In a wide-ranging interview with Moneycontrol, one of India's most respected surgeons, Dr Devi Shetty laid down a three-point plan to hasten vaccination, ramp up medical workforce, and prepare for the third wave, as the second wave of coronavirus ravages India. He also spoke about why no country in the world could have managed the caseload India is reporting, even as he lauded the government for its efforts to get oxygen to hospitals as cases surged in April. Shetty has been named as the head of the task force set up by the Karnataka government to prepare for the third wave of the pandemic.
Edited excerpts:
Q: Many experts believe that the worst may be over soon for India as far as the second wave of Coronavirus is concerned and that May-end, the first week of June is when there will be some respite. Based on what you see today, when do you believe there will be some light at the end of the tunnel?
A: I'm not an epidemiologist or a virologist, I'm only a heart surgeon. But to be realistic, we should be preparing ourselves for this fight to continue till at least the middle of next year, because this is how long generally that each pandemic lasted in the past. But the intensity will come down. Generally, what we noticed was that the pandemic second wave is always severe, the third wave will not be as severe as the second wave.
Q: Speaking of the third wave, this is expected to impact children, as the virus mutates to find new pools of susceptible people. Do we have enough pediatric ICU beds in the country? How should we prepare for this?
A: We have nearly 165 million children who are less than 20 years old, and they're very vulnerable. And the only way you can protect them is to vaccinate their young parents as soon as possible. Because believe me, it is not easy to manage a kid in the ICU without parents, it's simply not possible. So we need to create that. And secondly, and the most important thing we need to really double or triple our workforce. The current workforce that we have in managing COVID is tired, fed up. They're burnt out. You need to get a new battalion of a few lakh young doctors, young nurses to fight this battle. That will only happen if you consider giving grace marks for nurses preparing for the final exam and the young doctors who are waiting for the NEET exam. There are a large number of foreign medical graduates, give them some grace marks they will work for one year without any problem.
Q: As you have said before, beds don't treat patients, doctors and nurses do. Based on your suggestion, the government recently said final-year MBBS students as well as BSc and GNM-qualified nurses can be deployed for COVID duty and that people who complete 100 days will be given priority in government recruitment. Do you think this will help in adding capacity in a big way?
A: These kids don't care about salary or government jobs, we should give them incentives that will make them work in a COVID ICU ward. They want PG seats, they want to pass the exam. We need to give them grace marks. Do you think any doctor would like to work in the COVID ICU for the sake of money? These kids have been preparing for 2-3 years for the NEET exam, three months before the exam if they get COVID how are they going to pass the exam? And the problem we are going to face now is going to be worse than the problem we have ever faced mainly because adults are not that demanding. Whereas when there is a kid and the mother staying in the ICU, they will be demanding, and rightfully so. We have a window of opportunity and we have to act on it now.
Q: You have also said that we need to move quickly to vaccinate at least 300 million young parents in the next few months. Now considering all that we are seeing today in terms of the vaccine crunch in terms of the supply, how is this going to happen?
A: It's very simple. It is who is going to order the big number. If we go to those companies and say that we want to buy 300 million, 400 million doses and give them the money, they will give it to you and these are all vaccines which do not need trials, they have been used on millions of people. So one day of lockdown, how much it is going to cost us; the vaccine is the cheapest solution we have today against COVID and we have to use it.
Q: There's also a debate Dr Shetty in terms of the centralisation versus decentralised approach. Initially, state and private sector procurement was welcomed but now states and many Opposition parties have said the Centre should be procuring and also run a universal, free vaccination programme. What should be the way forward, because the pace of vaccination has already dipped?
A: See, I know that there are a lot of people who are criticising the government, I can tell you, the number of COVID patients what we have, if they are presented to the US government, there is no way they could manage it, forget about any other country. These are astronomical numbers, no country in the world has the infrastructure to manage. But in terms of oxygen, I can tell you I have gone through the details. Our government has done a phenomenal job, they have moved heaven and earth to get oxygen to the hospitals. Of course, a lot of people have suffered. But then if the whole country is falling sick, no healthcare infrastructure in the world can manage. All I'm trying to say is that whatever has happened has happened now for the vaccination the country has to buy together. So the bulk order will give you huge leverage in terms of negotiating for the best price. And unless these companies get money in advance, they won't commit. We need at least five different vaccine manufacturers to come forward and say, okay, you give me the money, I will deliver you on this time. We should just open our door for any country's vaccine company to come here, set up the shop, and sell it to us. But they have to give it to us within the next three months. After that, it may not make that kind of a difference.
Q: Multiple states have floated global tenders, corporates have asked the government to liberalise vaccine import...
A: All of them should come together as one vaccine procuring agency.
Q: In terms of prioritisation distribution, how can the government, the private sector, and the social sector come together because it is a warlike situation? So you do need all hands on deck.
A: Government institutions do not have the flexibility to vaccinate the way the private sector can. If I'm given a few million vaccines and told to vaccinate, I can vaccinate 26,026,000 people on one campus in 24 hours, I can manage double, who says I cannot vaccinate people at two o'clock at night. If people are desperate enough to want the vaccine, I will give the appointment at two o'clock at night, we will have a 24-hour shift and we vaccinate whoever comes to the hospital. This is a warlike situation, we need to have a totally different game plan.
Q: The other concern is that the virus has now moved to rural India, where the healthcare infra is lacking. Are there 2-3 things in which we can leverage existing infrastructure to treat patients in smaller towns?
A: Government hospitals in Tier-2 cities are the largest and the best-equipped hospitals. But what is missing there are the doctors, nurses, and paramedics. Theoretically, if you have a group of one and a half lakh nurses and maybe 50,000 doctors who are a mobile workforce, who are the people who are waiting for NEET, who have finished their training in nursing, but they haven't passed the exam. And they are mobile because they are young, they are willing to stay in a hotel for a month or two months. You mobilise this workforce to all the public hospitals in tier-two tier-three cities, amazing things can happen. They will make that hospital vibrant overnight.
Q: And as someone who is based in Karnataka, which is now the epicentre of the second wave in India, how bad is it likely to be before things get better?
A: I would say we are privileged compared to many other states because we have a fairly good healthcare infrastructure. Karnataka has perhaps the largest number of medical colleges. There are steel companies like JSW which are making oxygen. Our biggest problem is we do not have the number of nurses and doctors required. That is why I keep repeating myself like a broken record, that we need to induct fresh blood, you can't flog the horses which are already tired.
Q: If you have to reimagine the future of healthcare in India, considering there will be pandemics in the future, what would your prescription be?
A: We should assume that this is not the last pandemic. In the future, it may affect the heart, stomach or brain instead of the lungs. So if you have to prepare yourself, there is only one thing we have to do. We have to produce 10 times more doctors and nurses required for the country. Most government hospitals are always suboptimal because the government document shows that there is a shortage of 78 percent shortage of medical specialists. These hospitals are virtually defunct. There are more Indian-born nephrologists in the US than in India. More than 30 percent of doctors serving the National Health Service (UK) are Indians. So India is producing a workforce for the whole world. Every district in the country should have at least two or three medical colleges and there should be as many specialist postgraduate seats as the undergraduate seats. You can't stifle the aspirations of young people.
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