak has just dipped over the past week. However, fingers must remain crossed, as more time is required to assess whether the peak has really been scaled. Hopefully, this is some sign that we will be able to sit back and relax again soon!
Reuters: India promises more vaccines as daily COVID-19 deaths stay above 4,000
Coronavirus updates | DRDO’s 500-bed COVID-19 care hospital inaugurated in Uttarakhand
(Dr. Nisanth Menon Nedungalaparambil is Wonca Emergency Medicine SIG Executive from South Asia, Fellow of Academic College of Emergency Experts in India and member of the Emergency Medicine Association of India. The views, thoughts, and opinions expressed in the article belong solely to the author, and not necessarily to the author's employer nor organizations represented)
