Many loose ends to enlisting private hospitals in COVID-19 fight

With the number of coronavirus infections in the country nearing the 1,000-mark and the apprehensions regarding handling a sudden surge in patients witnessed by various countries such as Italy and the US, the Central and state governments are taking steps to enlist the private sector healthcare infrastructure to ramp up the war against COVID-19.

However, a number of hitches and confusion over key aspects of the engagement are hampering preparations at this critical juncture, which is crucial to flatten the curve and slow down the virus that has caused massive loss of lives in Europe, China, Iran and the US.

In talks with private hospitals

The Centre and state governments are in dialogue with the private hospitals and a broad agreement was made to ensure that COVID-19 patients are treated in these hospitals too as the public health centres will find it difficult to handle a surge in coronavirus cases.

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Most hospitals have done away with OPD (out-patient department) facilities and are keeping only emergency services operational. In most cases, the state governments have urged large hospitals in to keep facilities ready to admit COVID-19 patients and in some cases, the Centre – through industry organisations such as FICCI — is in parallel dialogue to step up preparedness.

On behalf of the Central government, the health ministry along with the home ministry and NITI Aayog are on the forefront of this initiative.

Picking up the tab

A key question that remains unanswered is, who will bear the cost of treating coronavirus-infected patients in private hospitals? Since the cost is high, efforts are still being made to find answer to this.

Initially, the NITI Aayog and several departments of the Central government urged private sector players to take up this mission as part of their CSR (Corporate Social Responsibility) initiatives.

However, it was found that not all private hospitals were in a position to do so and it was suggested that costs could be covered under the Ayushmaan Bharat health insurance scheme.

But, the scheme has not been tweaked in any way to enable this possibility and hence questions over the costs remain unanswered.

No insurance cover

To date, most COVID-19 patients are being treated in state-run hospitals, government organisations and charitable organisations. Only a small number of patients were treated in corporate hospitals and they were foreigners.

In fact, even the ₹50 lakh insurance cover announced by the Centre for doctors, para-medics, technicians and other medicare staff handling COVID-19 patients is available only for healthcare teams which come under the jurisdiction of the government.

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While the private sector is expected to handle the same assignment, this facility has not  been extended to their employees.

Shortage of equipment

Then there is the question of key essentials such as PPE (personal protective equipment), testing, ventilators and other key elements like hydroxychloroquine.

No private hospital will be in a position to follow the coronavirus treatment protocol without these important ingredients, but issues such as lack of PPE supply have not been resolved till now despite ongoing discussions between the government and private sector hospitals.

Due to surging global demand, every item associated with coronavirus treatment is in short supply now and private hospitals are looking forward to government finding a solution at the earliest.

8 PPE sets per patient

It is estimated that the average requirement to treat a single COVID-19 patient is eight sets of PPE each day — to make sure that doctors, para-medics, technicians and sanitary workers do not get infected.

Procuring adequate number of PPEs is a huge challenge and costs have skyrocketed during the recent times. Even simple items like drips will be in short supply if the coronavirus infections multiply and it will be tough to address the issues because of the unprecedented situation that has resulted in a countrywide lockdown.

Looking out for ventilators

According to Union Health Minister Dr Harsh Vardhan, to date, around 15,000 ventilators have been made available dedicated only to isolation beds in the country, especially for COVID-19 management and the number of ventilators being manufactured is gradually increasing, in addition to others available in the Intensive Care Units (ICUs) of public and private hospitals.

He said that every effort is being made to augment the need of ventilators by 30,000 in the coming weeks. However, there is no accurate data on the number of ventilators available in COVID-19 hotspots such as Maharashtra and Kerala.

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The Punjab government recently decided to order 50 ventilators to meet the spiralling demand due to coronavirus infections, pointing at the scramble to procure them.

Hydroxychloroquine is needed for healthcare sector personnel and even this is in short supply now, flying off the shelves even though the use of this drug without prescription is prohibited.

Lockdown hampering supplies

Just like masks and sanitizers, other essentials have become scarce since supply lines have been blocked due to the 21-day nationwide curfew imposed by Prime Minister Narendra Modi.

Warehouses are not operational and even if they are open, cargo services are not available to ferry the essentials to distributors and hospitals. Police crackdown to implement the curfew, without taking care to allow movement of essentials, has resulted in courier companies running scared.

Government hospitals are slightly better off since police have been more considerate in the case of consignments going to these facilities.

No clarity on testing

While testing by private labs has been allowed, the process still requires approval from a government doctor and the cost, capped at ₹4,500/- per test, is sure to be a damper for the poor.

Quicker and cheaper tests are still in the approval stage and the inability to test at a private hospital where the patient concerned is admitted, unless approved by the government adds to loss of valuable time.

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Even as there have been allegations on the health ministry that they aren’t testing enough people, Dr Harsh Vardhan said, “Our average testing load in the last five days has been 2,000 tests per day, despite the fact that our current testing capacity is around 12,000 tests per day. We’ve already tested 28,000 people and will increase the number as and when the need arises.”

Regarding the number of testing labs, he said, “From 15 labs we’re now testing for the coronavirus in 119 government laboratories in the entire country. We’re also being supported by 35 private lab chains.”

With many loose ends, drafting in the private sector medical facilities to play a strong role in the war against COVID-19 requires better coordination, quicker decision-making and streamlining of procurement.