Cities need more ICUs, specialist staff to fight COVID-19, say experts

A primary health care centre in Vasai. File pic

With lack of specific treatment for COVID-19, and absence of a strong healthcare infrastructure and specialists, a second wave of infection could lead to an extremely challenging situation in small cities of the Mumbai Metropolitan Region (MMR), warned health experts on Friday. They cautioned that if the state government does not shift its focus to cities like Kharghar, Panvel, Bhiwandi, Mira Bhayandar, Vasai and Virar now, then it might become a challenge later.

Mumbai, Thane and Navi Mumbai are set to handle a second outbreak of novel Coronavirus infection expected early next year, but small cities or regions within the MMR are yet to gear up, said the health experts.

Senior allergy and asthma specialist Dr Wiqar Shaikh said the pandemic has significantly stressed the public healthcare system in India, because the country's expenditure on healthcare was pretty low in the past decade. In 2019-20, India spent merely 1.29 per cent of its GDP. Among the countries classified as the "poorest" in the world, India's share of public expenditure on healthcare is far too low than other nations.

Mira Bhayandar Municipal Corporation health worker carries the body of a person who died of COVID-19 to the Tembha Hospital mortuary. File pic/Satej Shinde

Moreover, India has 8.5 hospital beds per 10,000 citizens and eight physicians per 10,000 people, and, therefore, the country's healthcare sector is simply not equipped for a crisis such as COVID-19, said Dr Shaikh, referring to a Fitch study. He also cited a Confederation of Indian Industry (CII) report that said India's public healthcare system is chronically underfunded, leaving huge gaps in the primary healthcare delivery.

More than 80 per cent of the population still does not have any significant health insurance coverage, and approximately 68 per cent of Indians have limited or no access to essential medicines, he said. The availability of free medicines in public healthcare facilities has declined to 8.9 per cent from 31.2 per cent for in-patient care, and to 5.9 per cent from 17.8 per cent for outpatient care during the past decade, he added.

Temporary centres a must

Under these circumstances, Dr Shaikh said it is extremely necessary to have temporary, jumbo COVID centres with adequate medical staff, medicines, lifesaving equipment such as oxygen and ventilators, and adequate investigation facilities.

Dr Subhash Hira, professor, University of Washington

Dr Ketan Vagholkar, professor of surgery at D Y Patil Hospital, said, "The first COVID-19 wave should have served as a big eye opener to healthcare systems. And for the MMR, one has to accept that it has a heterogeneous culture of healthcare systems. The bigger cities like Thane and Navi Mumbai have a stronger healthcare infrastructure backed by a medical teaching hospital, as compared to peripheral cities. MMR's smaller cities had a tough time during the first wave itself, and that's because they didn't have large secondary health care centres."

With a second wave already in Delhi and its neighbouring states, these smaller cities should become alert and strengthen and consolidate the healthcare infrastructure, he added.

Second wave will be worst

"There is an urgent need to set up good healthcare infrastructure that has essential speciality and services with respect to treating respiratory ailments and other complications of COVID-19," Dr Vagholkar said. "We also need a standby healthcare guard, comprising doctors, nurses and supporting staff, in addition to basic medical facilities for the second wave, which would be more stressful than the first."

Dr Subhash Hira, professor of Global Health at the University of Washington, said, "Mumbai with its neighbouring districts are already facing a second wave of COVID-19. While BMC has sufficient resources and surplus funds to tackle it, the neighbouring Panvel Municipal Corporation (PMC) that is just two years old is reeling with the lack of funds. The second wave, which is believed to be more deadlier than the first, requires more ICU and hospital infrastructures."

Dr Hira added, "An emergent pattern of illnesses seen in COVID-19 patients suggests a multi-system involvement, both during acute stage and post-COVID-19 stage that lasts about 6-9 months or longer. For Panvel corporation, it will require a wider specialist staff, not just respiratory specialists. Hence, the PMC needs to plan multi-specialty hospitals."

"Fewer hospital beds and fewer multi-disciplinary specialists will adversely affect the demand and supply equation in smaller cities. This is when COVID-19 treatment gets very costly."

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