Lucknow: With coronavirus wreaking havoc across the world, the responsibility to contain its outbreak in India's most populous state of Uttar Pradesh lies in the hands of state-run hospitals.
While the government claims that the situation in the state is still under control, it took Subhashini Ali, a CPI(M) leader and former MP, to request the authorities on Twitter to examine her close family friend for COVID-19 after she showed some symptoms.
“The family I knew had attended a marriage ceremony in New Delhi where people from the US were also present. She showed some symptoms which are common symptoms of the coronavirus and they tried to get her tested, but failed. I then wrote about it on my social media and then she was tested and fortunately she was tested negative,” said Ali, adding that “the point here is that the government is not testing the people it should have tested”.
The Comptroller and Auditor General (CAG) in its 2019 report raised several questions about the healthcare of Uttar Pradesh. The report said that the government of Uttar Pradesh was neither complying with the parameters set by the central government nor it was setting its own standards.
Shortage of Doctors
The shortage of doctors in the state is one of the major issues plaguing the state. According to an answer given in the Rajya Sabha, the number of registered doctors in the state in 2019 was 81,348 while the population of the state is 19,98,12,341. Rs 19,287 crore were spent on healthcare facilities in 2016-17.
Dr SK Shukla, a senior private doctor and health activist in Raebareli district, told this reporter during a telephonic conversation that the efforts made by the government are good, but it needs to strengthen its healthcare system because there are so many loopholes in their theory.
"As per the government data, there are only 750 ventilator beds across the state that means 10 beds for each district. My concern is how the government will treat every COVID-19 patient in case their situation deteriorates. Districts like Agra, Meerut and Noida are continuously seeing a surge in the number of cases and there are not many labs available in the Western Uttar Pradesh,” he said, adding, “The government says it is working on war footing to deal with this, but there is a dearth of doctors in the state and we do not know how the government will act if situation goes out their hand."
“There are umpteen number of private practitioners in the state who are probably not registered with the Indian Medical Association and are known as ‘quacks’. Quacks are the first point of contact for the people in rural India and what I think is that a brief training can be given to them and their help can also be sought in identifying symptomatic people. I know they cannot do the treatment, but they can help in identifying, raising awareness and counselling people under quarantine," opined Shukla.
NITI Aayog in June 2019 had released a report which ranked the states on the basis of their healthcare facilities. Three categories were used to divide states and Uttar Pradesh was kept in the biggest state category in this report. The performance index of the state was 28.61 and the rank was 21 which was last in the queue while Kerala was ranked first in the list with its performance index at 74.01.
Also read: Covid-19: One Step Back, One Step Forward
According to an Economic Survey report in 2018-19, “At least 70% of PHCs in Uttar Pradesh have only one doctor while about 5% have none.”
"The state has a 24×7 helpline centre; 18001805145 is the contact number where you can contact a team and talk about your symptoms, if you are experiencing any, and they will advise you about whether you need to visit a hospital or not," Amit Mohan, Principal Secretary (Health), had said during a media interaction.
Shortage of facilities in the ICU
As per the information gleaned from the office of Principal Secretary Health, there are 10 ventilator beds in each of the districts in the state. A 100-bed isolation ward has also been made available. In Lucknow, the Apex Medical College, a branch of Sanjay Gandhi Postgraduate Institute of Medical Science (SGPGI) has been converted into a COVID-19 hospital and is equipped with all the facilities needed to treat the serious patients.
A source in the government added that the ventilators and other medical machinery may be outsourced from private hospitals or the government may acquire them temporarily if there is a rise in the number of cases.
“ICU is required to be equipped with essential equipment, viz., High-end Monitor, Ventilator, Defibrillator, Ultrasound for invasive procedures, etc. as per national health mission Assessor’s Guidebook. Audit observed that only six High-end Monitors were available against the requirement of 14, seven Infusion pumps were available against the requirement of 14, while Ventilators, Ultrasound for invasive procedures and Arterial Blood Gas (ABG) analysis machine were not available at all in district hospital of Lucknow. Similarly, in district hospital Gorakhpur, there were no Ventilators, Infusion Pumps, Ultrasound for invasive procedures and ABG analysis machine,” reads the CAG report.
An excerpt of the CAG report over infection control in the community health centres (CHC) reads, “Infection control practices were not sufficiently embedded in the functioning of a large number of hospitals and all CHCs since they lacked even standard operating procedures (SOPs)/checklists for hygiene and infection control; disinfection and sterilisation of medical tools, instruments and equipment in the hospitals and CHCs was mostly limited to boiling and autoclaving, whereas a large number of hospitals and CHCs lacked chemical sterilisation and high level disinfection facility.”
Only 8 testing labs for a population of 20 crore
As of now, Uttar Pradesh only has eight testing labs equipped to test for COVID-19 cases, five of which are located in Central Uttar Pradesh, which has significantly less population in comparison with the Eastern and Western Uttar Pradesh. The labs presently testing the COVID-19 samples are King George Medical University, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Dr Ram Manohar Lohia Institute, Mehrotra Labs (private), Baba Raghav Das Medical College in Gorakhpur, Institute of Medical Sciences Banaras Hindu University, Lala Lajpat Rai Memorial Medical College Lab and Jawaharlal Nehru Medical College in Aligarh.
Also read: COVID-19: Scientists Turn to Wastewater-based Epidemiology
Unavailability of PPE and N95 masks
A senior resident posted at the Agra Medical College, in a telephonic conversation with this reporter, confirmed that the N95 masks and PPE were not being provided to them by the hospital authorities.
“We need one PPE a day because it cannot be used for the second time, but the hospital is saying that these are not available with them. We have information that they do have the stock, but are not being provided to us. We are now contemplating buying PPE, masks and other things from our own money as a private player in the market is ready to give it to us on a ‘no profit no loss’ basis,” they said.
Surveillance by the police
As per Amit Mohan, the government is doing a target-based job, which means people with symptoms, travel history or contact history are traced first and then quarantined.
Lucknow's Chief Medical Officer (CMO) Narendra Agarwal told NewsClick that the police' local intelligence unit has been involved in tracing such people who have a travel or contact history or are showing symptoms. "If you look at the cases from the entire state, then you will find that people with contact or travel history only have been found with active coronavirus. We do not have any asymptomatic case. Thus, we do not need any surveillance system. But in case there’s a surge, then we would need a system to track these people," he said.
Additional Chief Secretary (Home) Awanish Awasthi says that there is no surveillance system and the only system working in this case is widespread testing. He says, "The police have been doing a very good job and we have been able to trace all such people who are symptomatic. The chief minister has also held a video conference with all the religious leaders [and said] that they should cooperate in fighting this disease and we are actually getting good response from them." He further said that there is no denying the fact that half of the cases in the state are due to Tablighi Jamaat. “But with the brilliant efforts of the police, we traced them all and the whole idea of the government is to contain this virus at this point only,” said Awasthi.
"One thousand four hundred and ninety-nine people have been identified who had attended the Tablighi Jamaat event out of which 1,205 have been quarantined. Three hundred and five foreigners have also been identified out of which passports of 249 people have been seized," Additional Chief Secretary (Home) Awanish Awasthi said in a press conference on Monday.
Also, the cumulative number of passengers residing in Uttar Pradesh with a history of foreign travel is 57,395, while the number for passengers under observation stands at 17,879 with total number of symptomatic patients identified are 2,468 and number of symptomatic hospitalised are 268.
As of April 4, 2020, the number of positive COVID-19 cases in Uttar Pradesh stands at 234 with maximum number of cases coming from Gautam Budh Nagar (Noida), Agra and Meerut. As per official data with the Health Department in Uttar Pradesh, the total number of people quarantined across the state is 3,029, people under isolation are 368, people under watch of the doctors and authorities are 57,963 while people who have completed 28 days under watch are 41,506. Number of patients who have been cured is 21, number of people who have died due to coronavirus is two, number of ventilator beds available in the state is 750 and number of isolation beds is 11,639. Meanwhile, a total of 4,006 samples have been tested in Uttar Pradesh with 75 hospitals of level-I COVID-19.
Also read: After Covid-19, We Should All Be Cuba