The worst is yet to come in Delhi and Mumbai
Requisition health care workers; create temporary facilities; have a clear chain of command; help patients
The financial backbone and the political nerve-centre of our country are both reeling. And the worst is still yet to come. With the biggest single-day jump in cases this week, it’s critical to understand what is going on in Mumbai and Delhi — that along with Ahmedabad and Chennai — have become the cities to worry about. As part of my now-16,000 kilometre journey across India reporting the pandemic, I have spent considerable time studying the medical infrastructure in both places, apart from tracking deaths at graveyards and crematoriums.
In the pouring rain of a Mumbai storm, I met Narmada, a domestic worker, who has been living outside Mumbai’s Nair Hospital, looking after her coronavirus disease (Covid-19)-positive mother for 11 days, including cleaning up toilets, in what is meant to be a strictly isolation illness. Inside KEM Hospital, I have seen bodies unclaimed by families, and relatives huddled together with patients infected by Covid-19 on the floor, sometimes asleep on makeshift “beds” assembled from cardboard strips. In Delhi, I met the son of Seema, a nurse orderly who was denied both a test and treatment, including by Lok Nayak Jai Prakash Hospital where she worked. In the capital’s main crematorium, Nigambodh Ghat, I met a man unable to cremate his younger brother as there was “no space”. For 10 days, he had run from hospital to hospital, desperately seeking help. Now he was stranded between shamshan ghats. At a graveyard in the capital, Mohammad Sabir, whose 40-year-old wife died this week, said in words that haunt me, “We are poor, we will die like insects.”
I am no votary of the lockdown but some of the learnings in these cities are obvious; it is befuddling that the lockdown time was not used to implement them. In both Mumbai and Delhi, the narrative of “beds running short” is a misnomer. In fact, there are enough beds. Take Mumbai for example. In its private hospitals alone, there are 20,000 registered beds; there are another 5,000 in the public hospital system. Back of the envelope calculations suggest that the city needs roughly 5,000 beds, including 1,250 critical care intensive care unit (ICU) beds.
Theoretically, there is no shortage. Practically here is what’s happening. It’s not beds but health care staff which has run short. Whether it’s because many young residents have tested positive or because ward staff is unable to travel in the absence of local trains or because many health care professionals, especially in private hospitals, are not showing up to work.
One of the models Mumbai has got right is its National Sports Club of India Covid “Dome”, an erstwhile rock concert venue, that is now a 600-bed modular hospital. Led by Dr Muffazal Lakdawala, what has kept it relevant is its constant adaptability. It has experimented with mobile X-rays as one way of preliminary mass screening; it has built ICU containers on wheels and created contactless booths for doctors to talk to patients. With sections that separate cancer patients, pregnant women, the elderly and those who need regular oxygen, it has married science with zeal. But even in this exemplar venue, doctors, nurses and intensivists are woefully short and the facility is welcoming volunteers.
Delhi, by contrast, has not used the lockdown period to create makeshift jumbo facilities in stadiums and colleges; it urgently needs this. And unlike Mumbai, which also did so too late, it has not yet capped the fees of private hospitals, permitting a class divide in health care response that is morally egregious. Governments should be focusing on fixing a broken system; instead promoters of private hospitals and laboratories have begun to whisper about pressures to under-test. The problem is rooted in the paranoia and hysteria around testing positive and the suggestion that being Covid-19-positive is a calamitous event. Our focus must be on deaths, not cases.
Fundamental things need to be addressed in both cities. Health care workers need to be requisitioned from states that are doing relatively better on an urgent basis. There needs to be a clear chain of command, not multiple officials with giant egos fighting petty battles that pull doctors in different directions. People need to be encouraged to stay at home and not rush to the hospital if they have mild symptoms. In the absence of enough polymerase chain reaction (PCR) kits and dodgy serological tests, X-rays may be the only cost-effective way along with oximeters and temperature screening to sift who needs a swab. Oxygen cylinders need to travel into containment zones so that you can buy time for gasping patients till they get an ambulance. Above all, governments need to have representation (along with ambulances on standby) outside hospitals to talk to patients, families — to comfort them, advise them, or redirect them to the facilities where beds do exist.
I first saw the abdication of the Indian State when migrants were walking on the road. Now it is happening outside hospitals — and at funeral grounds. Covid-affected patients cannot be orphaned.
And no dashboard on a mobile app can be a substitute for a real person. Barkha Dutt is an award-winning journalist and author The views expressed are personal