Since the last few weeks, Bengalureans have been in a state of panic and confusion. COVID-positive patients are unsure where to go, those who are symptomatic are frantically trying to find a bed in case they get serious, while attenders of seriously-ill patients are desperately trying to find hospitals which will admit and treat emergencies.
We, at the social welfare organisation Naavu Bharatheeyaru, demand an urgent meeting to see how best the government and civil society can work together to minimise the distress that people are currently facing.
In a letter to Chief Minsiter B S Yediyurappa, we have identified 10 priority issues, as follows:
1. Need for a COVID-19 health policy
We have seen a number of announcements and circulars on how the government proposes to handle the pandemic through the health system. However, we do not see one comprehensive, clear policy in place that would enable the ordinary citizen to understand government’s approach to the crisis and clearly lays out the measures in place.
Such a policy would clearly state the protocols for accessing healthcare infrastructure for COVID and non-COVID illnesses, facilities and subsidies for economically-marginalised sections of society, roles and responsibilities of different government departments and of private hospitals, areas where the government seeks support from civil society organisations, pathway to containing the spread of COVID, etc. This policy should have a section on how the government will monitor the functioning of the healthcare system. It also needs to be applicable across the state and should therefore take into consideration the realities of rural areas. The draft policy should be finalised after consultations with civil society organisations.
2. Communication to the public
Critical elements of the policy should be converted into accessible communication for the public and prominently displayed through hoardings in public spaces, hospitals, railway stations, etc. This will go a long way in addressing the anxieties and panic among people. A functional helpline with all updated information should be set up at the earliest in multiple languages – Kannada, Tamil, Telugu, Urdu, Hindi and English.
A grievance redressal mechanism also needs to be put in place for those who have not been able to access the healthcare system or are finding it difficult to do so.
Clear lists of fever clinics, hospitals and COVID-19 care centres should be put out in the public after negotiating with the private and public institutions on the same. This will minimise the confusion over the last few days over the government circulating a list of hospitals receiving COVID patients but these not being available in reality. There are also instances of fever clinics not receiving calls and not being equipped to provide even basic amenities.
A list of officials who are responsible for the healthcare system vis-a-vis COVID should be put out in the public domain with phone numbers they can be accessed at. This is especially necessary when a patient is in crisis.
3. Ensure that proper systems of triage are in place
As per protocol, tertiary care and super-specialty hospitals with ICU and ventilator facilities have to be reserved strictly for severe patients with breathlessness, hypotension, septic shock, disorientation, bluish coloration of lips, etc., as well as for those with pre-existing/co-morbid health conditions such as uncontrolled diabetes and hypertension, chronic lung/kidney/liver diseases etc.
However, there is media and anecdotal evidence that these facilities are occupied by patients with mild to moderate symptoms from anywhere between 10 to 14 days. This is irrational use of scarce tertiary facilities. There is an urgent need to set up a triaging system where,
- Asymptomatic positive persons are allowed to self-isolate at home if they are able to.
- If there is no facility to self-isolate, asymptomatic patients have readily-accessible Covid Community Centres with all basic amenities and an ambulance on call to shift them if they develop severe symptoms. These can be apartments, lodges, hotels, stadiums, schools, religious centres etc. There should be a healthcare person on call.
- If positive persons are mildly symptomatic, they can be put up in dedicated Covid health facilities. These should have a full time healthcare personnel, oxygen cylinders, and an ambulance on call to shift those who develop severe symptoms.
The details of this should be widely publicised on priority, so as to ease beds in tertiary hospitals for severely-ill patients.
4. Real time information on availability of tertiary care beds, ICUs, ventilators
Healthcare staff are already over-burdened with handling the surge of sick patients. In this situation, it is a waste of resources to expect them to make calls to multiple hospitals to look for beds/other medical material necessary for treatment. Real-time information should be made available to all treating staff on the availability of ventilators, PPE kits, testing facilities, essential drugs, specialists, diagnostic facilities, ICU beds, etc. Bengaluru’s vibrant IT sector can be involved in this.
We need a clear protocol on what is to be done for:
- Patients who are symptomatic but not yet tested
- Patients who are found positive
- Patients who are primary contacts of those who have COVID-19
This has to be communicated via TV, radio, WhatsApp and auto announcements.
5. Regulation and oversight of private hospitals
We are concerned there are instances where private hospitals maybe cherry picking patients to admit only those with mild or moderate symptoms. While this can be classified as an ‘expert’ decision, there is a need for an independent mechanism to ensure that even private hospitals follow the triaging protocols.
The cost of care in private hospitals are exorbitant, ranging anywhere between Rs 4-7 lakh. Although the government has passed an order on price capping, it is unaffordable to most patients and even this is not being implemented in practice. A body of government healthcare professionals have to be set up to oversee that the treatment is evidence-based and rational.
6. Handing over test results to patients
Patients have a right to their test results and these should not be withheld. In reality, patients who have severe symptoms can be admitted into COVID hospitals only with a positive test result, and admission to a non-COVID hospital may require a negative test result. The government is rightly concerned that handing over test results is leading to panic and overcrowding of health facilities but the solution to this cannot be not handing over the results.
The solution is public awareness messages about where people should go and what the protocols are. Just putting this information out on government websites is totally inadequate. In the initial phase of the pandemic, the government had proactively put out messages on preventive measures. This should continue at different stages of the pandemic and will help build the trust of people in the government.
7. Acute shortage of health workers
At this crucial period of the pandemic, there are instances of health workers not turning up for work or absconding. This is putting extreme burden on their co-workers who end up doing extra-long shifts. The government has to address the concerns of health workers over their own and their family’s safety, availability of PPE, proper salaries, etc., and ensure that these essential services are not disrupted at any cost.
It is a welcome move that the government has increased the salaries of doctors – this incentive should be provided across the board to all health professionals such as ward attendants, nurses, ASHA workers, ambulance staff, mortuary staff and pourakarmikas who are involved in the disposal of medically-hazardous waste.
8. Protection of all healthcare workers
Adequate care should be given to all categories of healthcare workers – PPE kits, place for rest between shifts, place for isolation and quarantine if necessary.
9. Continuing care for non-COVID patients
Non-COVID patients are finding it difficult to access healthcare even in an emergency – for labour, for dialysis, blood transfusions, etc. Sometimes they are admitted only if they can produce a negative-COVID test report. This will increase morbidity and mortality. We urge that the government put systems in place to ensure that these essential services are not disrupted.
10. Daily Press Briefing
During the lockdown, the Chief Secretary and the Principal Secretary, RDPR (in her capacity as COVID Relief Committee chairperson) conducted a meeting with the representatives of various civil society organisations. We ask that a cabinet minister who is responsible for handling the COVID situation also brief the press every day.
[This article is based on press releases from the social welfare organisation Naavu Bharateeyaru, and has been published after edits.]