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Doctors in Vellore, a city in the southern Indian state of Tamil Nadu, did the worst when Covid-19 ravaged the country.
The coronavirus already had it mistreated and overwhelmed health systems across strips of India and headed south.
Jacob John, a doctor at the city’s Christian Medical College, said his hospital had approached the “breaking point.” Its 900 beds had filled up, the hospital was forced to push patients away and approached precariously to deplete oxygen supplies.
But when the catastrophic second wave of India hit Tamil Nadu and other southern states, places like Vellore were able to withstand the worst of their fury.
That they did so was due, in large part, to a legacy of investment in public and primary health care in the southern states, among the richest and most developed in India. In many other parts of India, experts say, the crisis has brutally exposed the chronic neglect of healthcare.
Tamil Nadu reports more infections than any other state, with 22,000 cases and nearly 500 deaths daily, while the 900,000 active cases in the five southern Indian states account for half of the country’s current total.
“It’s a difficult situation. We don’t have enough ICU beds and there are still patients we can’t accommodate when they come in, “said John.” I’m not saying we’re perfect…. ”.
Before the second wave hit the south, it overflowed the health systems of many other parts of the country, including the capital New Delhi and Uttar Pradesh, India’s most populous state. Patients died due to lack of oxygen and the crematoria were so overflowing that the bodies were dumped into the rivers.
Southern states have experienced their share of tragedy, but experts said they had been more resilient.
“Because you have a fairly well-developed healthcare infrastructure, the horror stories weren’t as shocking as in other states,” said Ratan Jalan, founder of Medium Healthcare Consulting and a former health executive. “There is this protection that comes into play.”
The southern states of India represent about 250 million of the country’s nearly 1.4 billion population.
Kerala and Tamil Nadu, in particular, are atypical in the health field, leading to metrics like infant mortality. Along with Karnataka, they also have more hospital beds and medical colleges. The states of southern India dominated the top places in the ranking of states for sustainable development published by the UN and a government think tank last week.
“People don’t have to do the same song and dance to get a hospital bed in Tamil Nadu as in [some other parts of India]”Said Lesley Branagan, an anthropologist who has researched Indian healthcare.” That spirit of fairness has remained there for decades. ”
While states like Maharashtra in the west have also received praise for their response, none have been most praised than Kerala, the first to detect a Covid-19 case in India last year.
Its early containment of the first wave was so effective that it reduced cases reported to zero on several days in May 2020. Cases increased to more than 40,000 a day last month, but have since been reduced. in the middle. The number of daily deaths has risen to almost 200.
Experts said Kerala and Tamil Nadu had tackled the crisis by relying on their networks of primary care workers to help patients find treatment. They have also created “war rooms” to distribute resources such as oxygen, avoiding devastating shortages.
The high case loads in the states were also a reflection of better evidence, according to experts who highlighted greater transparency. They noted, however, that the infrastructure for both infections and deaths was rampant everywhere and that the lack of clarity affected the response in some parts of the south, including Telangana.
Southern states, as well as Karnataka, closed last month and cases have fallen.
Bangalore, the capital of Karnataka and the technological hub of India, adds even more cases than other big cities.
When the city’s Apollo Hospital opened a 30-bed Covid ward in late April, it was full in 90 minutes, according to Ravi Mehta, head of critical care.
It was expanded to more than 100 beds, all occupied, and last month it reached three hours of running out of oxygen. Pressure has eased, Mehta said, but the hospital’s intensive care unit remains full and now cares for patients with serious complications such as black fungus infections.
“In a month, everything [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 hide deep inequalities in the region, with poorer areas having less access to services. At least two dozen patients died last month when a rural Karnataka hospital ran out of oxygen. In Goa, the southern tourist center, dozens of patients they have died due to lack of oxygen.
Reuben Abraham, chief executive of the IDFC Institute think tank, said Tamil Nadu and Kerala waited too long to enter a closure, which had undermined their response.
“Everything will depend on the maximum load [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), beyond that maximum load, the system will collapse. “
PV Ramesh, a doctor and former senior official from Andhra Pradesh, said the crisis should force a nationwide reflection on the failure of healthcare across the country.
“This is being seen as an oxygen supply crisis and not as a fundamental government crisis,” he said. “It simply came to our notice then. . . everyone will return to business as usual and no lessons will be learned ”.
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