Recently second COVID-19 wave has hit India with great ferocity.
How COVID second wave has affected health system?
There is a shortage of beds, hospitals are flooded with patients and ambulances are screaming through the streets.
There are curfews and lockdowns and death is in the air -a larger proportion of the elite has been infected.
In Mumbai, high-rises (elites) have been more affected than slums.
These elites now got exposed to the dysfunctionality of the healthcare system which the poor have endured for years.
There is imbalance between demand and supply of healthcare facilities for which WHO recommended new strategy -Triage.
What is triage strategy?
It is a time-tested, effective strategy to face the challenge of a sudden large load on the healthcare system which has limited availability of resources.
In this approach, patients are categorised based on severity when there are a large number of people requiring an urgent care.
The most severe are treated first as any delay will cost lives and the rest are treated later as per their level of severity.
This idea was first introduced by Napoleon’s military surgeons to treat battlefield injuries and it showed immediate impact.
It is now standard practice in many countries when treating mass casualties and has also been used effectively during COVID-19.
What is the significance of this strategy?
It has wide acceptance and implementation is based on the powerful but complex principles of justice and solidarity.
It is where the interests of everyone are put above the interest of an individual where those who need care first are prioritised over those who can wait, irrespective of who they are.
It works when there is social consensus on a level playing field.
Serious triage doesn’t only prioritise the sickest over the less sick but also discourages futile treatment for the very sick who are unlikely to benefit from the treatment.
Thus, a 90-year-old who maybe otherwise bedridden could be refused admission or someone with an advanced untreatable cancer who develops COVID-19 may be put lower in priority.
Thus executing triage in its truest sense is a big collective leap and needs a certain social sanction.
What are the challenges in this?
In an unequal world, the challenges to this idea are immense.
In India, a social triage based on class, caste and other hierarchies is everyday practice.
Also, whatever the severity of the crisis, it is hard to imagine a determined neutral state in implementing a strict triage.
Finally, given the current dominance of the private sector, triage has to involve state control over the private sector.
