On May 5th, India reported 412,431 new COVID-19 infections and 3,980 deaths. Since mid- April, the country has seen an increase in infections and deaths which has rapidly overwhelmed the country’s healthcare and public health infrastructure.

Pooja Yerramilli, MD, MPH, MGH Global Medicine Resident shares an update on the situation and work being done through the volunteer group India COVID SOS, whom she volunteers with.

From the conversations you have had with people in India, could you tell us what you have learned from the current situation on the ground?  

I would say it is really harrowing to hear the stories from clinicians on the ground and from family and friends who live in India.

We’re seeing a lot of the critical care physicians are completely tired from working around the clock. Same with physicians, nurses, etc. And even still, there’s a dearth of resources.

There are people that need hospital beds who are incapable of getting them. There are processes of self-triaging where people are deciding their elderly community members simply should not be taken to the hospital because it is too difficult and there are no resources available. They’re making the executive decision to leave them to pass at home.

How have we gotten to this point?

It’s incredibly frustrating that over a year into this pandemic it feels like we are where we were last April in our level of anxiety. It’s disheartening because we have the diagnostics, we have the therapeutics, but we don’t really have a mechanism for equitable distribution.

If we look at the number one mode of controlling the pandemic—getting everyone vaccinated—we know there is what people are calling vaccine apartheid. And we anticipated that would happen. The United States, in particular, has hoarded many vaccines. Forty percent of American adults have accessed at least a single dose of the vaccine whereas, in India, less than 10% have gotten a single dose. Low-income countries have received only 0.2% of the global vaccine supply.

And there are issues surrounding therapeutics as well. We still haven’t figured out how to deliver oxygen to low- and middle-income countries. We haven’t figured out how to ensure medications are equitably distributed around the world and that’s something we’ve been talking about for years, even before the pandemic.

We haven’t figured out, on the palliative care front, how to ensure adequate opioid access. We’re hearing in India that there is not enough morphine to be able to treat people who are dying at home.

These are really harrowing tales, but they’re symptoms of problems we’ve known have existed in our system for a long time.

What are you doing to support India in the midst of this surge in COVID-19 infections?

At first, I was just reaching out to various mentors and contacts I have. Then I was connected to a group: India COVID SOS.

They started by focusing on home-based care, “How do we offload the hospitals by promoting care of mild cases at home?” They created an infographic and translated it into all the major languages in India and circulated that widely. After the infographic was circulated, they started to get more support via volunteers. The group has grown to over 500 volunteers.

I’m one of the many volunteers trying to contribute in some small way. The primary projects I’ve been working on have been education-based. Asking how do we strengthen telemedicine type platforms that are beginning to be built across India to keep the mild and moderate cases at home and free up additional hospital beds for people in dire conditions?

Are there other efforts happening through India COVID SOS?

I would bucket the categories of activity into a couple of major areas vetting fundraising organizations, organizing delivery of oxygen supplies, and supporting homebased care. Everything the volunteers is doing is entirely guided by the input received from individuals and organizations on the ground.

What sources of hope lie in the midst of this surge?

I am incredibly hopeful when I see the level of outpouring and the level of recognition that something has to change. And I feel that within India and around the world, a lot of people have reached a breaking point where the systems we currently have in place are no longer justifiable.

I think the IP waiver is a good example. While we’re not completely overhauling our patent system, at least in the short term there’s recognition and understanding that this is a required step to be able to ensure equitable distribution. The recognition that we need to value our health workforces and build strong health systems, in particular primary care, to progress toward health equity is another good example.

I think these are hopeful steps in the right direction that show an acknowledgement the system is broken. If we keep this frustration and momentum for change going beyond this moment, then we can change these systems for good. That does give me some hope.

Pooja Yerramilli, MD, MPH, is currently working with Global Disaster Response and Humanitarian Action (GDRHA) at the MGH Center for Global Health to coordinate MGH efforts to respond to the COVID-19 surge in India. GDRHA is committed to providing well-trained personnel and resources to immediately respond to a full spectrum of humanitarian—natural or man-made—emergencies in coordination with local authorities. As a center of excellence in disaster preparedness and response, GDRHA leverages the multi-disciplinary expertise of MGH to deliver timely, high-level care to people affected by disasters and humanitarian emergencies.

Currently, a GDRHA team is deployed to Matamoros, Mexico, in coordination with Global Resource Management, to provide support at a migrant camp for individuals seeking asylum in the United States.

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