As India’s growing burden of coronavirus cases becomes a growing concern for the world, another health disaster is quietly unfolding.
The strictest blockade in the world paralyzed routine and critical health services. More than a million children have not received crucial vaccines and hospital births have shown a sharp decline, indicating that many women may have had unsafe home births. Outpatient intensive care for cancer fell 80% from February levels, the latest government data shows.
But the biggest crisis is India’s long battle against tuberculosis. The country has as many as 2.7 million TB patients today, by far the largest number in the world, and the disease kills some 421,000 Indians each year. The current gap in care could lead to an additional 6.3 million cases and 1.4 million deaths from tuberculosis by 2025, according to a study by Zarir Udwadia, a pulmonologist at PD Hinduja Hospital and Medical Research Center in Mumbai.
“If you miss a few days of any other treatment, you may not be harmed, but gaps in TB treatment will amplify resistance,” Udwadia said. “Our lack of healthcare infrastructure is the reason we have been sinking amidst the sea of Covid cases. It is the reason why we have not been able to advance against traditional and ancient enemies such as malaria, typhoid fever, dengue ”.
Failure to control tuberculosis has long plagued successive Indian governments, spending only 1.28% of gross domestic product on public health. That has left the system ill-equipped to control deadly diseases like the coronavirus – the South Asian nation now has the second highest count of Covid-19 infections in the world, behind only the US.
Blockade of medical care
More than 65 million people in India live in densely populated and poorly ventilated slums like Dharavi in Mumbai, one of the largest in Asia, which has long battled tuberculosis before it became a hotspot for coronavirus. The fact that both tuberculosis and Covid-19 have a significant overlap in symptoms (shortness of breath, cough, fever) makes these areas critical for managing both diseases.
The strict stay-at-home orders that the country enforced in late March shut down India’s gigantic tuberculosis program for nearly three months. In April, one million fewer children received the BCG vaccine that prevents severe tuberculosis, government data shows.
“There should have been a two-way detection from the beginning, because by looking for one, you may miss the other,” said Chapal Mehra, public health specialist and author of “Tuberculosis – India’s Ticking Time Bomb.” “India has ignored investment in healthcare for three to four decades, and governments in general have been guilty of this. We lack political will, we lack moral compulsions and it seems that we do not value enough the lives of our citizens ”.
While Prime Minister Narendra Modi was quick to praise frontline healthcare workers, calling them “crown warriors,” the federal government has only allocated an additional $ 2 billion to fund the epidemic’s medical needs. That has depleted resources for non-virus expenses.
A spokesman for the Indian Ministry of Health did not immediately respond to requests for comment. Finance Minister Nirmala Sitharaman has said that “the government will increase investments in public health to be fully prepared for such eventualities in the future.” But she didn’t mention a specific number or timeline for this.
‘Infect, infect, infect’
India’s health infrastructure is dilapidated at best, with understaffed public hospitals, chronic shortages of hospital beds, low intensive care capacity, and poorly trained staff. India has 1.7 nurses for every 1,000 inhabitants, 43% less than the World Health Organization recommends, and doctors are also in short supply.
The pandemic has also highlighted the fragility of resource-poor health systems in the region. India’s neighboring Pakistan had 40 million children who were not vaccinated against polio, while Nepal faced a 50% increase in stillborn babies.
When the pandemic broke out in India, understaffed and overcrowded hospitals had patients sleeping on the floor until beds were freed and several patients were cared for by a single oxygen station. Limited transportation during and after the closure also restricted people’s access to primary care centers and pharmacies, leading to treatment interruptions and delays in diagnoses.
India “does not take crises seriously” as it deals with so many, and government advisers struggled to mount an effective response to the coronavirus that would also ensure the ability to fight other diseases, according to T Jacob John, a leading virologist. from India and the former director of the Center for Advanced Research in Virology at the Indian Council of Medical Research.
“The coronavirus is an enemy with only one trick: infect, infect, infect,” John said. “Our war did not stop the enemy, but friendly fire did more damage against immunization, tuberculosis, institutional deliveries and many more.”
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