A relative of a patient who died due to Covid-19 grieves. (Representational image/HT PHOTO) PREMIUM
A relative of a patient who died due to Covid-19 grieves. (Representational image/HT PHOTO)

Grief, suffering, financial distress—how the second wave devastated households

Amid the second wave of the pandemic in the country — the fourth in Delhi — between the end of April and middle of May, patients and their families struggled with shortages — of beds, oxygen support, medicines. And at each step, costs escalated
By Fareeha Iftikhar & Kainat Sarfaraz
UPDATED ON JUN 01, 2021 04:21 PM IST

Anupam Sharma (48) hasn’t had the time to process the grief of losing her sister Alpana Sharma and brother-in-law Kamal Kumar to Covid-19. Her primary worry, at the moment, is how she would find the resources to repay their relatives for loans accrued during the process of treatment of her loved ones. While Anupam Sharma is working with a private university, her sister’s family lost all sources of income during the pandemic.

“The total expenses are in the range of 7-8 lakh. My sister’s family lived in rented accommodation and had rented a shop to run an apparel store, which mostly stayed shut during the lockdown. Whatever little savings they had were exhausted. They do not have any assets that can be used to repay the loan. We are struggling and don’t know how we will support my nephew’s education,” she said.

Her nephew, Ekansh (18), was aiming to become a physiotherapist after his graduation. However, with the death of his parents within a span of two weeks last month, the teenager is planning to drop out of college.

“How can I continue my education when we are struggling to pay the loans? We had to borrow money from various relatives and acquaintances for the treatment of my parents, especially my mother who had undergone a kidney transplant and developed complications after contracting Covid-19. We had to mortgage my mother and aunt’s jewellery to foot the hospital bill,” he said.

Also Read | Sustaining and scaling up the response to Covid is key to saving lives

The story of Anupam and Ekansh is likely to resonate with many families, who have been ravaged by the second wave of the pandemic and have lost all their savings in trying to save their loved ones.

Amid the second wave of the pandemic in the country — the fourth in Delhi — between the end of April and middle of May, patients and their families struggled with shortages — of beds, oxygen support, medicines. And at each step, costs escalated, with implications for household savings and indebtedness.

Savings exhausted, families in financial trouble

Dildar Singh, a 38-year-old businessman from Delhi who recently lost his uncle to Covid-19, and his family are now in dire financial straits. He fears that the private hospital, where his uncle was admitted, may take legal action if his family fails to clear the outstanding dues of 22 lakh.

“My uncle was into social work and did not earn a lot. He was dependent on his brothers and had medical insurance of around 7.5 lakh. We thought that his health insurance would cover his medical treatment but the hospital charged 22 lakh. When we couldn’t pay the amount, the hospital refused to release the body,” he said.

“Eventually, the hospital made me sign an undertaking while releasing the body on May 15, which states we would have to pay the amount within two weeks. We are now worried if there will be any legal action in the matter,” said Singh.

According to a State Bank of India research report published on May 17, health expenditure could rise by 11% in the family consumption budget amid the pandemic. “We believe health expenditure will rise significantly because of the pandemic…Based on current trends, if 30% of the infected people get hospitalised and amongst them, 30% opt for private hospital and taking a conservative 1.5 lakh as the cost of entire treatment (including medicines, hospitalisation charges, PPE kit, etc) total expenditure of hospitalisation comes around 35,000 crore because of increased consumption of health services,” the report said.

The report also pointed out the loss of income during the pandemic will affect health expenditure. This was reiterated by several families HT spoke to who said that the lockdown had already depleted the savings of the families. The burden of medical bills is just making matters worse.

Minal Janai (20) is a third-year engineering student from Nagpur. Her father, a private cab driver who had already witnessed huge financial losses amid the pandemic, suffered from an infection in his lungs due to Covid-19. She has been running pillar to post for the past month to arrange funds for the treatment of her Covid-19-infected family.

“We managed my mother and grandfather’s treatment by taking loans from relatives. But my father’s condition deteriorated at home. Since we did not get any beds in the government hospitals, we had to admit him to a private hospital. He is the sole breadwinner of our family. We have somehow arranged to pay 80,000 but still need 1,80,000 to pay the remaining amount to the hospital,” said Janai, who has also taken an educational loan.

Several families lost their loved ones to Covid-19 even after spending their entire savings on hospital bills. Kumar Mangalam, a resident of Nashik, said his father Chitragupta Sinha, 58, who worked as a supporting actor in some movies, was suffering from Covid-19 pneumonia. “My family of five tested positive for Covid-19 early in May. After my father’s condition deteriorated, we admitted him to a private hospital after failing to get a bed in a government hospital. His condition started worsening after he got pneumonia and had to be put on a ventilator. The hospital was charging 90,000 to 1 lakh a day.”

The family paid over 10 lakh to the hospital. “We could hardly raise 35,000 through online fundraisers. My father succumbed to the infection on May 20,” said Mangalam, who works in a private company in Ahmedabad.

The government response

Amid the unprecedented surge in cases, social media platforms were flooded with desperate pleas for help to find vacant hospital beds, ventilators, oxygen cylinders, oxygen concentrators, and medicines such as remdesivir. While there are many citizens who have stepped up to help, some exploited the situation. People ended up paying amounts as high as 50,000 to 2 lakh for oxygen concentrators, and 10,000 to 50,000 for a vial of Remdesivir.

This forced several states across the country to take several measures to put caps on health services. For instance, in Maharashtra, according to the government guidelines, it is mandatory for the private Covid-19 hospitals to bill Covid-19 patients as per the government’s fixed rates. In Uttar Pradesh, government officials said they too had issued guidelines capping prices of various health services and medicines related to Covid-19 – such as Covid-19 beds (different prices for ventilator and non-ventilator beds), tests, scans, ambulance, medicines, etc.

The Delhi government, over the past month, has streamlined the availability and costs of a number of essential medical items ranging from oxygen to medicines. On May 25, the Delhi government capped the charge of transportation of oxygen cylinders, while mandating that such cylinders would have to be sold only at MRP. Similarly, the government also fixed the rates for hearse services provided for deceased Covid-19 patients. The treatment cost in private hospitals was capped in June last year itself, government officials said.

Delhi Police also launched a crackdown against those involved in black marketing of Covid-19 resources. So far, Delhi police have arrested 366 people on charges of black marketing and cheating people by charging inflated prices and registered 600 cases in this regard.

The systemic deficiencies

Experts, meanwhile, say strict measures should be taken to implement these orders. Malini Aisola, who is associated with the Campaign for Dignified and Affordable Healthcare and works on public health advocacy, said that proper grievance redressal mechanisms have to be put into place and checks have to be introduced for implementation. One of these ways could be regular audits of Covid-19 bills, she said.

“For instance, in Delhi’s case, the current order does not specify which authority the patients can approach with their complaints, the manner in which they can file, the process that will be followed by relevant authorities to investigate the complaints, and the timeframe within which the complaints have to be addressed. Emphasis should be on swift redressal of grievances to the extent possible and the government may appoint empowered government officials to help patients to resolve issues in real-time in respect of overcharging and non-compliance with the orders, and the consequences of it,” she said.

Rama V Baru, a professor at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University (JNU), said that despite scientists predicting a second wave, the Centre did not coordinate with the state governments. “Basically there was no planning. There was no effort to rein in the private sector in terms of price capping and ensuring that standard treatment protocols were given and followed. Indiscriminate and irrational use of CT scans, drugs, plasma therapy added to the fear and expenditure.” she said.

Sonali Vaid, a public health professional in Delhi, said there have been several instances when people ended up paying “catastrophic health expenditure” pushing families into poverty.

“In normal times, people who can’t afford private hospitals can go to public health care services. But during a crisis, people do not have any choice. When the system is saturated, people will have to go wherever they get the beds. In such a situation, when people cannot exercise choice between whether they go to a public or a private facility, there should be some financial protection,” she said.

As the third wave of the Covid-19 pandemic is expected, Baru said that “revamping of vaccination” should be done on priority. “We need centralised procurement and distribution of vaccines with fixed prices. This will prevent the severity of illness and deaths...We have to learn from the tsunami of the second wave. The public sector facilities that have been created must not be closed down. Standard treatment guidelines must be put in place and price capping of all commodities that are required for treatment,” she added.

Vaid said that there is a need for “universal health coverage” to address the issue. “None should face financial hardships to access good quality healthcare — whether it’s the private or the public sector. We need to push for a better quality public health care system so that not only the poor but even middle and upper-class people can comfortably walk into government hospitals and get the care they need,” she added.

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