Centre’s Oxygen Data Denial Is a Reminder That India Lacks Avoidable Deaths Data

A healthcare worker holds an oxygen cylinder, New Delhi, April 28, 2021. Photo: Reuters/Adnan Abidi

• Any drive to prevent COVID-19 deaths should also take care to prevent other avoidable deaths that happen during a pandemic.
• We must pair our demand for more hospitals with good quality care as well, writes Dr L.R. Murmu.

The COVID-19 pandemic that has devastated lives and livelihood worldwide has brought to bear, with great clarity, the true meaning of health, of the sort that has almost faded from public memory. In 1948, the WHO defined health thus: “Health is the state of complete physical, mental, and social well-being and not the mere absence of disease of infirmity”. But discussions on COVID-19 have revolved around statistics of rate of infection, positivity, recovery, fatality and the benefits of vaccination. The public discourse is more enamored with the absence of disease or infirmity, instead of health per se.

The public health crisis was, and is, evident from the official COVID-19 death toll of 421,000 and counting. But others have found that this could be a gross underestimate. For example, the Centre for Global Development has suggested that the actual number could be 10-times higher. When the second COVID-19 outbreak engulfed the nation in April and May 2021, there was acute shortage of medical oxygen in many hospitals across the nation. This was despite a 7.5-fold increase in the number of oxygen-supported beds during the pandemic, from 50,583 to 381,758 (source: Centre’s affidavit before the Supreme Court, Gaurav Kumar Bansal v. Union of India). Newspapers reported at least 195 deaths from five states suspected to be due to lack of oxygen. When the Delhi high court took note of this crisis, its incensed judges remarked that the state had failed to protect citizens’ right to life. An anguished Supreme Court also lamented that many had lost their lives due to oxygen shortage, not necessarily the disease itself.

Against this backdrop, Minister of State for health Bharati Pravin Pawar’s statement in the Rajya Sabha that “no deaths due to lack of oxygen has been specifically reported by the states” was hard to believe. It rightly triggered widespread public and political outcry. No one seems willing to buy the government’s explanation. In fact, no states or union territories had certified any deaths as being due to ‘lack of oxygen’ citing lack of format, absence of proper documentation and that sort of thing.

A disaster by definition is a situation that overwhelms the locally available resources. The number of victims is so large that no system can handle it in a routine manner. As a corollary, an attending hospital or agency has to have a disaster management plan in place, well in advance. But most healthcare facilities in India plans as envisaged under the Disaster Management Act 2005. As a result, preparedness fell short on the medical oxygen front, affecting patients that depended on this clinically important substance.

The doctor-population ratio in India is 1:1,511, against the WHO’s recommended 1:1,000. And for nurses, it is 1:670, as opposed to 1:300. The Human Development Report 2020 also found that India has five beds per 10,000 population – placing the country at #155 in a list of 167 countries. So during the second wave, many hospitals were forced to make valiant efforts to accommodate more patients by increasing the number of ICU beds. But the situation was also aggravated by stretched manpower, especially as healthcare workers were also getting infected and had to be quarantined, or were succumbing themselves.

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Death following a disease, COVID-19 or otherwise, despite treatment is not unusual. However, widespread media coverage of painful images of breathless patients waiting at hospital gates or in ambulances rendered the oxygen shortage crisis more prominent. This spotlight should also have been extended to patients suffering heart attacks, stroke, etc. and those in need of dialysis and cancer care, who virtually faced near-insurmountable obstacles, typically resulting in inordinate delays and compromised treatment. Tragically, some pregnant women were even forced to deliver their babies on the streets, or died when scrambling from one hospital to another. The adverse outcomes among all these patients deserved just as much attention from government policymakers and healthcare professionals, under the rubric of avoidable mortality. ‘Avoidable mortality’ means deaths from causes that are considered avoidable, treatable or preventable, and would have been if the patients had been provided timely, effective care. In 2019, 22.5% of all deaths in the UK were considered avoidable – excluding COVID-19 deaths. There is no such data available in India.

A 2017 study concluded that it is not only the access but also the quality of care that matters when determining patients’ clinical outcomes. So we must pair our demand for more hospitals with good quality care as well. An audit of avoidable deaths is imperative to identify and assess weaknesses or gaps in the care-delivery system. This will improve results both in terms of minimising deaths and disability, not only among COVID survivors but among all patients who need due care. The aim ought to be “no avoidable death, no avoidable disability”.