The manpower crisis

The devastation that has followed the second wave of the Covid-19 crisis has brought into sharp focus the need for contingency planning for providing oxygen, hospital beds, and medicine. Health planners should add one more to that list: Ways to mitigate the shortage of medical professionals. In a recent webinar, cardiac surgeon and entrepreneur Devi Shetty gave details of the crisis that had escaped the attention of policymakers. He pointed out that for every one patient who tested positive it could be assumed that five to 10 people were infected but not tested.

If approximately 350,000 people are testing positive, this means a humongous 1.5 to 2 million people are getting infected every day. Assuming even 5 per cent of this number need ICU beds, India will need some 80,000 beds daily — a huge ask when set against the 75,000-95,000 ICU beds currently available. Again, assuming each patient spends at least 10 days in hospital, India needs to create 500,000 beds in short order. Creating this physical infrastructure is a challenging task but not impossible.

But as Dr Shetty points out, beds do not treat patients. India urgently needs nurses as well as doctors and paramedical personnel to treat Covid-19 patients — and this could be the next big crisis, given the acute existing shortage. Currently, government hospitals collectively have a 78 per cent shortage of medical personnel, so it is the private hospitals that have to bear the burden. By Dr Shetty’s calculation, India will need 200,000 nurses and 150,000 doctors to manage the Covid-19 crisis over the next year (which could include the third wave). Producing so many fully qualified people in a quick time could be near-impossible. But eminently do-able solutions are at hand. For instance, the doctor says, some 220,000 student-nurses have completed their general nursing and midwifery courses or BScs and are waiting for their exams. It is possible to mobilise these trainees on the front line by exempting them from the exams if they work in Covid-19 units for one year. An added incentive could be to promise them preference in government medical jobs after this period.

Similarly, 130,000 doctors are waiting to crack the NEET to get into the post graduate courses. Given that there are only 35,000 such seats available, the suggestion is that the National Medical Commission (NMC) grant grace marks to those who don’t qualify for next year’s selection if they work in a Covid-19 unit for a year. Another 25,000 doctors who have completed their training but have not yet appeared for their exams could also be told to step in. There are also a few thousand medical specialists with diplomas in critical specialties like intensive care cardiology or emergency medicine who aren’t recognised by the NMC. If these diplomas are recognised, they can be deployed to manage Covid ICUs across the country. These steps would also provide much-needed relief for existing medical personnel who have been on the front line without a break for over a year, are dangerously exhausted, and are unlikely to accept monetary incentives to continue if the pandemic retains its current intensity. These are standard steps deployed in war situations, and could work just as well for the Covid-19 pandemic, which undoubtedly qualifies as a war-like crisis. The government would do well to consider these sensible suggestions instead of waiting for the next crisis to hit the nation.

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