Rajasthan, M.P., Chhattisgarh issue orders to take over private hospitals for COVID patients

In Bikaner, Rajasthan, nursing students before leaving for door-to-door checking in the wake of the coronavirus outbreak.

The rapid spread of COVID-19 cases has led to a renewed demand for more coordinated efforts and more public spending on health. While private hospitals in India have been directed to admit and treat symptomatic patients, owing to limited testing facilities and the high cost of testing as well as treatment, the number of such patients taking treatment in the private sector has been generally low. The Central government has so far not shown the will to give broad directions to the highly privatised health sector to pool in its resources for the public.

Several State governments have taken steps to “nationalise” private health care in order to meet the COVID challenge. the Left Democratic Front government in Kerala has taken the lead in screening, testing and isolating cases apart from providing rations at the doorstep of households. The State’s Industries Department has directed public sector enterprises to raise the production and supply of hand sanitisers. The Kerala State Drugs and Pharmaceuticals Limited has been allocated funds to produce medicines for the treatment of COVID patients.

On March 26, Rajasthan, Chhattisgarh and Madhya Pradesh issued orders for the takeover of a section of private hospitals in some districts. In Chhattisgarh, orders were issued initially for the takeover of all private hospitals and nursing homes but later rescinded the same day. Orders were issued for the takeover of one institute, the 500-bed Raipur Institute of Medical Sciences, under the Chhattisgarh Epidemic Disease Covid 19 Rules. In Rajasthan, under the Rajasthan Epidemic Diseases Act 1957, the administration acquired the premises and infrastructure of five private hospitals in Bhilwara district and a sixth in Ajmer district for COVID treatment. In the order, the administrators of the hospitals were instructed to cooperate with the decision.

In M.P., which saw a recent change of guard in government, the order to acquire some private hospitals was issued on March 26 following the rise in suspected and confirmed COVID infections. The order specified that all supplies of personal protection equipment (PPE) would be routed through the State Public Health Supplies Corporation. But an earlier decision to convert the Bhopal Memorial Hospital and Research Centre, set up under the directions of the Supreme Court for survivors and patients of the 1984 Union Carbide gas leak disaster, into a State-level COVID treatment institute has run into controversy.

Against blanket lockdown

Bottlenecks in the deliveries of essential goods, including medical supplies, continue to be a problem despite fresh guidelines issued by the Centre for the delivery of essential goods through e-commerce. The Jan Swasthya Abhiyaan and the All India Peoples Science Network have expressed concern at the closure of regular clinical services and outpatient services in tertiary care hospitals run by both the Centre and the States in order to accommodate the heavy load of COVID cases. In a statement issued on March 27, the two organisations held that with new cases being reported from almost every part of the country, there was a “high probability that the spread of the disease was being seriously underestimated”. While the lockdown measure could flatten the curve and “buy some more time”, it wasn’t enough if unaccompanied by other public health measures such as testing of suspected cases, isolation and tracing and testing of contacts.

The organisations quoted the examples of Spain and France where, despite early lockdowns, the number of cases and fatalities increased. On the other hand, they said the examples of South Korea and Taiwan could be emulated where the outbreak was controlled by extensive testing, selective lockdown of hot spots, isolation and tracing, and not a complete lockdown. They also pointed out that countries in western Europe had effective social security systems for the working poor to cope with lockdowns, but in India that was not the case. The package announced by the government was not adequate. Even those persons who were providing services categorised as essential were being harassed by police in various States.

The suspension of public transport services, they said, had adversely affected patients undergoing dialysis or chemotherapy. They reported disruptions in TB, HIV and Non-Communicable Disease control programmes. They cautioned that if COVID-19 cases continued to appear beyond April 14, it should not be seen as reason to continue the nationwide lockdown, rather the government should consider evidence based graded lockdowns. Lockdown should be lifted in areas where no cases have been reported and substituted with surveillance and mitigation, they said.

The effect of the lockdown has been felt most by daily-wagers and low-income groups everywhere. As most governments, barring Kerala, which took many steps prior to the national lockdown, were taken unawares by the Prime Minister’s announcement on March 24, steps for mitigation, especially for the marginalised sections, could not be undertaken. With low levels of testing, as admitted by health officials themselves, and denials over community transmission, the long-term effects of the lockdown on the health of such groups will be felt only much later.