CoVID 19; ”Why not the money spent on more beds and oxygen plants?” Asks Dr Kafeel Khan

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India is currently on the second wave of CoVID 19. In the dangerous peril of dealing with the new strain of the virus, people are struggling to keep their lives on, not getting a hospital bed, dying at home, dying on the streets, getting infected inside prisons. The citizens of India are at the face of grave unavailability of a basic needs like oxygen which is life saving for a CoVID patient and a hospital bed. In most hospitals, there is a shortage of beds, and people are forced to take in vaccines which haven’t completed trials, at high expense.

Dr Kafeel Khan, who is on his 4th year of suspension from BRD medical college, Gorakhpur reminds fellow Indians that the issue of procurement of oxygen, when it was raised post the oxygen tragedy in UP’s government medical college, caused by the non payment of bills was majorly ignored. Dr Kafeel in a tweet tagged health minister Dr HarshVardhan to consider the matter urgently. As per the reports, only after the scarcity of oxygen went up, the health ministry decided to allow the foundation of more oxygen plants a few days back.  For raising the question of procuring liquid oxygen in a UP government hospital Dr Kafeel had to endure multiple arrests and incarceration during the four years. What led to the death of hundreds of children affected by Japanese Encephalitis, in fact was a signal to the entire country. During this period, his work formulated into a campaign named ‘Health for All’ which demands an absolute rebuilding of health infrastructure and more inclusive policies.

Though the proposals were presented to ministers and people’s representatives, including Dr Harsh Vardhan, these ideas weren’t responded to. As the mayhem of covid second wave continues, in an interview given to Keyboard Journal, Dr Kafeel Khan asks why are Indians denied life saving oxygen. He says vaccination and protection from the virus must be ensured for all Indian citizens. He mentions the fact that India, even when being the biggest manufacturer of vaccines against CoVID is also facing the biggest shortage.

Q. What we witness now is chaotic and there is almost no assurance that Indian health sector can save lives during this period. Can you tell us about how the connection between mutations of CoVID 19 and the state of health infrastructure are resulting in panic? 

The whole world has been through the second wave, first in UK, Brazil, South Africa, then European countries, US etc. I think these countries were well prepared. They curtailed it in a month or one and half of months. Now they are in a much relieved position. But in India, I think there are three causes that gripped India this way.

First, the government in itself lets down its guard. Because of the five states election and because of a slowed down economy. Second, is the pandemic fatigue. People have been fatigued wearing masks , not being able to go to work etc. The fatigue has settled down deep in the periphery. Even when people are aware of the grave situation, they are not following the protocols as such. There is so much of poverty right now, the economic slowdown has caused so much worry in people. They have to ensure at least two meals. Instead of thinking about dying of corona they are saying they’ve to go for work or else they will die inside their homes. Economic breakdown that is happening all over the world, in India, for past seven years, the economy is in trouble.

In an article I wrote in December I indicated that the coming months are going to be very horrible for India, but I never realised it will be so bad. When the data says one lac sixty thousand (as per 18th April) people are affected and 1700 people died, at the ground level, situations are different. In peripheral areas of UP, Lucknow, Gorakhpur, Bihar, the administration had been restricting people from doing Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. If people couldn’t do RT-PCR test they wouldn’t be able to get admitted and these patients would die at home. People are dying in their houses.

In December 2020, Indian Council of Medical Research released the data about their survey,  according to which 21.4% of Indians have got antibodies against CoVID 19. That means 30 crore people, but the government data says that only one crore people are affected. What happened to the rest? They were asymptomatic, they were recovered.

The government is unprepared to deal with the covid second wave. It is already one and half years of CoVID 19. The government should have made more hospitals, more beds, more oxygen plants and should’ve been well prepared. Not much done to strengthen an already fragile health system in this one and half years.

Q. What do the updated research and reports say about the vaccines that are produced in India?

All the medicines that are in the use against CoVID 19 are on trial. There is hardly any data which approved their use in critically ill patient. They’re only recommended for the moderate CoVID patient. For one vial of Remdesivir vaccine the price is 1500, in the black market they are selling it for 10,000 rupees. If one use Remdesivir four times a day, for ten days that will cause around five lacs rupees. A poor person can’t even think about that. Even the middle class families can’t think about that. If the government was serious about this situation, since the medicine is in use for one year and given it to lacs of people why haven’t they done any research on whether this drug is useful or not? Why didn’t they bring the data about this on the public domain?

They procured Remdesivir and kept in government hospitals, now the supply is over and everybody has to buy it. Now the layman is thinking Remdesivir is a life saving drug, I’m not able to buy this to my mother and my mother died because she didn’t get Remdesivir. No. Your mother died because of CoVID 19. Remdesivir is not a life saving drug. WHO in November 2020 released the advisory against use of Remdesivir in critically ill COVID patients. Because the data US and other countries come up with cited that there is no use of it in decreasing mortality rate. Why not the money spent on this medicine be spent on more beds? More oxygen plants? Because oxygen is life saving. Delhi CM says there is oxygen shortage. In some hospitals in UP you can see boards saying there is no bed and available.

In crematoriums bodies are cremated together. In Delhi, furnace of two electric crematoriums melted because of 24 hours continuous working. Now, they have waiting lists for getting cremated. If a person die today, the family will get a time for burial the next day. You can just go there, dump your loved one and come back. The situation is very horrible in North India. The mayhem that’s been created is a total government, administrative failure, because you had enough time to be prepared. The five states election has different phases in different states. Election rallies are going on and prime minister and home minister are busy with it.

Any virus mutate. There is a German variant, UK variant, South African variant. It mutates each day. There will be thousands of corona variants in coming days. Corona is going to be in our day to day life, just like influenza virus. We need to take vaccine every year to protect ourselves from influenza, similarly we may need to deal with CoVID as well.

India is a big manufacturer of vaccine. But only eight per cent of people got vaccinated. Many of them didn’t get their second dose. PM on independence day announced that by 2021 July we will vaccinate half of our population but we are nowhere near that. I think even if the pace in which the current government moving on with vaccination goes on, it would leave out the most poor, most marginalized communities. Few days back when I went to AIIMS Delhi there is a small colony of laborers who are on constructing buildings. They are yet to be vaccinated. They are living in congested  spaces inside AIIMS premises. They aren’t vaccinated because they are Dalits and marginalized communities, nobody cares about them. If the government have to curtail the spread it needs to take care of each and every Indian citizen.

The state governments in Northern India were not prepared to deal with the second wave. They didn’t initiate any new oxygen plants, which are necessary to curtail this menace. We knew that second wave will come but nothing is done.

When Ivermectin was used with azithromycin that became a fatal combination. Then they came up with anti- malaria drug hydrocloroquine. Finally they came up with the conclusion that these drugs are not useful. They haven’t done any conclusive action on very expensive drugs like Remdesivir. May be these drugs are saving a few among the hundreds of patients but we don’t have exact data about that. Drugs that WHO says not to use for CoVID are still used in India. Indian Council of Medical Research could’ve done a multi centric trial of the vaccines in various states and come out with an idea whether the drugs are useful or not .

CoVAXIN is produced as a collaborative project of ICMR and Bharat Biotech. Two trials of CoVAXIN have come out and third trial was started in December 2020. Because of the emergency use authorisation was given to them on 16th January the use started. As per the reports we are getting, CoVAXIN do not have much side effects.The patients are getting less severe symptoms. Even when they get affected they are in less need of ventilator, less need of oxygen, and less need of hospitalization.

The Serum Institute of India’s CoVISHIELD is effective as far I know from people who have taken the vaccine. Currently, there is a legal dispute going on between SII and AstraZeneca Oxford over vaccine export from India. Till now, India have exported 60 million doses. Currently, there is a vaccine shortage in India, the biggest manufacturer is facing the biggest shortage.

Q.What lead to the immediate formation of a campaign named ‘Doctors on the Road’?

Currently we, a team of doctors, nurses, paramedics from various parts of India are on a mission named ‘Doctors on the Road’. We started this initiative on 14th April, Baba Saheb Ambedkar’s birth anniversary. All the news about CoVID patients deaths are coming from metro cities and all the work is being done there. If you go to the periphery areas and villages you’ll see no test is happening, no restrictions, no awareness etc. Everyone is concentrated on not letting the news go to the public. It is more of hiding things instead of doing something. We spend one or two hours of our day in our localities or few days in a week, goes to these areas and talk to the people about CoVID second wave. We give them masks, sanitizer, soap etc. We are trying to aware the public. If we find anyone with CoVID 19 symptoms we admit them to the hospital.

Q. Indian medical professionals came long way since the beginning of the virus outbreak, demanding for basic primary requirements like PPE kits and masks. Do you think the efforts of the community is reciprocated from the government’s side?

There are 1076 registered cases of doctors’ death in India since CoVID hit the country. These are only the numbers of doctors died. The government promised to give compensation of one crore to each their families. Only few families who are educated enough to get the process done have received it. In parliament, the health minister said they don’t have data on how many paramedical professionals and doctors are died. PPE kit is so scarce . People who work in the graveyard mostly don’t have PPE. The cops, people who work at the restaurants etc do not wear PPE. Those doctors who are appointed in the higher positions in institutes like ICMR or AIIMS are working in terms of government. They are not bothering about the ground reality.

Q. What do you think of the new vaccination policy introduced by PM Modi?

It’s a welcome move now above 18 would be able to get vaccine. State government, private hospitals could buy vaccines. It’s more decentralised now. But they have to pay and then again the burden would come to poor and marginalised communities who is struggling for a meal.

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