Doctors ask, “How many lives are the system willing to sacrifice?”

By Dr. Rahul Roy and Dr. Ishita Banerjee

In recent years, India’s public healthcare system has seen the least amount of investment and budgetary allocation since independence. India has 1 so-called Sarkari doctor for every 17,500 people and 1 ventilator for every 3,37,000 people. I sometimes wonder if Covid-19 had originated in India, what would be our plight!

Let’s do the math here:

India has a whopping population of 130 crores. Even if 1% of the population is infected, the number would stand at 1.3 crores. Now, let’s imagine the best possible scenario, where 99% of the infected gets cured with just symptomatic treatment and just 1% need ventilators or ICU. Even in this daydream, the required number of ventilators would be 1.3 lacs. Now, India has approximately 38,000 functional ventilators, thus, in this scenario, there would be 1 ventilator for every 3 patients. Hence, almost 70% of the people seeking ICU care would die, just because of inadequate treatment. Horrifying stats, aren’t they? One begins to wonder: Is it then possible for us to succeed in this battle yet?

Yes, of course.

And here comes the importance of the most neglected branch and set of doctors in Medical science: Preventive and Social Medicine (PSM). It is this branch of medicine which is the reason why every Indian newborn today is entitled to get vaccines that fight 11 diseases, a feat that leaves even the rich first world countries envious.

The following flowchart demonstrates how PSM could help us understand and fight Covid-19:

In layman’s terms, the natural history of a particular disease (here Covid 19) may be divided into two main phases as shown in the flowchart. While the Pathogenesis phase concerns individuals who are already diseased, the Pre-Pathogenesis phase deals with preventing individuals from getting infected in the first place. This phase attempts to prevent infection from spreading in two ways — Primordial Prevention and Primary Prevention.

One may think of Primordial Prevention as the type of prevention that can be done when the virus and disease (the risk factors) are not yet present in your locality. For example, it is common knowledge that smoking can lead to lung cancer. Therefore, if we prevent ourselves from smoking (the risk factor), we are less likely to suffer from Lung Carcinoma (the disease).

Similarly, Primary Prevention could be thought to be the type of prevention that must be done when the virus is already present in your locality but you haven’t caught it yet. For example, if your locality already has infected mosquitoes in it, one of the ways you can prevent yourself from getting malaria is by using mosquito nets.

In the case of Covid 19, India could have proactively gone for Primordial Prevention if, by the second week of January, India would have strictly screened international passengers and sealed all of its international borders. This would have prevented International Travelers (the carriers) from entering India, thus stopping the introduction of the disease.

Meanwhile, as far as Primary Prevention is concerned, Lockdowns are the only possible way by which large numbers of people can be prevented from getting infected. Additionally, people working in Essential Services must take protection by wearing gloves and proper N95/Triple layered surgical masks.

The implementation of Primary Prevention was not done proactively in India, hence, we had our first case of Covid-19 on 30th January, 2020.

By virtue of PSM and Primordial Prevention, we have successfully restricted diseases such as yellow fever from entering our country. But, on the other hand, we have failed to control the entry of diseases like tuberculosis and its spread, leading to more than 4 lakh deaths per year. Now, if we fail to contain the spread of Covid-19, the disease would pass on into our future generations too, if any at all, killing millions of people even after proper treatment protocol and control measures are followed. Hence, in our view, prevention, so as to completely nullify the disease, is the most effective way to fight Covid-19.

Many countries, including India, are constantly working towards the development of a Covid-19 vaccine, which would be the best possible way to develop Herd Immunity against the virus. As Dr. Michael Osterholm, an infectious disease expert, told Fox News, “I think the bottom line … is a really important one — that we are all obviously occupied and terribly concerned about what’s happening right now, but we could be in the first inning of a nine-inning game [where] we’ve got 18 or more months left until we get the vaccine.”

For now, we are all in the same sinking boat — no health care organisation in our country is truly well-suited or well prepared to respond to this pandemic, in terms of the stockpiles of PPE and other essentials. We are in a fight against the virus and there is certainly no time for double talk here, what we need is straight talk.

There are two kinds of people in this country — those who are in isolation and those who will soon be in it. The challenges are many, but the silver lining I see here is that we are all poised against Covid-19, and hopefully there will be conversations about healthcare from now on.

Rahul is a Medical Officer with the WBHS and Ishita is a Final Year MBBS student.

Image Credit: Reuters.

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