The novel coronavirus disease, commonly known as COVID-19, has posed an unprecedented challenge to health care systems across the world. The speed and size of its spread has rendered most health care models ineffective and policy makers are forced to frequently change strategies to contain the pandemic to accommodate daily realities. In the absence of any known vaccine and drug for COVID-19 in modern medicine, containment appears to be the only way forward. Accordingly, most countries follow the model of isolation and social distancing to contain the spread. For various reasons, this has not been very successful so far in Western Europe and the United States, as the number of affected individuals and mortality continue to rise rapidly. India is one of the few countries that took relatively early steps to implement isolation and social distancing. This was a much-needed and correct strategy, given the size and density of the population and the comparatively low income levels of the majority of people who make their living on a daily basis. The disease is still spreading. The first case was reported on 30 January 2020 and the number has been increasing ever since. This is a tough task facing Indian healthcare policymakers and professionals.
Challenges of the Indian healthcare system during the current pandemic
India's healthcare is already struggling with a number of issues including a heavy disease burden, lack of adequate health infrastructure and manpower. Compared to most high-income countries, India has a lot to catch up on in these areas. According to the latest data available on the World Bank's World Development Indicators (WDI) database, India has only 0.7 hospital beds per 1000 population, while the US has 2.9 and Italy has 3.4. Similarly, if we compare the health sector workforce, as of 2017, India had only 2.1 nurses per 1000 population, while Italy had 5.9 and the US had 8.5–5.1. India has about 50 million people suffering from diabetes and 54 million from cardiovascular diseases (CVD).2 India also has the highest number of people suffering from tuberculosis, which is about 2.8 million (ibid). The morbidity profile of the country as well as the lack of health care infrastructure and resources to meet the needs of normal times, makes COVID 19 a serious challenge for India. Therefore, India has to make optimal use of all available resources to deal with the current crisis. This applies to health infrastructure, human resources and medical equipment and immunity-boosting drugs and food supplements.AYUSH as a Quickly Utilised Resource
A key resource that India has is its AYUSH sector, which comprises the traditional medical systems of Ayurveda, Siddha, Unani, Yoga and Sowa-Rigpa and the modern system of homeopathy. In crisis situations like the present one, this sector is a great asset to India as compared to countries in the West. Its infrastructure, human resources and even medicines and lifestyle prescriptions come in handy to the country in dealing with the pandemic. Table 1 presents the AYUSH healthcare infrastructure and human resources in India in detail. As of March 2020, India had 3,986 AYUSH hospitals and 27,199 registered AYUSH dispensaries. Ayurveda is the most popular system of traditional medicine (TM) in India with 3186 hospitals and 17,102 dispensaries. These endowed facilities, which are spread across the country, can be used for isolation and quarantine facilities under proper supervision, following what the current treatment protocol prescribes. The same is the case with human resources. There are about 1.4 million registered AYUSH doctors spread across India. A large number of these personnel, about 6 lakh, have done regular five-and-a-half-year graduation and many of them have also done three-year postgraduate course in formal AYUSH medical colleges and universities. According to the ministry's annual report for 2018-19, there are 401 Ayurveda, 11 Siddha and 53 Unani colleges affiliated to 59 universities in the country. Of these, 155 institutions offer postgraduate courses in Indian System of Medicine (ISM). According to the ministry's dashboard, the capacity of these institutions is 46,835 in undergraduate and 5,885 in postgraduate courses. Those who studied and trained in the modern curriculum of these systems in formal institutions can easily handle the general health protocols, especially where there is no allopathy medicine use, which, in any case, is not for COVID patients except if they are suffering from other diseases. or bronchial problems, which may increase during COVID-19. This is certainly better than leaving patients to take care of themselves at home. Indian systems of medicine like Ayurveda lay a lot of emphasis on immunity development. A large number of medicines in these systems are already marketed as food and nutritional supplements, especially in countries where the systems are not recognised as medical systems. They, like Chyavanaprash, are targeted at the body's immunity. These are products with fewer side effects, although they should be taken under the supervision of qualified health practitioners. They are ideal to take in case of infectious diseases that affect the immune system, as preventive medicine. There are 8,964 AYUSH manufacturing units that can supply adequately, if allowed to do so. The systems also lay emphasis on the diet (pathya) and lifestyle (jeevchariya) of the individual, as the effectiveness of medicines depends on that. All of these are part of preventive medicine and contribute to immunity development. Modern health experts also recommend healthy diet and anti-stress activities. Ayurveda and yoga seem to be a perfect combination for both.One advantage of AYUSH systems is the accessibility of most products, especially in rural areas. Indian systems of medicine talk about the definite beneficial effects of Indian spices in boosting immunity. Many AYUSH immunomodulators use ingredients that can be found in most Indian households such as turmeric, basil, ginger, mustard oil, etc. Using these ingredients, households can prepare immunoboosters like kashayam for daily consumption. This will serve a dual purpose as people will not have to step out of their homes to prepare these, thus respecting the lockdown, as well as help build their immunity. It must be noted that these formulations are prescribed only as precautionary measures and not as a cure, until scientifically proven otherwise, so that all other preventive measures such as regular hand washing are not ignored. There is ample evidence that yoga helps in stress and anxiety management and can improve mental health. Just like homegrown Ayurvedic formulations, Yoga too has a household benefit if promoted through mass media. Using these measures the Indian population can prepare against the virus without any side effects at a very low cost. Perhaps, these preventive measures will reduce the chances of developing severe symptoms if infected with the new Corona virus. Although most COVID 19 cases are asymptomatic or show only mild symptoms, there are still chances that a large portion of the population will eventually develop severe symptoms after getting infected. If and when this happens, it is absolutely necessary that the established AYUSH infrastructure and health care workers along with allopathic doctors and modern health care infrastructure are well prepared to take care of those patients. For this to happen, the government must start using AYUSH resources before community spread so that they are prepared for what is to come. It is important to build trust and confidence in the systems. It is also necessary to spread awareness through mass media, social media and print media. Also, the AYUSH Ministry should be very vigilant to eliminate any false claims arising during this time as they hamper the legitimacy of the system. Such false claims and fake cures will cause serious damage to the system.
