The virus has spread to 185 countries, infecting more than 2.3 million patients, and killing over 160,500 worldwide since it first emerged in Wuhan late last year. United States, alone, has 734,552 coronavirus cases and 38,835 deaths. Fortunately, more than 66,500 have recovered from the disease. A teen-aged US national COVID-19 patient died on the way back from hospital after it refused treatment. He was without an insurance card (NBC News, 28 March).
The gynaecology unit of Shaikh Zayed Hospital (Pakistan) boycotted duty after unknowingly performing a caesarean section on a COVID19-positive woman. Pakistan government locked down out-patient departments of hospitals instead of treating patients of even ordinary diseases. A German state’s finance minister committed suicide.
What do the news reflect? Even rich countries like the USA has inadequate medicare system to deal with the epidemic. A Kaiser Family Foundation study assessed the average cost of simple coronavirus treatment in USA at around $9,763, and $20,000 for complicated treatment. Out-of-pocket insurance payment would be over $1,300 (The Hill March 27, 2020). Confirmed cases in the US stood at over 367,650 with 10,943 deaths on Tuesday afternoon. These deaths are in addition to 12,000 to 61,000 deaths every year due to seasonal flu. Europe fatalities approach 100,000.
Need for cooperation: The pandemic has exposed deficiencies of healthcare systems worldwide. Now is the time for the world to shun siege mentality and pool their resources to deal with the virulent virus. Instead Donald Trump warned in usual pugnacious style, `If it was a mistake, a mistake is a mistake. But if they were knowingly responsible, yeah, then there should be consequences’. Toeing Trump, US Secretary of State Mike Pompeo accused China of blocking access to a laboratory in Chinese city of Wuhan, which might reportedly be the source of the outbreak. He stressed `the world has the pandemic because Beijing and the World Health Organization failed to provide information about the virus on time’.
To avoid lockdown in cities people are trekking back to their villages in India, some as far as 2000 kilometers. One person died having travelled over 200 km. Being infested with the virus carries a stigma. Law enforcers have started witch hunt of any one who comes in contact with a corona affectee. A tableeghi (preacher) committed suicide in India.Others went into hiding.
COVID19 has exposed deficiencies in Modicare. The promised hospitalisation coverage of Rs 500,000 a year to 100 million poor, or 500 million Indians, is a myth. The government has assumed role of a payer, rather than the provider, and needs to create infrastructure, resources and management.
Healthcare in Pakistan: Healthcare in Pakistan is in shambles. That’s why the Supreme Court had to take suo moto notice of the mess. It appears to be on auto-pilot. No study. No survey. No commission of inquiry. Like India, it started a health-card system, which has a limited coverage in specified districts.
The familiar medical systems of wealthy countries are the Bismarck model (multi-payer health-insurance model), the Beveridge model, the National Health Insurance Model, the out-of-pocket model, and the US model. The government could have picked up good points of medical systems of wealthy and poor countries alike. The Bismarck model is being followed in Belgium, France, Germany, Japan and Switzerland.
Generally, healthcare providers in this model are private entities. The government neither owns nor employs most physicians. Health insurance also is provided by private companies, not by the governments. Governments strictly regulate costs and other aspects of healthcare (no arbitrary fees and fleecing). The USA outspends its peer nations on health. Yet it has no universal-health insurance, nor universal health coverage.
Thailand’s successful healthcare plan reflects three lessons: being prepared, exercising tight control, and being pragmatic and politically broadminded. Thailand took the opposition and other stakeholders aboard. As such, the plan remained intact despite change of governments. Thailand’s per capita income, health expenditures, and tax base is comparable to India. Yet, it achieved universal healthcare in 2002.
It spends around four per cent of its GDP on health. In Thailand, out-of-pocket medical expense has fallen to 12 percent, as compared to 40-60 percent in wealthy countries. The proportion of children dying in the first five years of life fell to less than 1.2 percent. Thailand saved money by shutting down or consolidating selected good-for-nothing lackadaisical hospitals (like ours) that had large government budgets.
Short of funds, Pakistan needs to put its fragmented unbridled hospitals under one civil-military supervisory board, and distribute load reasonably. The Federal Government Services Hospital is supposed to cater for federal government servants. Actuated by political expediency, the government has shifted the burden of residents of the non-government-servant population of Rawalpindi/Islamabad to FGSH. It should be taken away. The hospital is so overcrowded even during normal days that it is no good for serving personnel.
It is very difficult for government servants to get back medical expenses incurred out of their own pocket. The Civil Surgeons, including that of TB Hospital, have stopped countersigning bills. They say the hospital is closed. Even defence-paid civilians, whose bills are already signed by the AFIC commandant, are required to get bills counter-signed by the TB hospital civil surgeon. I for one suffered heart attacks in November 1999. The Controller Military Pensions (Medical Reimbursement Group) is equally lethargic in paying bills. He has not reimbursed my stents-bill despite the lapse of five months.
There is no justification to close down OPDs. If so, doctors and paramedics should forego pay and perks. The civil surgeon should be divested of the power to endorse AFIC commandant/commanding officers’ signatures. Military and other accounting departments should reimburse bills without ‘quid pro quo’. Blackmarketing of masks, sanitizers and essential medicines should stop.
A silver limning: The united (not present day fragmented) world defeated earlier epidemics — smallpox, Black Death, Spanish Flu and cholera — and came out stronger. Trump should take cue from past unity, and stop china fixation.
Inferences: USA should strengthen the World health Organisation instead of shrinking its funds. The WHO is yet to float guidelines about many questions. Utility of Remdesivir, hydrooxychloroquin, Avgon, BCG vaccination, and plasma.
Take masks, there is no guideline. Whether healthy people should go around wearing face masks to reduce the spread of the disease. Officials in China, Hong Kong and Taiwan have recommended it in crowded places such as buses or subway cars.
A handful of countries in Eastern Europe have mandated mask wearing in public. In eastern Asia, the practice of wearing medical masks in public is well-established. It emerged as a convention during the 2002-2003 epidemic of severe acute respiratory syndrome (SARS), caused by a coronavirus. Experts at the World Health Organization say there’s no such need. Those in the U.S. started out with that position, but in early April recommended people use cloth face coverings when in public rather than medical masks. That’s because the popular demand for masks has aggravated a shortage of them among medical personnel, who need them the most. Protective gear including masks should be available for doctors and paramedics.
It appears there is no conclusive scientific consensus on the value of wearing a mask in public. A debatable opinion is that widespread use of face masks by the public may have reduced transmission in outbreaks of influenza and SARS, which like Covid-19, are respiratory diseases. The WHO should guide the world about COVID19 related issues.
