India's pain: beyond COVID-19 case numbers and mortality rates
Authors: Rohini Dutta, Tarinee Kucchal
Journal: The Lancet (2021)

The premature relaxation of safety measures, the mass gatherings, the insufficient vaccine roll-outs, and the spread of highly virulent COVID-19 variants have brought India's health system to its knees. This issue has attracted much scrutiny and international criticism over the failures of the administration. However, the Editors1The LancetIndia's COVID-19 emergency.Lancet. 2021; 3971683Summary Full Text Full Text PDF PubMed Scopus (95) Google Scholar do not look beyond the numbers or shed sufficient light on the plight of the Indian public. Although local and global communities are uniting to send aid, many of these efforts are too late. Challenges in the procurement and distribution of this aid because of inadequate planning and coordination has led to delays in access, skyrocketing case numbers, and premature deaths outside of hospital. As a consequence, the public has started taking matters into their own hands. The scarcity of resources has created a market that exploits suffering. COVID-related cyber scams have risen by 86%.2Desai RD Cybercrime in India surges amidst coronavirus lockdown.https://www.forbes.com/sites/ronakdesai/2020/05/14/cybercrime-in-india-surges-amidst-coronavirus-lockdown/?sh=11d49851392eDate: May 14, 2020Date accessed: May 14, 2021Google Scholar Medical resources being sold on the black market have increased the cost of oxygen cylinders by 15 times and counterfeit medications circulate at 17 times the official genuine price cap.3Guenot M India's COVID-19 surge is highlighting a ruthless, global black market for oxygen, where sellers jack prices up to 1,000%.https://www.businessinsider.com/india-covid-19-black-market-oxygen-crisis-1000-markup-2021-4Date: April 23, 2021Date accessed: May 12, 2021Google ScholarWell intentioned but poorly executed government attempts to regulate this price increase by con­trolling the release of these resources only aggravates the scarcity. Ambu­lances now charge an exorbitant INR 30 000 (US$400) to travel to the nearest hospital, and crematoriums demand service fees 53 times the base price, just to observe the last rights of a loved one.4Rai P Uttar Pradesh: from Rs 3000 to Rs 30,000, cost of cremation singes kin of dead.https://timesofindia.indiatimes.com/city/meerut/from-rs-3k-to-rs-30k-cost-of-cremation-singes-kin-of-dead/articleshow/82133002.cmsDate: April 19, 2021Date accessed: May 12, 2021Google Scholar Subject to the mercy of a failing system, India's people are fighting for their survival. Widely publicised stories of deaths related to medication and oxygen shortages are driving people to hoard medications obtained through fake prescriptions and to safeguard hospital-grade oxygen concentrators in private homes. Bribes enable the reservations of hospital beds when an individual is still asymptomatic at home, creating a perceived bed shortage. In one instance, 12 beds were booked in different hospitals under a single patient, preventing access to those who needed it.5Dwarakanath N Covid: BBMP officials found taking bribes to allot reserved hospital beds in Bengaluru.https://www.indiatoday.in/coronavirus-outbreak/story/bbmp-taking-bribes-allot-reserved-hospital-beds-bengaluru-1798882-2021-05-04Date: May 4, 2021Date accessed: May 13, 2021Google ScholarSadly, these and other measures are only accessible to those with the financial means or connection to people in power. This accessibility is not possible for most people in the lower socioeconomic class, who are instead left to die at home or in the streets. This crisis has created a society that lives in fear, despair, anxiety, and terror. The population feels power­less to change their situation and abandoned by their community and government, and among them there is a palpable grief and helplessness that governs society. No amount of aid can mend these wounds, and India stands to be scarred from this experience for years to come. Only time and the resilience of India's people will reveal how quickly they recover. As health-care workers, we recognise that it is necessary to prioritise the physical and psychological wellbeing of Indian people. Knowing the front-line realities and the psychological toll it takes on patients, health-care workers should go beyond calls to the government for better policies and governance and no longer shy from political commentary. COVID-19 has politicised health care, and the time to be apolitical is over. It is necessary to demand a seat at the table to ensure that the bureaucracy and health system work to benefit our community's wellbeing first. We declare no competing interests. India's COVID-19 emergencyThe scenes of suffering in India are hard to comprehend. As of May 4, more than 20·2 million cases of COVID-19 had been reported, with a rolling average of 378 000 cases a day, together with more than 222 000 deaths, which experts believe are likely to be substantial underestimates. Hospitals are overwhelmed, and health workers are exhausted and becoming infected. Social media is full of desperate people (doctors and the public) seeking medical oxygen, hospital beds, and other necessities. Yet before the second wave of cases of COVID-19 began to mount in early March, Indian Minister of Health Harsh Vardhan declared that India was in the "endgame" of the epidemic. Full-Text PDF