“There’s no point dwelling on what might or could have been, you just go forward”. — Jack Nicholson

If we are to believe the numbers given by the state and central government, it seems India has until now managed to tackle the COVID crisis quite well. Despite a few cases of religious mass gatherings and some elite weddings and garden parties, the nationwide lockdown since 24 March 2020 has ensured that India does not become the next USA, Spain or Italy. The disturbing part is the increasing gap between the recovery rate and the number of new cases. We, as common people do not really know where we are heading. Now let’s have a look at countries like South Korea, Taiwan, and Singapore. These are the countries that could successfully flatten the curve before COVID-19 cases could reach the exponential growth rate like most other countries.

South Korea, with the largest initial outbreak outside China, managed to bring down the total number of new cases without even having to impose a national lockdown. Taiwan, another neighbouring country to China could limit the total number of cases to just 395 (till April 17, 2020) in a span of 4 months since its first outbreak in January 2020. Similarly, Singapore, which has already reported over 5,000 cases, has had only 10 deaths until April 17, 2020. Aren’t these numbers intriguing? How have these countries managed to limit the spread of the virus so effectively?

The answer lies in 3 specific steps: preparedness from the very beginning, rigorous random testing, social distancing, and contact tracing. All three countries mentioned above took the coronavirus seriously right from the start, perhaps because the sufferings from the SARS 2003 outbreak are still fresh in public memory. Taiwan started screening passengers at airports since the day they came to know about the outbreak in Wuhan. South Korea, with a population of 51 million, tested 20,000 people daily. Singapore was tracing, detecting, and isolating people at large. Not only immunocompromised patients, but even those who came in with the mildest symptoms were treated with utmost care from the very beginning. These countries were using tracking devices for updates from the suspected and infected patients. Even Canada has reduced the impact of COVID- 19 by taking necessary steps without any delays.

Has India managed to do the same? The answer is both yes and no. Yes, because Kerala, the southernmost state in India is already working towards flattening the curve. Kerala which has a large diasporic population had a higher chance of spreading the contagion as they returned from all over the world. However, the state promptly responded to the crisis with extensive random testing at different locations without violating the lockdown imposed by the central government. Indeed, the Kerala model has worked like a miracle. It has also set a great example for the rest of the country.

As the country reels under the pressure of this recent COVID crisis, how has it affected India’s general health care system? How, for instance, has this affected cancer patients who have to visit the hospital for regular treatments, pregnant women who are going into labor, stroke survivors, heart patients, geriatrics, and patients with mental illnesses?  How are they coping in the midst of this pandemic? It has become clear that the healthcare industry in India needs a massive reform in order to fight such contagious diseases. Given that the country’s healthcare system is already overwhelmed with a sudden surge in the number of health related cases, governments have been trying to “flatten the curve” through social distancing and self-isolation so that existing infrastructures can continue to accommodate the number of patients requiring critical care. It’s however too early to call India a success story. To understand where India stands and what the future holds, we need to pay attention to a few things:

1. Public health vs private healthcare systems

At present India ranks 129 out of 189 countries in Human Development Reports published by United Nations Development Programme. A report by The Financial Express says India spends only 1.15% (as compared to 1.3% for the last three years) of the GDP on healthcare which brings India to rank 184 out of 191 countries.  More funds need to be allocated to heathcare in India. The Pradhan Mantri Jan Arogya Abhiyan (PM-JAY) or the Aayushman Bharat was launched in 2018 which was to provide insurance coverage (for hospitalization) of up to Rs 5 lakh to about 50 crore poor people. Although there are no detailed reports of its execution, this year the Niti Aayog was proposed as a public-private partnership (PPP) plan which allowed the takeover of government-run district hospitals by private investors. The Indian Medical Association opposed such model. COVID-19 showed us why. The private hospitals were charging humongous amounts of money for a simple screening test. What would have happened if the government had no control over the hospitals? Poor people wouldn’t get even the bare minimum. Thus PPP model in Indian healthcare is expected to fail miserably.

On the other hand, private healthcare facility in India is doing well and people have started depending on the doctors and hospitals of our country rather than visiting abroad unless absolutely necessary. This indirectly indicates that the private players are striking gold. But can we really grow individually if the country falls behind? Is making money the only motivation for these private enterprises? We all know the answer, but it’s time they should realise the existence of the unprivileged. Both the government and the private healthcare providers need to direct funds towards public health and healthcare in general as we know health is wealth.

2. Low cost medical equipment

The biomedical industry mostly imports high performance diagnostic and therapeutic equipment. This, in turn, increases the cost of the service provided through those instruments. For few of such facilities provided by the government, too many patients and mismanagement reduces the availability to the ones who needs it the most. Needless to say, the middle class can neither avail these facilities, nor afford the private hospitals. Therefore, access to CT scan, MRI, and many more diagnostic tests and treatments which are commonly prescribed, becomes a financial burden for most. COVID-19 sets a wonderful path to what could be done to improve this scenario. A three-year-old Pune based start-up, Mylab Discovery Solutions, a molecular diagnostic company came up with highly accurate COVID-19 test kits, with faster response time for 1200 INR as compared to 4500 INR charged by the private labs using the imported test kits. They got a funding of Rs 1 crore from Action COVID Team Grants to scale up their production, which could further bring down the price of the test kits. As more kits become available, the whole country will be able to shift to the model of random testing and tracing of COVID-19 positive cases. The healthcare industry in India should welcome more such companies with qualified scientists and large scale manufacturing units to meet the increasing demand of disease diagnosis and treatment in India. Moreover, price control on medical devices and reduction of import duty on raw materials and medical equipment could be done to make healthcare more affordable and equitable.

3. Role of academic and research institutes

The academic institutes are focusing more and more on teaching interdisciplinary subjects to prepare the students to find some application in the healthcare industry as they envision the huge demand to be created in the healthcare sector. It is not necessary that one becomes a doctor or a scientist to contribute to the healthcare industry. The technologists operating the devices, the biomedical engineers taking care of the medical devices, the medical physicists taking care of radiation safety, and the paramedics are all part of the healthcare industry, who are currently risking their own lives to serve the nation and its people. We need more young, dynamic people to boost up the healthcare system.

Almost all the research institutes in India are already working on innovation in diagnosis and treatment of diseases. They understand that universal healthcare is no less essential than basic necessities like food and hygiene. As researchers, we mostly focus on low cost, easy to use, biodegradable/reusable, diagnostic devices which can be used at home as well as in hospitals and diagnostic centres. The researchers not only develop equipment, they also analyse data. That brings in the other domains like network engineers and AI specialists to collaborate with the biomedical researchers. An article published in a medical journal in England mentioned that situations like corona virus spread would bring in a digital revolution in the healthcare sector. As education is uninterruptedly continued through digital platforms globally, digitized healthcare gadgets could reduce the vulnerability of the healthcare providers and increase tracking of patient condition. India is almost digitized now with internet connectivity reaching the majority. So digitizing health monitoring is possible through telemetry. Moreover, laboratories in India are capable of producing vaccines and medicines better than many other countries as we witnessed that we need not depend/threat other countries for hydroxychloroquine. But what we need is funding for the research. The Department of Science and Technology – Science and Engineering Board announced several special research projects for fighting COVID-19. We still require more funding from the government on healthcare projects.

4. Technology transfer

IIT Kanpur, IIT Roorkee, IIT Hyderabad developed low-cost ventilators that could be used during COVID-19 outbreak to provide life support. IIT Delhi developed an infection-proof fabric for the healthcare providers to prevent hospital-acquired infections.  A team of researchers at IIT Bombay developed nasal gel to prevent spread of the coronavirus. IIT Ropar developed a UV-technology fitted ‘trunk’ for homes to sanitise grocery, currency and other essential products acquired from the market. All of these discoveries happened in such a short time! Undoubtedly, there is potential in India to revolutionize healthcare. But where are the products? How many of the research innovations are actually coming out as products or getting commercialized? The vast gap between innovative protocol discovery and large scale manufacturing (which could make the products affordable) needs immediate attention to reform the present healthcare industry. Strong collaboration of the research and academic institutes with the industry can support the commercialization and actually help reconstruct healthcare system in India.

5. Rural development – awareness and monitoring

About 70% of India’s population live in the rural areas of the country, which means they are deprived of the best facilities and that most of them are unaware of the services they deserve. We all know education and health do not reach these areas the way they should.  Although the government has launched a list of schemes for skill development, employment, basic education and healthcare, we the privileged ones should also take up certain responsibilities. We need to spread more awareness regarding hygiene and healthcare. It can be proposed that involvement in projects related to rural development could be made as a part of the curriculum for higher studies. Monitoring of vital signs by organizing health camps just as we organize blood donation camps will result in early detection of chronic diseases, just like rapid testing would help contain the spread of epidemics like COVID-19. Efforts from the young generation along with their supervisors will not only help in development of the poor but also build strong characters in students who would understand the value of giving back to the society.

To summarize, we need to reboot our healthcare system once we win the fight against corona. The healthcare industry would certainly get exhausted as we are not able to take care of the frontline workers as the way we should have done. We should learn from the situation and bring into action the changes that are required for public health in India. All of us can contribute in our own little way and make India proud and rich.