Deterioration in India shows weakness in healthcare system

India in the past days has witnessed a record increase in daily COVID-19 cases, placing mounting pressure on the populous country's already overburdened healthcare system.

In this South Asian country, patients gasped at the crowded, crisis-hit hospitals, where a shortage of medicines, as well as non-availability of beds and oxygen, continued to be worsened. People cried for help as their family members lay motionless inside cars, on stretchers and in beds.

Amid the overwhelming outbreak, the international community has extended a helping hand to India. China, for example, said on Friday it "is ready to provide support and help according to India's need, and is in communication with the Indian side on this." Meanwhile, the United States has triggered mounting anger on social media for its behaviour of hoarding vaccines.

MISPLACED FAITH

On Sunday, India's COVID-19 tally reached 16,960,172 with 349,691 new cases recorded in the past 24 hours. This is the fourth consecutive day when over 300,000 daily cases were registered in the country.

India's federal government has been caught off guard despite warnings of a possible second wave.

It launched the first vaccination drive against the coronavirus on Jan. 16. Healthcare and frontline workers were then inoculated, followed by those above 60 years of age or 45 years with co-morbidities.

However, about two months into the drive and having vaccinated just more than 20 million out of the country's more than 1.38-billion population, the government claimed it was in the "endgame" of the ongoing epidemic.

When new infections showed an upward trend, India seemed to have lowered the guard, resuming activities similar to the pre-pandemic phase, like the re-opening of cinema halls, malls, bars and restaurants to full capacity, as well as the allowing of religious festivals, sporting events, etc., which saw full participation.

Images of the public flouting COVID-19 protocol and taking a ritual bath in the Ganges river in the Indian state of Uttarakhand drew caution from health experts to call off the event, a suggestion scorned by the local government.

In five states, the country went ahead to conduct elections, allowing election rallies, which witnessed huge participation. Prime Minister Narendra Modi held huge rallies across the election-bound states and addressed the jam-packed audience without wearing a face mask. In an election rally in West Bengal, Modi said it was heartening to see people all around wherever he looked.

"We had misplaced faith in illusory herd immunity and unrealistic mathematical models which were over-optimistic," said K. Srinath Reddy, president of the Public Health Foundation of India (PHFI). "The urgency to revive the economy made policymakers across the country believe this and people too welcomed a return to an unrestrained life."

"Very few governments across India planned for a second wave. So, old neglect of the health system and recent indifference to planning resulted in the serious challenges that health systems are facing," he added.

"WE ARE HELPLESS"

The situation in India was a "devastating reminder" of what the deadly disease could do, according to the World Health Organization (WHO). With a new "double mutant" variant named B.1.617, the ongoing devastating second wave of the outbreak has wreaked havoc across the country.

In the past weeks, social media in India have been flooded with doctors breaking down. Some urged the public to take precautions and home remedies to avoid hospitalisation. A nadir was reached when hospitals announced dwindling oxygen supplies, urging attendants to take their patients to other facilities.

"We are helpless. Have never seen such a situation before. People are panicking," Dr Trupti Gilada, a specialist in infectious diseases from Mumbai, can be heard in her five-minute video post as saying while breaking down and wiping tears.

"We have to manage so many patients. Critically ill patients are being treated at home because there are no beds and we are not enjoying this," she added.

On the evening of April 16, Vinay Srivastava, a journalist from the northern Indian state of Uttar Pradesh who contracted COVID-19, pleaded for a hospital bed and took to social media to inform the audience about his deteriorating condition until his oxygen level fell down and he died.

Hospitals one after another in the Indian capital reported that their oxygen supplies have been exhausted and sought immediate intervention of the government in replenishing them.

On April 25, 20 COVID-19 patients admitted at the Jaipur Golden Hospital died from a shortage of oxygen. One day before, at least 25 critical patients admitted at New Delhi's Sir Ganga Ram Hospital died under similar circumstances.

The oxygen crunch came at a time when the supplies of Remdesivir, a broad-spectrum antiviral drug, vanished. Local media carried reports about the shortage of Remdesivir in hospitals, the sale of the injections in the black market, and the arrest of people at the hands of local police for trying to sell it at exorbitant rates.

When deaths spiked, crematoria were overwhelmed. They worked round-the-clock to keep up with the pace of bodies arriving. Relatives had to wait with the bodies of their dear ones outside crematoria for their turn.

Though the authorities said the situation is under control, disturbing images of mass cremation and burning funeral pyres have hogged headlines. Reports said that in the Indian state of Gujarat, gas and firewood furnaces at crematoria have been running so long without a break that metal parts have begun to melt.

TOUGH FIGHT

To augment the supply of oxygen, the Indian government has decided to run special trains to ferry oxygen and import 50,000 MT of medical oxygen.

It also announced that import duty was removed from Remdesivir active pharmaceutical ingredients, injection and specific substances used in the manufacture of Remdesivir.

The federal government has asked all states to ensure judicious use of Remdesivir, stop the black marketing or hoarding of drugs and facilitate the smooth inter-state supplies of medicines.

As hospitals continue to turn away seriously ill patients, pharmacies struggle to supply basic medicines such as Paracetamol or Favipiravir, an antiviral tablet approved for treating mild to moderate COVID-19 symptoms.

"What is happening around us is soul-crushing," said Dr Indu Bhushan, former CEO of Ayushman Bharat, an Indian government agency providing national healthcare coverage.

"Everyone I know has at least one COVID-19 positive family member or has one who died of COVID-19," he added. "I dread receiving calls from family or friends these days as mostly it is to seek help in finding a bed. In most cases, I have failed."

"We need to build a futuristic health security system that integrates the one health approach, strong surveillance platforms, and an autonomous agency to coordinate public health actions," said Giridhara R Babu, head of life course epidemiology at the PHFI, in an interview with a local newspaper.

"So far, there is no empirical evidence to suggest whether eliminating COVID-19 is feasible in any near term," he added.

With the case surge in India, countries across the world have expressed their concern and offered to extend a helping hand.

"China expresses sincere sympathies to India over the deteriorating situation in the country recently. The Chinese government and people firmly support the Indian government and people in fighting the coronavirus," said Chinese Foreign Ministry spokesperson Zhao Lijian on Friday during a press briefing.

Pakistan Prime Minister Imran Khan has expressed solidarity with India, saying they must fight together this global challenge confronting humanity.

"Our prayers for a speedy recovery go to all those suffering from the pandemic in our neighbourhood and the world," Khan wrote on social media.

France, Australia and the European Union have also come out to help India in its anti-virus fight. Saudi Arabia has shipped 80 MT of liquid oxygen to India.

In this chorus of unity, the United States has hit a wrong note.

"Anti-U.S. and anti-Western sentiment exploded across social media with growing criticism directed at the Biden-Harris administration for sitting on stockpiles of unused vaccines and jealously guarding patents," the Times of India said Sunday in a report.

It added that Washington has turned a deaf ear to the severe epidemic situation in countries like India and Brazil, which rank second and third respectively in the global chart of infections.

Citing a report by the Duke Global Health Innovation Center, the media noted that the United States will have "an oversupply of up to 300 million or more vaccine doses as soon as July," while many developing countries have to wait for years before they can complete mass vaccination.

This behaviour is "undermining the WHO's effort to forestall vaccine inequity," it added.