Coronavirus Reads, Digest 4
Is India ready for the community transmission stage? And NYC sets up a field hospital in Central Park.
It’s Monday, March 30th.
There are a lot of updates from India today.
For the first time, an Indian health ministry document has said limited community transmission of the virus is occurring within the country. The community transmission phase of a pandemic is when the source of a patient’s infection cannot be directly traced, indicating wider spread. The ministry later in the day sought to underplay the extent of community transmission, but most experts believe that India is already in this stage.
There are currently over 1,200 confirmed COVID-19 cases, but several “hotspots” across the country where outbreaks could be occurring. More on that below.
The 10 Questions Indian Health reporters want answers on:
After frustrations over a lack of transparency and obfuscation from the Health ministry especially during their press conferences, several health reporters in the Indian media have collated their questions publicly.
An excerpt:
Currently, all those who have tested for Covid-19 are being admitted to hospitals. In case of a likely increase in the numbers of people infected, what is the plan for isolating those who are mildly sick? Will they be asked to stay at home or does the government have plans to create decentralised isolation facilities at the community or village level? If so, what are the plans?
View the rest of the questions on Scroll.in: https://scroll.in/pulse/957613/health-reporters-have-10-questions-for-the-government-as-indias-coronavirus-crisis-deepens
Eye on New Outbreaks
Bhilwara, a small town in Rajasthan has been an unlikely center of the virus outbreak in northern India after a local doctor who had travelled widely in the area and treated dozens of patients, died of COVID-19 symptoms. Thousands of local residents are being tested, at least 56 have now tested positive and 2 have died.
BBC’s Soutik Biswas has been tracking the story, Is This Textile City Set to be 'India's Italy'?
Police and hospital authorities are monitoring a potential outbreak in Delhi, from a religious conference of 500 people around March 18th at the Nizamuddin shrine. Over 200 people have developed symptoms, while many of those that attended have travelled to other states and have since tested positive for COVID-19, including in Kashmir, Andhra Pradesh and Andaman and Nicobar Islands. Read the full news report in The Hindu.
Personal Protective Equipment Focus: Delays mean 25-30 days for supplies
PPE, or the gowns, masks et al that healthcare workers including doctors and nurses need to protect themselves from getting infected, is in desperately short supply in India as well.
Unfortunately, despite the government pushing forward on manufacturing them, the central PPE procurement agency has told hospitals it will take at least 25 days to deliver personal protective equipment for healthcare workers due to a short supply of raw materials, delays in transport due to the lockdown, and only a limited number of centers where they have been approved to be assembled. The limited numbers of kits already available are being sent to hospitals.
Meanwhile, doctors and nurses across the country continue to work without PPE or even N95 masks.
Due to the coronavirus’ highly contagious nature through respiratory droplets, treating infected patients is risky for healthcare workers. If they get infected, they risk passing it to other patients or colleagues, and cannot work. If they develop any symptoms, they must go into a quarantine.
What happens to a healthcare system when doctors and nurses get infected? New York City is battling this right now:
Nurses Die, Doctors Fall Sick and Panic Rises on Virus Front Lines, by Michael Schwirtz, The New York Times
Data shows that India already faces a shortage of over 600,000 doctors and 2 million nurses. In fact the government is already considering letting final year medical students treat patients to help alleviate the strain, a move several American medical schools are also making.
It is worrying to consider the consequences of healthcare workers getting sick early on in India’s outbreak, especially in smaller towns and villages where there are fewer of them to begin with.
Who will treat patients if doctors and nurses get sick?
For some perspective on who will be able to access healthcare in India, look at Rukmini S’s data analysis in Livemint. She notes that while the poor will be most likely to experience respiratory illness and get incapacitated by it, the rich, who report better self-health get significantly more hospital care.
Hospital infrastructure
Are India’s hospitals prepared, and as the need arises are they preparing for temporary hospitals and isolation wards?
Faced with a lack of hospital beds, ICU access and ventilators, the states of Chhattisgarh, Rajasthan and Madhya Pradesh have taken over private hospitals for COVID-19 treatment, which is supposed to be free of charge. Several countries in Europe have followed this model. Could more of India follow suit?
Three Indian States Take Over Private Hospitals by Ipsita Chakravarty, Scroll,
China had built a 1000-bed hospital in Wuhan in two weeks, and set up massive temporary wards. They have reportedly offered to help India build such makeshift shelters.
Meanwhile, reports indicate some Indian railway coaches are being prepared to be used as isolation wards. Read more in The Hindustan Times on how berths are being removed, with the goal of making 10 coaches per week into wards.
Lockdown updates
A video from Bareilly, Uttar Pradesh of returning migrant workers being sprayed with a chemical disinfectant drew widespread outrage after going viral. The local police responded and said that it would not happen again. Disinformation is clearly widespread on how to contain the spread of the virus. Read the full report in The Hindu. This, as India’s poor continue to suffer the inhumane effects of the lockdown.
Sanitary napkins have finally been deemed essential items that can be manufactured and delivered during the lockdown, 6 days after they were not included in the initial list. I wonder how many women were involved in compiling the list initially?
And in the Hindustan Times, C Uday Bhaskar argues that India must use its internal security resources with empathy, instead of wielding force, to distribute food stocks, or when the need arises, to set up temporary shelters.
U.S. and International
In the U.S., President Trump extended social distancing guidelines to April 30, as the country could have as many as 200,000 deaths.
In New York City, the massive Javits Convention Center has been turned into a 1,000-bed temporary hospital by FEMA. Here’s a first look inside from CNN: https://edition.cnn.com/videos/health/2020/03/28/new-york-coronavirus-field-hospital-prokupecz-lok-vpx.cnn/video/playlists/coronavirus/
And a 68-bed field hospital is also being set up inside Central Park.
Meanwhile, President Trump evaded questioning on his assertion that New York was overestimating the amount of ventilators it needed. He rebuked journalist Yamiche Alcindor when she asked him about the issue during a press conference.
Later, #WeLoveYamiche was trending on Twitter.
The U.S. health department’s civil rights office is opening investigations to ensure there isn’t discrimination in deciding who receives medical care. This after Alabama and Washington states filed complaints that protocol on life saving medical in the pandemic were discriminatory.
New details have emerged on how local bureaucrats in China kept the medical community from sounding the alarm on the virus early enough, despite efforts to create a better communicative system after the 2003 SARS outbreak.
China Created a Fail-Safe System to Track Contagions. It Failed. By Steven Lee Myers, The New York Times
David Frum writes about how the pandemic has hit pause on globalization and global cooperation, but we shouldn’t lose the global economy as “a fenced-off world will be a poorer world.” The Coronavirus Is Demonstrating the Value of Globalization, The Atlantic
Side Effects of the Quarantine
During the extended period of quarantine, parents around the world are getting creative with how to entertain their children.
A set of parents in the UK threw a formal dinner party for their small children during self-isolation, complete with a milk tasting in a wine glass.
And a father in Washington D.C. tried to bring a movie theater experience to their home.