CHRISMED Journal of Health and Research

REVIEW ARTICLE
Year
: 2022  |  Volume : 9  |  Issue : 2  |  Page : 107--111

Lock to unlock: A multidimensional impact of COVID-19 in India


Murugan Mageshwari, Abhijit Boratne Vinodrao 
 Department of Community Medicine, MGMCRI, SBV (Deemed to be University), Puducherry, India

Correspondence Address:
Abhijit Boratne Vinodrao
Department of Community Medicine, MGMCRI, SBV (Deemed to be University), Puducherry
India

Abstract

The COVID-19 pandemic forced for first lockdown in India in March 2020. Resurgence of COVID-19 cases has forced many states in India to reintroduce the movement restrictions in March 2021. With four times increase in number of cases, many hospitals are swamped with patients, shortage of doctors and healthcare workers, shortage of personal protective equipment (PPEs), medications, and oxygen. The second wave led to out of pocket expenditures, hike in health care budget, burnouts among the health care workers (HCWs), migration, and hampered education system. The crisis was due to insufficient oxygen and beds, repeated changes in the treatment protocol and testing strategies, violence against HCWs and front line workers (FLWs), vaccination hesitancy to vaccination shortage, and increased morbidity to mortality. The quarantine and isolation of HCWs and FLWs become difficult due to the insufficient workforce. This formed as an opportunity leading to public–private partnership for patient care and successful vaccination. The pandemic brought the concept of advanced technologies and inventions such as use of Robotics, Apps such as Arogyasetu and CoWin, Ventilators, and O2 plants (O2 concentrator), and self-testing kits (COVISELF). Apart from the COVID appropriate behaviors, mass vaccination and newly approved treatments, the policymakers can stabilize the country with helping hand from industries, development of workforce, adequate production, and supply of medicines-vaccine and PPEs to rejuvenate the healthcare industry at the earliest.



How to cite this article:
Mageshwari M, Vinodrao AB. Lock to unlock: A multidimensional impact of COVID-19 in India.CHRISMED J Health Res 2022;9:107-111


How to cite this URL:
Mageshwari M, Vinodrao AB. Lock to unlock: A multidimensional impact of COVID-19 in India. CHRISMED J Health Res [serial online] 2022 [cited 2023 Jan 30 ];9:107-111
Available from: https://www.cjhr.org/text.asp?2022/9/2/107/364536


Full Text



 Introduction



On March 11, 2020, the World Health Organization (WHO) declared COVID-19 outbreak as a pandemic and emphasized to step-up preparedness, infection prevention and control, and implementation of containment plan at all three levels of the health system-National, State and District.[1] The first lockdown (formally known as timely, comprehensive, robust response, i.e., a number of nonpharmacological interventions encompassing stay-at-home orders, curfew, societal restrictions) was implemented in India when there were 360 cases with 27 recovered and 7 deaths on March 22, 2020.[2]

The Epidemic Diseases Act and the Amendment Bill together provide the structure for central and state governments to control the spread of an infectious and fatal outbreak. These legislations provide a guidance regarding the first actions to be taken in case of such outbreaks including public notifications, fund disbursal, compensation packages, deployment of equipment, infrastructure to curb the spread of highly communicable life-threatening diseases, and also addressing the increased instance of violence against healthcare professionals.[3] Similarly, a resurgence of COVID-19 case has forced many states in India to reintroduce the movement restrictions as the second wave hit India too hardly in March 25, 2021 when there were 11846096 cases with 1,126,250 recovered and 160,983 deaths.[4],[5]

We are facing still a worse scenario which deals with the lives of many health care professionals. This second wave has an altered mutation of the virus which took many lives and hardly battered the Indian economy to the core. Still, we face the same issues in the second wave as compared to the first. The active surveillance was in practice in the first wave, while it is not possible now due to a large number of cases in the community. Nonacceptance of COVID illness, many people are going to health care facility too late when complications are already set in leading to high mortality despite the decent recovered cases. With four times increase in number of cases, many hospitals are swamped with patients, shortage of doctors and healthcare workers, shortage of personal protective equipment (PPE) for medical professionals, and required medications including oxygen for critically ill patients.[6] This certainly signifies the need of a robust healthcare system which has many challenges and opportunities too.

The lockdown resulted in many changes in the health care system which shined lights on the evidence-based medicine and its technology.[7] The second wave leads to out of pocket expenditures (OOPE), hike in health care budget, burnouts among the health care workers (HCWs), shift in migration, and suspension of face-to-face learning in the education due to lack of space for social distancing. There was a shift in the global focus on insufficient oxygen and beds, repeated changes in the treatment protocol and testing strategies, vaccination hesitancy to vaccination shortage, and morbidity to mortality in response to the pandemic.[8] Hence, the aim and objective of the article are to review various published articles to document global impacts of COVID-19.

 Urban to Rural Shift of COVID Cases



The COVID-19 pandemic has highlighted the shortcomings of healthcare systems worldwide. Many countries across the globe, irrespective of their economic and social status are struggling to flatten the virus curve. In context to India, not only the major cities but also the rural areas are even flooded with the case overload. Alongside the lack of infrastructural facilities to accommodate the huge number of patients and shortage of healthcare professionals, turned the situation alarmingly grim in most of the places.[9]

 Changes in the Healthcare System



The fear of contacting the disease, cost of safety measures, testing, consultation charges, cost of PPE, hospitalization, and expensive medication was a concern in India. This led to the hike in the health care budget, adding to the emergency funds given by the central government.[10] Issue related to screening and diagnostic test for all emergency patients was burden on hospital services. Any breach into these procedures has put the whole HCW team at risk. The quarantine and isolation of HCWs and front-line workers (FLWs) becomes difficult due to the insufficient workforce and over-confidence due to partial or full vaccination.[11]

The first wave of the pandemic proven better healthcare facilities and ensuring safety measures in hospitals had a drastic increase in healthcare costs. Doctors have been compelled to use PPE kits, N95 masks even during a routine outpatient department visits too. Advanced safety measures and periodic sanitization in hospitals also added up the cost of healthcare. The second wave paved way to still hike the costs of living, which includes the basic oxygen support too at patient's OOPE. From surplus to shortage, this second wave has opened up multidimensional problems.[12]

 Changes in Pharmaceutical Sector



Irrational use of drugs was solved during the pandemic by framing the delivery of drugs through proper channel (following physician's advice and prior necessary testing). Thus pharmacy vendors also contributed lot by motivating the persons with signs and symptoms for testing, extending the need for gearing up the provision of drugs, and improving the infrastructure development. Now, the second wave has resulted in the issues of selling the life-saving drugs and medical equipment for the highest possible monetary benefits. There was huge shift from the vaccine hesitancy to the vaccine shortage due to repeated changes in the treatment protocol increasing the interval time between two consecutive doses raising a debatable issue.[13],[14]

There was a tremendous rise in the pharmaceutical growth, which was an evident cause for balancing the economy of the country during the crisis. We got the whole PPE such as masks of different types, disposable gloves, face shield, head cover, goggles, gowns, rubber boots, and sanitizers at marginal rates, which formed the base for the growth of the economy. The vaccines can also play a vital role in growth in this pandemic era pushing the economy. Ventilators and PPE were consigned from the vendors in the country and abroad, hiking the cost of expenditure and forming a part of growth in the economical shift.[15]

 Public-Private Partnership



The public health care system is unprepared for the task in the pandemic due to inadequate funding and monitoring of quality control resulting in the shift from public to private hospitals preference. Private providers were able to make massive profits by charging patients exorbitantly. This formed as an opportunity for the public health system to rejuvenate their rightful position as the predominant health care providers in the country leading to the public-private partnership (Government taken over most of the private hospitals to convert into COVID Care Centres).[8],[16]

Combating the second wave, the scenario is still worsened when the hospitals are devoid of beds with respect to an overwhelming unprecedented number of cases, so there was a call for private players in health sectors to act effectively. Many helping hands and industries volunteered during crisis. During the second wave, the government planned to increase number of vaccination centres where private hospitals were called for help managing the whole population, enabling successful vaccination among 22,55,71,144 individuals as of June 5, 2021.[17]

 Technology in Healthcare



COVID-19 scaled up new innovation in healthcare arena by making use of advanced technologies and inventions. The use of Robotics (MITRA-a well-designed Indian Robot delivers the medicines, foods and check the vitals for the diseased persons in hospital isolation wards) and the application of virtual healthcare have become more evident in healthcare sector during the initial pandemic period. Due to social distancing and movement restriction, these were the better way to handle the diseased persons limiting the spread of disease.[18]

Nowadays, the spread is super-fast leading to virtual consultation from the physicians turning to hospitals at the end stage of the disease that is irreversible. The paradigm shift in healthcare industry made the system safer, affordable, and accessible to a certain extent. Initially, there were hardly availability of reverse transcription polymerase chain reaction testing, and later, it has been implemented even in primary health centres and private labs too.[19] The cost of testing also reduced to a greater extent in 1 year.

ArogyaSetu app (Indian COVID-19 contact tracing, syndromic mapping, and self-assessment mobile app) was introduced by the government for safety purpose. Initiation was taken to download the app by whole community which paved way for yet another important innovation implemented in second wave-CoWin app (A mobile app meant for facility level users to perform the tasks such as Vaccinator, Supervisors, and Surveyors and every citizen can self-register for COVID-19 vaccination) for vaccination. Indigenous companies produced ventilators and O2 plants, enhancing the innovation further a step ahead with the introduction of O2 concentrator. The action plan was drastically enhanced by a new innovation in the technology to curb the virus by COVID-19 Self-testing kit (COVISELF) approved by ICMR.[17],[19],[20],[21],[22]

 Hike in Healthcare Budget



The government initially used the contingency funds for emergency pandemic response announcing 1.7 lakh crore fund for the poor to fight against pandemic.[23] Rs. 17,287 crore were released after several states complained of inadequacy in the funding to fight against the Novel Coronavirus and moved to the phase of Rs. 35000 crore allocation for COVID-19 vaccination. Reserve Bank of India approved the transfer of Rs. 99122 crore to the government to implement strategies to curb the virus. Despite funding, there is a marked increase in the healthcare budget and OOPE.[24],[25],[26]

 Hike in Overall Economy



The overall gross domestic product in 2021 is slightly higher (2% increase) when compared with the last financial year of 2020 because the financial year starting was the first lockdown which was strictly measured in terms of poor monetary terms. In India, not only the direct fiscal expenditure (fiscal policy is the government revenue collection like taxes and expenditures to influence the country's economy) is much smaller for which the middle class and below cohort are worst affected. The rising inflation and poor purchasing power impacted on high indirect taxes on the fuel, etc. which is an indirect OOPE during pandemic.[15],[27],[28],[29],[30]

 Social Stigmatism



Social stigma in the context of health plays even more vital role in the impact of COVID-19. The COVID-19 pandemic has provoked social stigma and discriminatory behaviors of the people of certain ethnic background, many people are labeled, stereotyped, treated separately with special attention, even more cautious to accept the vaccines in the market, experience loss of status because of perceived link of the disease, fear of affecting the closed ones which has also led to affect the mental health to the level of committing suicide. Fear of not accessing the integrated child development services for basic amenities due to fear of COVID-19 thereby increasing the poverty, under nutrition, and hunger drastically.

 Collaboration for COVAX



A collaboration among the Serum Institute of India, the world's largest vaccine manufacturer by volume, Gavi and the Bill and Melinda Gates foundation has accelerated the manufacturing of 100 million to 300 million doses additionally for low-and middle-income countries as part of the Gavi COVAX AMC. The COVAX which was produced by our country has been helping all the countries with respect to the safeguard the HCWs globally. Thus, the deal helped assure access to early doses for the most vulnerable on a truly global scale.[31]

 Migrant Population Needs



COVID-19 has caused an unprecedented collapse in economic activities over months together. As per the estimate, in India, 20 million people were jobless during lockdown where the migrants suffered a lot with no job, no income, no access to health care, risk of food shortages and homelessness since the Government of India has urged the migrants to avoid travelling back to their home towns. Even if they seek new employment with atmost difficulties they have been excluded in providing the PPEs, further distancing measures were difficult to get implemented since they live in cramped dormitories with poor sanitary conditions. Furthermore, undocumented migrant workers have limited access to the COVID-19 testing and treatment. In few cases, the migrant returnees are met by their family and the community members which adds fuel to the stigmatization and discrimination. Therefore, the Government needs to address the challenges faced by the migrants by including them in the health services and through cash transfer and other social programmes and by protecting them from discrimination.[32]

 Burnouts and Safety of Health-Care and Front-Line Workers



The global pandemic has affected frontline healthcare professionals to a great extent. Nowadays modern wars are getting finished within few weeks to months, but this pandemic fight is going on since 1 and ½ years and the end has not yet come. The journey started with COVID-19 cases and the pattern of caseload kept on changing (starting from the COVID-19 to Mucormycosis deaths and pediatric age group involvement). Because of all these above conditions the HCWs and the FLWs started feeling burnouts resulting in morbidity and mortality. They are enduring extreme work conditions and sacrifices in order to help the infected. The anxiety of knowing that one's life is at risk when doing their job is very challenging for HCWs and FLWs. It is physically and mentally draining leading to an inevitable spike in burnouts and posttraumatic stress disorder among them. Due to the crisis, the HCWs faced shortage of manpower that led to the temporary recruitment of few of extra hands. Due to various reasons, the patient's relatives and the bystanders turned violent against HC and FLWs. This caused injuries and psychological stress on whole HC personnel. The government had to bring rules and regulations to prevent such untoward incidents against HC and FLWs.[33],[34],[35],[36]

 Future Needs



The healthcare system in the country needs an upgrade on every level, from infrastructural development to process and data managementThe doctor population ratio in the country is not healthy. While the WHO prescribes that, in India the doctor-population ratio of 1:1000 is less showcases the need for deploying more number of qualified doctors in the healthcare spectrumIn the upcoming days, we can expect not only the Indian Government but also authorities across the world to come up with plans and actions to rejuvenate the healthcare industry on a global scaleHealth diplomacy and health economics will become the talk of the town in futureCountries like India can certainly expand its global diplomatic footprint in the post-COVID-19 world by making use of its resources.

 Conclusion



India has got multidimensional impact of COVID-19 which can be brought under control by COVID appropriate behaviors, mass vaccination and newly approved treatments. The second wave taught us valuable lessons like better in terms of oxygen supply in district hospitals and community health centers. The risk is much greater for India's economy and surviving a deadlier second wave is too difficult if it prolongs. We need the public private partnership, helping hand from industries, with the plans and actions to rejuvenate the healthcare industry at earliest in achieving its elimination goals.

Recommendations

Indian vaccination drive stalls, also needs to be six times faster to achieve the 100% vaccination targets by the end of this year. As per the current scenario, the per day vaccination census is topped to 2,50,10,390. So now, we have to focus on the active cases, effectiveness of the vaccine and fasten the work for vaccination for children and adolescentsAfter easing out the lockdown, reverse migration will happen. So we need to keep an eye on and provide all types of supports to this populationThe attention of policymakers for right investments in health sector should be the main aim to reduce the OOPEDevelopment of manpower in health industry, adequate production and supply of medicines, vaccine, PPEs, and necessary equipments must be done throughout the countryBuilding a resilient public sector for provisioning universal health care services.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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