By- Jan Aarogya Abhiyan
Need for broad based public health measures and people’s involvement
WHY THE HUGE SECOND COVID19 WAVE?
The partial lockdown declared in Maharashtra from 14th April is a very unfortunate development. Some people have argued that this has become inevitable because of irresponsible behaviour of ordinary people. There is no doubt that many ordinary citizens have not been following COVID appropriate behaviour. But we should also remember that this epidemic of inappropriate behaviour has been fueled by irresponsible activities of many leaders, from the top most level to the small time leaders in local communities. The massive election rallies, the huge congregation of Kumbh Mela and all such programmes have been conducted under the leadership of our great leaders, by violating all basic norms of Covid appropriate behaviour. Secondly it should be also remembered that ordinary people have to go out to earn their bread and butter. Many social conditions at work places and in transport system create inevitable constraints. For example, given our very poor public transport system, there has been inevitably violation of physical distancing in buses and local trains in Mumbai, Pune. Moreover various Covid-19 virus mutants, some of which seem to be far more infectious, may have also contributed to this very huge increase in number of cases.
NO ENHANCEMENT OF HOSPITAL BED CAPACITY
The stifling problem is not merely the explosive rise in the number of RT-PCR positive cases, but the explosive rise in cases which require hospitalization. The scarcity of hospital beds has happened because, despite getting a year’s time, the government has not increased the number of hospital beds in Public Health Services, a step which has been long overdue. This has been due to the very low health budget and the continued policy of starving the public health services of facilities and trained human power. Hundreds of doctors pass out of government medical colleges in Maharashtra every year, all of these have all signed a bond with the government to serve in govt facilities for two years. So there is no dearth of doctors in Maharashtra public health services if the govt seriously implements this policy. Similarly nursing staff and other staff must also be recruited on war footing at least temporarily, to increase hospital bed capacity to an adequate extent at all levels starting from villages to towns to bigger towns to Metropolitan cities. Shri Rajesh Tope when he took charge as health minister, had promised that he will recruit 17000 new staff to fill the vacant posts in the Public health department, but this has not been done till today! It is unjust to focus the criticism only on the behaviour of common people, while not taking note of all other factors which have led to acute shortage of hospital beds and higher mortality.
CURBING SPREAD WITHIN HOUSEHOLDS
As regards the management of this huge rise in Covid-19 cases, it must be borne in mind that though mini lockdown will reduce virus transmission in social spaces, unless certain precautions are taken, the virus will continue to spread within households. .Hence the total impact may not be reduction in total number of infections and total number of serious cases requiring hospitalization. For stopping the intra-household spread of the virus, the fundamental activities of control of this epidemic which consist of tracing all the contacts of all positive persons, testing them, and isolating them if they are positive, is also extremely crucial. This activity has to increase many fold, and this would require recruiting of additional staff.
Unlike in the developed countries, in India in majority of the families, it is not possible to spare a separate room for the COVID positive person and therefore it is very much necessary to shift such people to institutional quarantine. What is equally important is -all symptomatic persons have to be kept not only separate but under medical observation, so that deterioration if any, would be detected early and would be timely hospitalized. They must undergo some basic test like blood sugar, C reactive protein, their oxygen saturation must be measured twice a day and the severity, duration of symptoms should be recorded. Based on these four parameters a small proportion of such people in quarantine centres can be shifted to a hospital in a timely manner. This is especially required for people who are above 45 years of age, or have some co-morbidity like diabetes, hypertension, heart disease et cetera.
PROTECTING THE VULNERABLE PEOPLE FROM THE ILL EFFECTS OF THE MINI LOCKDOWN
Bringing to standstill interaction in public spaces through a partial lockdown is only one step to reduce the virus spread. The second step that certainly needs to be taken is to protect the vulnerable population from the ill effects of the lockdown. Well-known measures like free distribution of ration as well as cash transfer to vulnerable sections, immediate starting of food distribution centres for the poorest etc. are also important as halting interaction in public places through mini lockdown. A cash transfer of Rs. 1000 per capita should be immediately made to all unorganized workers.
To meet the expenses of such measures, all governments should raise additional funds through progressive taxation. While central government must use their powers to increase the taxes on the large corporates and richest 1% of Indians for a COVID response fund, state governments can increase excise and other state level taxes to support COVID relief measures. The government should also use this crisis as an opportunity to strengthen primary health care and make structural transformation of the public health system with huge, adequate rise in health budget.
VACCINATION IS NOT THE ANSWER TO THE IMMEDIATE PROBLEM OF HUGE ACUTE SHORTAGE OF HOSPITAL BEDS
Vaccination has an important supplementary role in curbing this epidemic. But vaccination is not the answer to the immediate problem of huge acute shortage of hospital beds because of the unprecedented rise in Covid-19cases. About 60 to 80% of people get protection from Covid-19disease two weeks after their second dose. Thus those who would have taken the first dose in April would start getting full protection after 15th May and by that time the current huge rise in cases is likely to come down. Moreover even though vaccination protects from severeCovid-19disease and death, it reduces virus transmission only partially. Some people who have been successfully vaccinated continue to get infected, viruses multiply in their respiratory tract and they spread this virus to others to a certain extent. Therefore all people who have received vaccination must continue to use mask even after vaccination. Vaccine producers have not claimed that vaccination stops virus spread. Thus overall vaccination is not very effective immediate counter to the explosive rise in cases and need for Hospital admissions. Incidentally the demand of the Indian Medical Association to deny ration to those who have not been vaccinated, is totally unscientific and inhuman.
For effective control of the spread of the virus and for vaccination, people’s participation is extremely crucial. To achieve this, vigorous educational campaign through much more effective communication has to be launched to give advice to people about the vaccine spread -mask-use, physical distancing, hand-hygiene, and the importance of tracing, testing and institutional isolation. Misleading propaganda against Covid appropriate behaviour and against vaccination etc. should be countered with extensive coverage of appropriate health education. Towards this, the State government must partner with wide variety of interested social organisations and groups in a systematic and organised manner in rural and urban areas across the state.– Jan Arogya Abhiyan has given concrete suggestions about this to the State Health Minister, and action on this is awaited.
SPECIAL MEASURES FOR UNORGANISED SECTOR WORKERS
- Registration process for vaccination has to be simplified, friendly for the less educated. Community based social organizations, need to be involved.
- The age-bar of 45 years should be removed for all service workers in the unorganized sector, and they should be vaccinated as a priority.
- People who have yellow or orange ration card must get free vaccine at government expenses in private hospitals also.
- Coordination committee of working class and other social organisations have to be formed at various levels so that measures can be planned and executed for the unorganisedsector workers in a proper manner.
- NREGS should immediately be re-activated and expanded to cover urban areas also.
SPECIAL MEASURES FOR RURL AREAS
- Last year the government had formed broad based ‘Corona Committees’ consisting of not only the health staff like the medical officer, PHC-nurse, ASHA, Anganwadi Worker but also staff from other departments like gram panchayat members, gram-sevak, police-patil, gram panchayat, NGO workers etc and the principal of the village school was the chair. This helped a great deal in effective co-ordination among various constituencies and implementation of various steps for epidemic control. Now non-health staff is not involved at all; all the work is being carried out only by the health-staff. These ‘Corona Committees’ must be brought back immediately.
- All the decisions are being taken by general administration without involvement of Public Health Officials, experts. The health staff has no recourse to dialogue with higher officials leading to de-motivation. This must change immediately.
- In Rural Hospitals, there is acute shortage of experts and gross deficiency in care especially in Marathwada Vidarbh, and Konkan area. New equipment including a few ventilators have been supplied in a few places but no trained staff.
- Fully functional Covid-beds must be increased in sub-district hospitals and below. Each PHC must have 20 fully functional Oxygen beds.
- Only 25% of ambulances are functional. All must be fully functional
- Women, elderly and such vulnerable people in rural areas find it difficult to travel and access vaccination. Vaccination camps must be set up in different villages and transport be arranged for the vulnerable people.