Can Ayushman Bharat help India to weather the COVID19 Storm?

Italy had a well-resourced and efficient Universal Healthcare System, but that didn't deter hospitals from choosing to limit resources and make distressing triage judgments. Based on the current position, Indian doctors may also face hurdles shortly. What role can Ayushman Bharat play to flatten the curve of the epidemic? A HE report.

The Indian healthcare sector has never done this before. Neither have our doctors done anything similar. Our doctors do surgeries, work in an emergency room, teach, in addition to a lot of other things.

Today, they have to keep themselves, the hospital and its frontline workers secure, because when you even intubate someone, the virus becomes airborne. They also need to wear maximum protective clothing, and they have never worked in such situations before.

There are also other significant issues like how to avoid contamination when you remove the protective equipment. What if they turn towards the other side? Many spend hours to iron out these issues.

How can we revamp this model? Can Ayushman Bharat play any role in this?

Time to Adopt a Wartime Mentality

It's a test of a lifetime for the Indian government as well as healthcare authorities. New hospitals were constructed in Wuhan in a week. However, it doesn't look like a possibility in India. Undeniably, with a bed-population ratio of nearly 1:1,000, and with around one million hospital beds and less than 100,000 intensive care unit (ICU) beds, India is not at all equipped to resist the crisis. Data collected by the health ministry has revealed that currently, there are 15,980 isolation beds and 37,326 quarantine beds available.

In the wake of the epidemic, the government has also revamped its public health crisis management. According to news reports, the National Health Authority is trying to formulate a COVID-19 special package under the government's flagship Ayushman Bharat scheme. The measure is to ensure that the health system is prepared, in case of a requirement.

India needs a manifold increase in capacity. Accessing resources fast is something we have done during wartime. But it takes time to add more beds, buy more equipment or hire more people. However, planning takes less time than resources. Hospitals should set up isolation wards to isolate corona patient. Most big cities have only a handful of such departments.  

Further, the Indian Council of Medical Research would carefully review the COVID package. The plan still must be approved by the NHA's governing panel. Officials have also declared that such a proposal would be essential if coronavirus disperses to the community.

Testing Times for Healthcare Sector

PMJAY has 19,840 hospitals empanelled under the scheme. But not all the hospitals empanelled under the programme have isolation wards. The NHA is also trying to fix rates for the COVID 19 package.

Union Health Minister Harsh Vardhan conducted a high-profile reassessment meeting last week with heads of All India Institute of Medical Sciences, RML and Safdarjung Hospital for checking healthcare sector's groundwork.

The Confederation of Indian Industries has recommended that under-utilised or unoccupied public and private hospitals should be used for Covid-19 quarantine.

Free treatment of symptoms of new coronavirus (COVID-19) disease is available through different packages of Ayushman Bharat-PMJAY for beneficiaries at empanelled and other designated hospitals, according to Dr Indu Bhushan, CEO, National Health Authority (NHA). The symptoms for which free treatment is available under Ayushman Bharat-PMJAY to include Pneumonia, Fever, Respiratory Failure. Bhushan tweeted, "Treatment of symptoms of #COVID19 #Corona like Pneumonia, Fever and Respiratory Failure. It is available, thru diff. Packages, under #AyushmanBharat #PMJAY free of cost for eligible people in empanelled hospitals & other designated hospitals."

Another challenge would be to involve private hospitals, who might be wary of treating COVID patients along with regular patients, as many are not designed for infectious diseases. Many don't have negative pressure rooms.

From an outbreak standpoint, the essential pieces of the standard are its vast majority of patient rooms to be single occupancy and the ability to isolate infected people in emergency departments from the general population, and it can be an expensive proposition for Ayushman Bharat scheme.

Maharashtra, for instance, has used Seven Hills Hospital as a quarantine facility to isolate corona suspects from other patients. Medanta hospital had also admitted a few patients due to the request of industry. NHA is also keeping a close watch on live data as well as on the call centre details that Ayushman scheme sits on to detect any usual pattern. The measure is expected to help in minimising the impact of coronavirus in India.

Indian response also includes monitoring the data of PMJAY, especially looking for unusual spikes in influenza-like illness and severe acute respiratory infections.

If there's an abnormal increase, ICMR should be informed to ensure there's no outbreak. Officials said that this data would not be shared without proper vetting.

Similarly, PMJAY officials are sifting through the data from call centres carefully. If the number of calls from any district goes up extraordinarily, the trend would be captured for further analysis of whether this has any relation to COVID-19.

"We are preparing ourselves in case there's a spread. That includes ensuring the private sector facility to support treatment of COVID-19 cases. NHA is currently assessing the capacity and readiness of private hospitals on this.”

Also, NHA and ICMR are in talks to allow testing for coronavirus by authorised Ayushman centres, while trying to ensure that the disease doesn't spread any further in the country.

Even in the UK, PM Boris Johnson predicted that its National Health Service could be inundated by the novel coronavirus like the Italian health system within two weeks. It already gives home-screening facilities for patients.

Whatever it takes

Even as Aysuhman Bharat had not played a proactive role in corona warfare so far, things may change depending on how long the virus lasts. The more we minimise traffic during the time of social distancing, the better. Many doctors in other countries are also transitioning to "virtual first" care models, as a way to halt the spread of COVID-19 in their offices and waiting rooms. Most doctors talk to patients over the phone or by video conference and then decide who needs to come to the office for an in-patient appointment. Pushing non-essential meetings virtually could also help ease load of patients for healthcare workers.

Many doctors have expressed concerns about whether the country has enough equipment like ventilators, a crucial device that can save lives of people suffering from acute respiratory distress. As fears of global ventilator shortages grow, there is also pressure on companies to increase the production of parts.

The pandemic of 1918 led to more loss of lives than both world wars combined, and the epidemic is on course to do the likewise now. So, it is vital to equip for the challenge immediately.