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A letter to my fellow countrymen: A physician’s perspective on Coronavirus and India

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When someone talks about their health, the first thing that comes to our mind is hospitals. The hospitals, healthcare systems, physicians and para-medical staff have become a synonym for health and healthcare. However, it is very important to make a distinction between both these words. The World Health Organization defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1. If we take this definition literally, we can see that the health is a state of being, not a state of disruption. Fundamentally, health can be achieved if we have harmony between our physical, mental and social well-being. Most of us can achieve this harmony even without going to a doctor. It is the times when you have any issues with either your physical or mental well-being, you go to the health system for the fix.

On the other hand, the word ‘healthcare’ can be defined as the structural systems created to regain the physical and mental well-being should some of us are unable to maintain our health for various reasons. While the healthcare can be achieved by various structural systems such as Ayurveda, Homeopathy, Naturopathy or Allopathy. Most of us are mainly familiar with the health systems that are part of the allopathic regime. I am talking about your family physician, your friend who just finished their residency, your father’s cardiologist friend, your dentist; basically, anyone and everyone that you associate with your health today.  

While throughout the history, our healthcare systems have evolved to a point where we can diagnose and cure almost every disease that were considered as a god given curse by our ancestors, we are still unable to create healthy communities; at least not by solely focusing on health system strengthening. For example, if we see the data generated by the, the US spends the highest amount of money (10586 USD per capita) on healthcare than any other country on the list.2 However, if we compare the life expectancy of an infant born in USA with other countries, the United States is ranked at number 28 in the same list.2 Clearly, the health system spending is not directly converting to good health outcomes. By no means I am arguing that investing in the health system strengthening is not important. I am just asking a fundamental question: is strengthening our healthcare systems the only way we can be healthy?

Metaphorically speaking, the health system’s role in the game of life is similar to the role of a goalkeeper in the football (soccer) field. In the best-case scenario, the teams are structured in a way that their main aim is to keep the ball away from the goal post. Because no matter how good the goalkeeper is, she or he knows that if the ball comes their way, there is a big chance that they won’t be able to stop the ball. Not because of their incompetency but because of the huge size of goal post. The role of our hospitals and healthcare system in the society is exactly similar to this goalkeeper. No matter how good the healthcare systems are, there will be times when they won’t be able to tackle the burden; especially when the goal post is getting bigger and bigger each day.

As the world is tackling an unprecedented burden due to COVID-19 pandemic. We are seeing how the health systems are struggling to cope up with it. Even for a country like USA (the world’s highest paid goalkeeper), the burden has proven to be invincible. The hospital systems are struggling, frontline workers are getting infected, the health equipment are fully occupied, and the supply chains are breaking down. If this is the case with USA, what happens with a country like India? If we see the same OECD graph as above, India spends the least amount of money on healthcare out of all the countries (USD 209 per capita)2. To give you a context, the average spending of all the countries on that chart is USD 3994 per capita.2 Adding to that, India has the lowest number of physicians per 1000 inhabitants when compared to other countries currently devastated by COVID-19 burden (0.8 per 1000 in India vs. 4.0 per 1000 in Italy).3 While, the health system in India is used to thrive in an environment where resources are not handful, the truth of the situation is that our healthcare system is feeble and under resourced. These facts are especially troublesome when we are fighting with a strong team – COVID-19- that will keep aiming at our goal post, i.e. that will keep sending patients to the ICUs.

In an ideal situation, the goalkeeper should be able to save as many goals as possible. But even if we assume that our healthcare system will be able to tackle the situation in the most efficient way, it will be naïve enough to think that our limited capacity will allow us to cater to all the patients. As per some of the reports in Indian media, the Indian healthcare system has approximately. 40,000 incubators actively available at disposal.4 As per the report by Center of Disease, Dynamics, Economics and Policy, the estimated number of COVID-19 patients in India will range from 13 lakh (1.3 million) to 25 lakh (2.5 million).5 If we just take the present statistics from other countries, approximately 5 % of the patients are estimated to be requiring ventilator support. That converts to a requirement of 65,000 ventilators in a best-case scenario, and a whopping 125,000 ventilators in a worst-case scenario. Just imagine all the players from the opposite team shooting a ball at your goalkeeper at the same time. Even if the goalkeeper is good, he/she will definitely fail to stop 10 balls. For us, the future seems similarly bleak. Even if we wish for the best, the situation will not allow our healthcare system to function at its best.

 Now the imminent question is: how will we be able to tackle the outbreak if the predictions turns out to be true? This question is complicated, and the disease progress is unpredictable at this point in time. However, there is one thing that is certain and is somewhat controllable. That is to make our team’s defense strong. What if our team does not allow the opposite team to shoot for that goal? What if we strengthen our defenses against this imminent threat – COVID-19 pandemic – in a way that allows us to stop the disease from sending patients to ICU. As I mentioned before in this article, the concept of health is totally different from the notion of healthcare. Simply speaking, the health of a person may be determined by what they eat, how they live, in what socio-economic strata are they from (which is somewhat corelated with their education status), what type of job do they do, in which area do they live in, so on and so forth. All these factors will determine whether they will be able to defend against a disease or not. For example, someone who is a vegetable vendor would not be able to completely isolate himself, especially if he is staying in a 2 room house with 8 of his family members.

Even for COVID-19 outbreak, these factors will really determine how we – India – as a country will fight against this outbreak. On a grand scale, as a country, we definitely need to rethink how we define health and healthcare in the future, but for now our primary intention should be just to focus on current outbreak; so that we can pass this phase gracefully and with minimum damage. While it might seem to be another disease, but from what we can see around the world, it can really break our healthcare system and more importantly can have a big impact in terms of human fatalities. Hence, I urge all the Indian citizens to rethink how they want to live for a while. It is definitely tempting to go outside and see what is happening. But as I mentioned before, the only way to tackle this virus is to make our team stronger, and one of our team players is our ability to break the chain. If we break the chain of transmission, we will at least buy some time before the virus shoots for that goal. The catch here is that the virus is a powerful player, why would it stop just by defense from our one player? But isn’t it true that we have ten players (or probably more) in our team? Why don’t we use them? Why don’t we make our team even stronger?

Hence, through this humble letter, I want to request all of my fellow citizens to help us – the physicians, the government and the public health professionals – in making team India strong. For this fight, each and every aspect of our life matters – your hygiene, your education (spreading true information about the disease rather than rumors), the area in which you live (imagine people living in slums where there is no social distancing) and how you treat your fellow citizens. There is no need to panic in this situation. There is no need to be hostile against people who are out there in open. The only way to go forward gracefully is to help one another. You might do it by staying inside, or you might want to do it by avoiding the spread of false rumors on social media.

You might want to do it by appreciating the health workers at 5 PM each day or you might want to do it by donating funds to the government relief funds. You might want to do it by taking care of the family members of your house helps or you might want to do it by supporting the people in lower socioeconomic strata.  Whatever you do to support the nation will only make our team stronger. So, please be considerate and be strong. We can make this happen. As a nation. As a democracy. As a family.

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