Public Health Infrastructure for Pandemics

India needs a permanent database of its most vulnerable population, the 65+ who are constituting most deaths globally. Even among them, it is only those with serious co-morbidities that are being affected.

Governments all over are nationalizing private health care for the period of COVID-19 or depending on them for results with incentives for COVID registrations and for Ventilator usage. Naturally, private health care finds it beneficial to push Covid +ve cases, hospitalizations and ICU/Ventilator usage.

In New York, majority of those kept on Ventilator died in one hospital system very soon. Governments are also taking care of uninsured. This again brings us to the need for a Public Health System which would have a Pandemic team always ready in the Respiratory Viruses season.

When hospital treatment becomes a transaction between a third party payer and a hospital, the treatment is always different from when it is the party directly paying for the treatment. The socioeconomic background also matters for treatment varies based on that. Majority of the dead in New York belonged to African Americans/Latino. Many states in USA have nearly 30 percent of their deaths from the African American community. In Albany,Georgia, it is reported that 90 percent of the deaths are from African Americans. Socio economic inequities exacerbate rather than normalize even in Pandemics. It doesnt help that their jobs do not provide them insurance benefits since many of them work for cash. In D.C, they constitute 46% of population and in Chicago, 30% of population and are mostly in poor neighborhoods.

India is paying all ration card holders for treatment at private hospitals. If India can expand the AIIMS model to create more hospitals per district, it would be helpful since the government can utilize the same money it is reimbursing to set up a robust Public Health Infrastructure. The Poor still trust Government Hospitals as first choice despite private choices since private hospitals squeeze a lot from patients in name of other expenses which are not covered by Insurance.

Even in USA, a insured would have received a bill of $65,000 USD+ for Covid Treatment but President Trump has recently announced that government will pay for treatment as well for uninsured not just diagnosis. USA has 7 times more beds in public hospitals than in private hospitals. Public hospitals had 33 million admissions in 2017.

India has just 7 lakh beds in the public health sector for 139 cr population. India needs at-least 10 times of the same or 7 Million beds for its 1.39Bn population. India needs to invest into Public Health Infrastructure and have trained staff. Like it has institutionalized Swacch Bharat, it should also institutionalize Public Health infrastructure.

These respiratory viruses, lab viruses will keep recurring as we have been observing in the past decade globally. So It is no longer a option, but a mandate to have a strong Public Health Infrastructure. Target of 7 Mn Beds by 2024 in Public Health/Government Hospitals.