Preparedness of Uttar Pradesh to Tackle Covid-19 Outbreak During Lockdown 4.0

Co-Written by Tehzeeb Anis & Prof. Mohammad Akram

coronavirus UP

COVID-19 is highly contagious infection and has already affected more than 4.5 million people globally. India is also setting up new records in spike of Covid-19 cases almost daily. Within 24 hours, India has recorded biggest single day spike in number of cases with 5242 new patient as of 17th May 2020. To stop Coronavirus from its community spread, Government of India, at an early stage, put the country in lockdown and this step has been praised by the World Health Organization. India is now under lockdown 4.0. States are also doing excellent work in fighting the battle with this infectious diseases.

Uttar Pradesh (UP) being India’s most populated state with over 200 million people is also fighting with this deadly virus. UP is witnessing about 4400 confirmed cases and more than 110 deaths as per the reports available. Lockdown 4 in UP, following the patterns of lockdown 3, is expecting further relaxations in the condition related to lockdown. We have seen movement of migrant people in thousands in different regions of UP till recently. UP has also witnessed some of the avoidable road accidents recently. Some time back there were reports related to improper conditions in several quarantine centers. When UP is entering in lockdown 4.0, an important question arises: Is UP’s healthcare system well prepared to fight with this pandemic?

The healthcare system of UP consists Sub-centers, Primary Health Centers (PHCs) and Community Health Centers (CHCs). The total number of sub-centers, PHCs and CHCs in UP is 20,521, 3,497 and 773, according to NITI Ayog . According to a report published in Indiaspend titled ‘As Population Rises, UP’s Healthcare System Collapses’, the Primary Health centers in UP has been decreased by 8% over 15 years to 2015 a period when the state’s population increased by more than 25%; smaller sub centres, the first point of public contact, increased by no more than 2% over 25 years to 2015, a period when the population grew by more than 51%. One of the most important reason for poor health care system is that healthcare has been low on the priorities of successive UP governments. Several other factors like shortage of healthcare professionals, increasing cost of healthcare, the mushrooming of private healthcare and a lack of planning also contributes to the poor healthcare system in Uttar Pradesh .

Again question is being raised whether UP is ready to tackle the problem of coronavirus with a fraction of healthcare facilities for a larger population? UP also faces huge shortage in Covid-19 testing laboratories. According to a report published in The Hindu Businessline, UP’s chief minister said that when the first case of coronavirus was reported in UP there was not a single testing laboratory. However, with the help of the Union Government, 22 government laboratories and 4 private testing laboratories are working successfully as of 10th May 2020[ ].

The most important health infrastructure needed during this outbreak is hospital beds, ICU beds and ventilators and UP faces acute shortage of these equipment. As the number of cases of Covid-19 is spreading rapidly, the demand for hospital beds, ICU beds and Ventilators are also increasing.

According to a report in The Indian Express, the presentation, which was based on the data up to April 23, revealed that Uttar Pradesh, Bihar and Assam had the largest numbers of districts with grave shortages of all three kinds of equipment needed for Covid-19 [ ]. UP should learn from Kerala how to tackle with this Covid-19 pandemic as Kerala has already managed to successfully flattened the curve. At the initial stage, Kerala was the state of India where first case of coronavirus was reported and it topped the list. However with its excellent strategies, the state has manage to control the growing number of cases. Kerala has extensive testing laboratories which helped in identifying the Covid-19 patients along with that it followed a painstaking contact-tracing process and then publishing of the route map of an infected person, so that everyone with the potential to being infected could be put in self-isolation. Another major reason why Kerala has successfully been able to flatten the curve is because of its excellent inter-department coordination at all levels. The state, district and village panchayat at the grass root level is well coordinated [ ]. The primary Health Centers (PHCs) of Kerala are very good. There has also been a lot of improvement in the secondary and tertiary care. Kerala had several private hospitals coming in the private sector and has a very good government public healthcare delivery system. The reason for good infrastructure of Kerala is that the state invests more money in their public healthcare systems.

The case is not same for UP. The public health care system of UP is bad and the reason is that the healthcare has never been on the top priority of successive UP government. If proper measure is not taken then the condition of UP may worsen like that of Maharashtra where 34 out of 36 district is affected with Covid-19. Maharashtra remains one of worst hit state. Despite the fact that Maharashtra has good health infrastructure with 10,580 sub centers at the primary level, 1,811 PHCs at the secondary level and 360 CHCs at the tertiary level, the state is not able to has control on the growing number of cases. One of the important reason for increase in the number of cases is that the Maharashtra government is doing extensive testing, contract tracing and quarantining of high risk patients. The other reason for the spike in cases in Maharashtra are mainly due to hospital-related infections, with patients who were admitted for other ailments later testing positive and spreading it among healthcare staffs and other peoples. The mortality rate in Maharashtra is also significantly higher than other states like Tamil Nadu, Delhi and Gujarat where number of cases are also high.

With the growing number of Covid-19 cases the government of Uttar Pradesh should also use strategies like Kerala and do extensive testing and strict quarantine implementation should be done. Uttar Pradesh should also do pool testing as suggested by Indian Council of Medical Research (ICMR) where testing up to five samples in a single test is done. The objective of this pool testing is to increase the capacity of laboratories to test more samples in the same time with less expenses. The government of Uttar Pradesh should wisely make plans to overcome the situation. The migrant workers coming back to their native places should be kept in isolation in a district quarantine centers despite of sending them to their village quarantine centers or home quarantines and compulsory screening should be done to each of them as number of cases are increasing without showing any symptoms. Social distancing should be strictly implemented which will slow the rising cases. Hotels, marriage halls and other facility centers with attached bathrooms facilities should be set up as quarantine centers and hospital beds should be arranged there to overcome the crisis of isolation beds. To reduce the shortage of manpower in healthcare facilities during this epidemic, final year as well as pre final year medical students should be well trained and allowed to cater the patients.

Tehzeeb Anis– is a Ph.D. first year research Scholar at the Department of Sociology, Aligarh Muslim University, Aligarh. Email:[email protected]

Prof. Mohammad Akram– is Professor of sociology at Department of sociology, Aligarh Muslim University, Aligarh, India. He has five published books and several research papers to his credit. He has worked on areas of sociology of health, migration, work, education and social policies. He is engaged in the profession of teaching, research and supervision for more than twenty years. He is an elected member of the managing committee of Indian Sociological Society (ISS). Email: [email protected],



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