“The rights of every man are diminished when the rights of one man are threatened.”
– John Fitzgerald Kennedy
It is needless to assert how the world as we perceived earlier has undergone drastic change since the inception of this challenging pandemic.Although it is tough to defeat the adversities, it is not an unsurmountable obstacle which could not be tackled employing proper mechanisms to prevent and mitigate the challenges posed to public at large.Having survived the first and the wave of COVID 19 pandemic, we are again in threat of the imminent third wave.In the initial stages of the pandemic,saveral policy decisions, guidelines, advisory and regulations have been formulated by both Central and state governments across the widths and lengths of the nation.But as of now, effect or impact of COVID is not as harsh and heavy on lives and number of positives cases has been thin.Yet it cannot be considered prudent to engage in the privilege of relaxation with a sense of triumph due to the ongoing vaccinations.Since, the second wave is appearing to ebbing, it would still be inappropriate to lose the sense of urgency and not take precautionary measures to shield ourselves from third wave.It is advisable to utilize this buffer time for further advancement and improvement of medical facilities because public necessity needs to be highly prioritized at this crucial stage when failing to adopt appropriate measure might bear dire consequences.Rather, this this opportunity should be outrightly seized and should be utilized to consider and cater very possible issue born out of this pandemic and provide appropriate relief and remedy to ensure common welfare.According to Article 25(1) of Universal Declaration of Human Rights,“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
It is observed that an urgent need of some regulation has emerged with regard to provision of treatment and medical facilities to home bound critically ill COVID positive patients who are denied admissions to hospital.Unable to accommodate, the hospitals had to alienate such critically ill COVID positive patients to home care with scarce facility and insufficient medical attention.In regards to the instant issue, the Petitioners have moved court, seeking legal and regulatory remedy for such patients undergoing home care based treatment being critically ill.The Petitioners have suggested various recommendations and measure to adeptly resolve the issue.Where exists wide range of regulation for symptomatic,mild symptomatic and asymptomatic patients, absence of any regulation for the severely symptomatic home bound patients distursb the coherence of the regulatory framework in relation to pandemic in the nation.Ironically,had the government been more thoughtful towards the agonies of these deprived group of patients and taken initiatives,it would have contributed towards greater public interest.
The issues which persist are not due to lack of appropriate response to the upsurge of COVID in the peak of pandemic but also because of inefficient public distribution network in the nation.There are various orders, circulars and SOPs related to mild and asymptomatic patients in home isolation does not unnecessitate the need of regulation for home bound critically ill COVID positive patients who are denied admissions to hospital as both these kind of patients could not be succesfully brought under the same category.Hence, such group of people who fall in the latter category suffer from severe violations of right to health and medical care under article 21 of the Constitution and therefore, it becomes the paramount duty of the state and central government to proactively take measures to care for the health of the public at large.It is important to understand and acknowledge that the remedy we seek is for a deprived group as a matter of right born out of necessity at this crucial point of the pandemic.There is a possibility that taking such measures into consideration might aid in significantly decreasing the momentus of the imminent third wave.
The first primary observation is unavailability of any regulation, SOP, advisory or guideline in the month of June.It can also be observed that most of these advisory are prior to commencement of the vacation and thereafter, no major implementations have taken place.After going through several orders and advisory, it was observed that home isolation and home care based treatment is preferably or voluntarily opted by patients with mild symptoms and asymptomatic patients but, none of these orders and advisory offer any insight upon the persistent issue as to what should be done in the event of home bound critically ill patients are denied admissions to COVID hospital.However, an advisory of State of West Bengal does deal with prioritizing admissions in Covid hospitals to patients with significant symptoms.The Delhi HC in Rakesh Malhotra vs. GNCTD WP(C.)-3031 of 2021 observed that only requirement for most patients is to take medications and remain in home isolation, but 10% of these patients are infected with disease requiring hospitalization primarily due to the requirement of oxygen support and consistent monitoring.Such critical patients require hospitalization and delay in initiation of treatment might also result in grave medical complication to the extent of loss of life.For a long time such patients have been buying oxygen cylinders at exorbitantly high prices as a precautionary measure.9-key points from the observations by Delhi High Court decision in Rakesh Malhotra v. GNCTD, 2021 SCC OnLine Del 1811, decided on 20-04-2021 on essential drugs, dearth of oxygen and vaccine:
- Centre to review the allocation of oxygen on a dynamic basis.Hospital that are running out of their supplies of oxygen, Centre to make the availability.
- Notice of contempt to M/s INOX for non-compliance with this Court’s Order.
- Medical Machines/Equipment’s, medicines, etc. that are imported should be handled and cleared at top priority.
- Centre and the ICMR, to review the form in which the information is required to be uploaded by the testing agencies, to reduce their burden and wastage of time, as this appears to be acting as a bottleneck in the matter of preparation of reports.
- Central Government & its agencies to issue necessary directions to all the licensee and Government should undertake to check on a regular basis to unearth all such cases of hoarding which are leading to scarcity of drugs for needy patients
- Strict Penal Action.
- Centre to review the distribution of Remedesivir Drug daily.
- Manufacturers to be encouraged so as to ramp up their production on a war footing of all essential medications for COVID treatment.
- Criminal Waste: If even a single dose of vaccine is wasted, it would amount to criminal waste.Government to devise ways for registering volunteers below the age of 45 and above the age of 18 to take residual doses of vaccine.
Taking into consideration Covid care kits and oxygen cylinders for patients in home care and geo-tagging of oxygen cylinders, it can be observed UP has been disappointingly unsuccessful in securing oxygen supply to needy patients in home isolation in lieu of supply shortage,only to discover actual excessive usage of oxygen in hospital leading to wastage.As a result of this colossal failure, inexplicable distress was caused to patients.On the contrary, Odisha has handled the Covid surge successfully by implementing geo-tagging of oxygen cylinder
A large number of patients lost lives either on account of shortage of oxygen supply or denial to provide the same.However, the genuine concern is different. It is the inefficient distribution network of our nation connecting tankers,transport and hospital.The most important issue was that most oxygen supplies were not utilized for meeting medical demands rather used for industrial purposes.Hence, important intervention was done to prevent non utilization of oxygen for medical purposes and not allow moderate and severe positive patients to suffocate to death.To resolve the problem of insufficient supply of oxygen, some state governments undertook measures like geo tagging to get data on their location and repurposing tankers used for other purposes to serve the demand of oxygen.Moreover,simply attributing the issue of black marketing to mala fide intents of black marketeers would not be sufficient.It is necessary to accept another perception with regard to individuals hoarding supplies due to rapid rise in prices of medical oxygen.This can probably be attributed to home bound severely affected patients being short of government aid with respect to supply of oxygen.Not even taking into account, divers and mountaineers who might be considered to be involved in such hoardings.It is also noteworthy that if home bound severely affected patients have not hoarded their oxygen, it is obvious that they have been exploited by black marketeers operating in profit motive due to lack of choice on the part of such patients.
In Government Of India ordered strict compliance to ICMR Guidelines dated 10.7.2020 ordered home collection of samples can be done by private laboratories.But, there is no order as such related to all other laboratories or every laboratories,the wording is strictly private labs and hence, government laboratories refrain from extending aid to patients who seek home testing or home collection of samples.It is important to acknowledge that when a critically ill patient is denied admissions to hospitals, the financial condition of the patient is not determined at that point.It is possible that patient denied admissions might be financially distressed enough to fail to afford basic medications and oxygen facilities without governmental support.During the surge of Covid, the most suitable decision would has been oxygen rationing and its sensible usage.This continues to stand as an ideal solution for imminent third wave as this unavoidable circumstance should not be underestimated.
Even after all these provisions,there does not seem to be an adequate or concrete regulartory framework for a large number of recommendations as suggested above in the first column of the table.There still exists lack of 24/7 chat facility, virtual nursing care and Vital monitoring,respiratory therapy sessions, nutrition assessment and guidelines on building immunity and nutrition and also psychological counselling.Moreover,there is provision for updating status of bed availability but it conveniently skipped the information regarding availability of oxygen cylinders, ventilators etc.There are no directions regarding efficient maintenance of insurance claim desk at hospitals.There are also no directions as to collating data of plasma donors and ventilator.There is no directions regarding designating shops or pharmacies and their hourly update on availability of oxygen, injections etc. There are also no directions for mapping plasma donors and evolving a more transparent mechanisms to communicate with them.Systematic oxygen allocation policies and geo tagging must be adopted and implemented as preventive measures.
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