Dr Dipu TS, Associate Professor-Division of Infectious Diseases, Amrita Hospital, Kochi highlights the need to create a large pool of human resources to cater to unexpected surges in demand for healthcare services, such as during a pandemic, war or natural disasters, in parallel with increasing investments in physical infrastructure like hospitals and medical devices and supplies
Every country’s economic well-being, to a significant extent, depends on a robust, efficient, and well-organised healthcare system. But, as witnessed recently, a raging public health crisis that snuffs out millions of lives in a matter of months stretches healthcare delivery system to the breaking point, even for resource-rich nations like the US. One can well imagine the stress and strain of a global pandemic on developing countries like India which even in the best of times struggle to meet the day-to-day healthcare needs of their large, underserved populations.
In this scenario, let us consider the challenges faced by India in the last two years in battling the pandemic and how infrastructure development and preparedness could help us manage COVID-19 or any other public health crisis much more effectively in future.
During the first wave of the pandemic, there was a severe, nation-wide scarcity of beds, intensive care units, ventilators, oxygen, and life-saving medications. The government tried to circumvent this shortage by purchasing 60,000 ventilators, with around 17,000 of them being delivered to various states across the country.
However, COVID patients who urgently needed a ventilator and other life-saving devices were still unable to receive them owing to a shortage of healthcare staff, ranging from critical care experts to nurses and paramedics like respiratory therapists. This illustrates the country’s lack of preparedness to address the pandemic of such a scale not only in terms of medical infrastructure but also manpower and the inability to maintain a strong supply chain.
It also clearly highlights the need to create a large pool of human resources to cater to unexpected surges in demand for healthcare services, such as during a pandemic, war or natural disasters, in parallel with increasing investments in physical infrastructure like hospitals and medical devices and supplies.
In a quickly spreading pandemic, aggressive symptom screening, testing, isolating and quarantining is the best method to flatten the curve and prevent more people from falling sick. The official numbers of verified cases and deaths are an important psychological aspect of determining the pandemic’s urgency and magnitude, and the related governmental response. The testing capability for COVID-19 in India lagged behind substantially at the start of the pandemic, which resulted in severe under-identification and under-reporting of COVID cases.
This indicates the growing need for conversion of scientific research outcomes into ready-to-use market solutions in an expedited manner. It also highlights the important role of government organisations like DBT-BIRAC in empowering healthcare industry by supporting the commercialisation of in-house medical research products.
In this light, the setting up of Indian SARS-CoV-2 Genomics Consortium (INSACOG) labs was a good initiative from the government to sequence the gene and understand the newer variants of concern on a real-time basis to alert the system for appropriate measures.
The government’s failure to stockpile specific drugs like injection remdesivir and injection tocilizumab for COVID treatment drove millions of Indians to despair. Though the vaccination drive took off efficiently in early stages, its scaling-up to the general population took more time than expected.
Holding state elections and observing certain religious festivals with large gatherings did not help the cause of universal masking and social distancing. India, though a democratic country, needs to have a policy to put off elections in desperate times like a raging pandemic.
A plan to better tackle the next public health emergency, like a nationwide pandemic, needs to take into account several elements. The first and foremost is increasing preparedness for such an eventuality. This involves strengthening of healthcare infrastructure, building resilience and scalability of response, expanding the available pool of manpower, securing the supply chain, and creating a national action plan, with regular drills to check the effectiveness of the response.
Other elements include increasing awareness among public about what to do in a public health crisis, strengthening of telemedicine infrastructure, conducting preventive vaccinations among vulnerable groups, protocolisation of coordination channels, early adoption of guidelines, public- private partnership, home quarantine, use of technology to determine early deterioration, and exchange of information between nations. Integration of forecasting models of various scenarios would also aid in general preparedness.
Healthcare systems and medical organizations should focus on digital health, flexible workforce, new care pathways, supply chain management and economic strategies, as part of building robust and adaptable care systems.
Digital health should be able to support the transition of care for patients from home quarantine to a healthcare facility, such as a first-line healthcare centre or tertiary care facility, according to an individual’s medical needs.
Resilient workforce can be realised through rostering, adjusting staff-to-patient ratios that account for attrition during crisis, ready-to-deploy contingent workforce, and focusing on wellness of medical staff engaging in treating patients.
Care plans that involve participation of patients, volunteers and healthcare workers, along with integration of technology and multidisciplinary teams, generate a patient-centred process.
A central command centre needs to be formulated to address logistical management for demands arising during all phases of pandemic and its preparedness.
A pandemic is not only a public health crisis, but also an economic crisis for majority of the population, as jobs and other opportunities to earn a living are severely affected. To support the citizens during times like this, various financial models have to be explored that expedite insurance reimbursements so as to cover healthcare expenses of people.
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