India’s southern states show resilience amid Covid disaster

Doctors in Vellore, a city in the state of Tamil Nadu on India’s southern tip, braced for the worst as Covid-19 swept the country.

Corona virus was already Beaten and confused healthcare systems across large swathes of India and was heading south.

Jacob John, a physician at the city’s Christian Medical College, said his hospital was nearing a “breaking point.” His 900-bed bed was filled, and the hospital had to turn away patients and came precariously close to depleting its oxygen supply.

But when a disastrous second wave in India hit Tamil Nadu and other southern states, places like Vellore were able to withstand the worst of their wrath.

They did so in large part because of the legacy of investing in primary and public health care in the southern states, among India’s most wealthy and developed. In many other parts of India, experts said, the crisis has brutally exposed chronic neglect of health care.

Tamil Nadu has reported more infections than any other state, with 22,000 cases and nearly 500 deaths per day, while 900,000 active cases across India’s five southern states account for half of the country’s current total.

“It’s a tough situation. We don’t have enough ICU beds and there are still patients that we can’t accommodate when they come in,” John said. “I’m not saying we’re perfect. . . But when the dust finally settles, I’m sure these investments would have saved lives.”

Before the second wave hit the south, it overwhelmed health care systems in many other parts of the country, including the capital, New Delhi, and Uttar Pradesh, India’s most populous state. The patients died from lack of oxygen and the crematoriums were so soaked that the bodies were thrown into the rivers.

Southern states have seen their share of tragedy, but experts said they have proven more resilient.

“Because you have a very developed healthcare infrastructure, the horror stories have not been as horrific as they have been in other states,” said Ratan Jalan, founder of Medium Healthcare Consulting and former CEO of Healthcare. “There is that protection that comes into play.”

India’s southern states account for about 250 million of the country’s 1.4 billion population.

Kerala and Tamil Nadu, in particular, are outliers in healthcare, driving metrics such as infant mortality. Besides Karnataka, they also boast more hospital beds and medical colleges. India’s southern states dominated the top rankings of states by sustainable development released by the United Nations and a government think tank last week.

“People don’t have to sing the same song and dance to get a bed in Tamil Nadu Hospital as in [some other parts of India]said Leslie Branaghan, an anthropologist who has conducted research in Indian healthcare. “This egalitarian spirit has been there for decades.”

Bar chart of beds per 1,000 people showing hospital beds by population

While states like Maharashtra in the West have received praise for their response, none have been praised more praise From Kerala, the first to find out a case of Covid-19 in India last year.

Early containment of the first wave was so effective that it cut reported cases to zero in several days in May 2020. Cases rose to more than 40,000 per day last month but have since halved. The number of daily deaths has risen to nearly 200.

Experts said Kerala and Tamil Nadu have responded to the crisis by building on networks of primary care workers to help patients find treatment. They also created “war rooms” to distribute resources such as oxygen, avoiding devastating shortages.

The high number of cases in the states was also a reflection of better testing, which experts said highlighted greater transparency. But they noted that the shortage of infections and deaths was ubiquitous and that the response in parts of the south, including Telangana, was marred by a lack of clarity.

Southern states, as well as Karnataka, were locked down last month, and cases have been declining.

Bangalore, the capital of Karnataka and the tech hub of India, is still adding more cases compared to other big cities.

Bar chart of the top 10 medical colleges by state showing that southern states have a disproportionate number of medical colleges

When the city’s Apollo Hospital opened a 30-bed ward in late April, it was full within 90 minutes, according to Ravi Mehta, chief of critical care.

It expanded to more than 100 beds, all occupied, and last month came within three hours of running out of oxygen. Mehta said the pressure has eased, but the hospital’s intensive care unit is still full and is now dealing with patients with serious complications such as black fungus infections.

“In one month [went] Crazy,” he said. “Now we have to pick up the pieces and give the best possible care to those who are still struggling.”

However, the apparent successes of the South mask deep inequalities within the region, with poorer regions having less access to services. at most two dozen Patients died last month when a hospital in rural Karnataka ran out of oxygen. In Goa, the southern tourist hub, Dozens of patients They died due to lack of oxygen.

Robin Abraham, CEO of the IDFC Institute think tank, said Tamil Nadu and Kerala had waited too long before closing, which undermined their response.

Everything will depend on the height of the pregnancy [that a system can withstand],” he said. “No matter how good your health system is — I don’t care if it’s Switzerland, Kerala or the United States — after peak pregnancy, the system will collapse.”

B.V. said. Ramesh, a doctor and former government employee in Andhra Pradesh, said the crisis should force the country to reflect on the failure of healthcare across the country.

“This is seen as a crisis in oxygen supply rather than a fundamental governance crisis,” he said. “When the tide recedes…everyone will go back to business as usual and no lessons will be learned.”

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