GAZETA WARSZAWSKA - 6. Covid-19 or not, you’ll pay more at hospitals

6. Covid-19 or not, you’ll pay more at hospitals

The cost: Most private hospitals now consider every patient as a suspected Covid-19 case, which means doctors and nurses must take precautionary measures such as using personal protective equipment (PPE), masks, gloves, face shield covers, etc. This has led to the cost of hospitalisation going up by a staggering 25-30%, reports TOI. The cost of one PPE alone is between Rs 1,800 and Rs 2,000 and hospitals say cost escalations are inevitable. Some nursing homes have hiked consultation fees for OPD patients too as the doctor wears PPE and gloves.
The burden: A 69-year-old man, who was suspected for Covid-19, had to be in isolation for three days in a private hospital in Bengaluru in March until he tested negative. “The isolation ward charge per day was Rs 10,500 which is not fully covered by insurance. In the total bill there was a mention of 5 PPEs used, each priced at Rs 2,000. The PPEs were also not covered by the insurance policy,” said the patient’s son. The family had to pay Rs 1.4 lakh for six days of hospitalisation, including the isolation. The cost would have been minimum 30% less in pre-Covid times, the family says. In some cases, the daily “Covid-19 charge” exceeds the daily hospitalisation amount fixed by the insurers forcing patients to pay it.
An excuse too: Another TOI report had highlighted how some private hospitals procure consumables like gloves and PPEs at a fraction of the maximum retail price but charge patients the MRP. It’s the same with medicines.
Public vs private: A study by the Union ministry of statistics released earlier this year had said hospitalisation for any ailment in a private hospital costs six times more than the expense incurred in a government institution. The average hospitalisation expenditure per person in a government hospital is Rs 4,452 compared to Rs 31,845 at a private facility.

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5 THINGS FIRST

Limited passenger train services to resume; Retail inflation and industrial production data for April to be released; Kerala high court to hear plea against making Aarogya Setu app mandatory for employees; Delhi high court to hear plea against Haryana government order restricting movement of essentials; International Nurses Day

PM hints at graded lockdown relaxation as cases cross 70k

PM Modi indicated that steps to open the economy would continue to be pursued in line with relaxations announced so far even as efforts to reduce incidence of Covid-19 continue apace and social distancing norms are followed. He hinted that a more graded relaxation of the lockdown could be on its way during a lengthy interaction with chief ministers on Monday. “I am of the firm view that the measures needed in the first phase of lockdown were not needed during the second phase and, similarly, the measures needed in the third phase are not needed in the fourth,” an official release quoted the PM as saying. “We have a twofold challenge — to reduce the transmission rate of the disease and to increase public activity gradually, while adhering to all the guidelines,” he said.
Also, India’s Covid-19 count went past 70,000 on Monday, just two days after crossing the 60,000 milestone. And Maharashtra continued to report above 1,000 new cases for the sixth day running while the pandemic spread alarmingly in Tamil Nadu, which added its highest single-day number of cases at 798. However, the overall count of new cases across the country was down from Sunday’s record high (of 4,308) to 3,607. India case count is now 70,793 with Maharashtra accounting for nearly a third. Just four states — Maharashtra, Gujarat, Tamil Nadu and Delhi — have 66% of India’s Covid caseload.
In what would be a relief for health authorities though, Monday’s death toll from the virus came down to 82 after remaining at 113 for two consecutive days. Maharashtra recorded the highest 36 deaths, taking its total toll to 868, with Mumbai alone accounting for 528.
In order to keep a closer watch on the prevalence and spread of Covid-19 in the country, the health ministry has initiated a facility-based surveillance in all districts and a more-focussed population-based "sero-survey" of high- and low-risk groups in select districts. The surveillance will be in addition to routine testing as per current guidelines, the ministry said. And it will not only help the government and its agencies monitor Covid-19 trends but also check for community transmission in any part of the country. A sero-survey involves testing of blood serum of a group of individuals and this will be used to monitor trends in prevalence of the novel coronavirus infection at the district level.

How your travel by rail and air will change

Train travel resumes today with the Ministry of Home Affairs (MHA) issuing the relevant guidelines. This has also fuelled hopes that air travel may resume soon. So what can passengers expect?

Trained for travel: To begin with, there’ll be only 15 pairs of trains that will start plying, with just AC classes — bookings allowed up to 7 days in advance, with no Reservation Against Cancellation (RAC) or waitlisted tickets. Only passengers with confirmed e-tickets will be allowed entry into railway stations, provided they do not show symptoms of any influenza like illness (ILI). Hand sanitisers will be issued at both entry and exit, as well as coaches and wearing of face masks will be compulsory. The major change, however, will be the reporting time for boarding a train — passengers will be required to reach at least 90 minutes before the scheduled departure time, according to Indian Railways. Additionally, necessary social distancing, of minimum 6 feet, will need to be maintained during boarding and travel. This means not just long queues but also possibly fewer passengers per coach.
Have no airs: Civil aviation minister Hardeep Singh Puri indicated to Outlook magazine last week that domestic air travel could start before May 15. However, he told CNBC-TV18 that keeping the middle seat in the aircraft vacant will not be a feasible option for airlines — making it all the more challenging to maintain the requisite social distancing norms. Certain airlines like Air Vistara have already issued guidelines for reducing contact between their crew and passengers by up to 80% — such as no in-flight meal service for economy and premium economy passengers, no in-flight reading material, thermal screening of crew before and after departure, among other measures.
Ground reality: Delhi’s Indira Gandhi International Airport, which is the country’s busiest — handling close to 7 crore passengers annually — said on Monday that it will use ultra-violet (UV) rays to disinfect all surfaces, through mobile towers, handheld torches and baggage tunnels. It will also be placing shoe-sanitiser mats that will be soaked with a chemical to disinfect passengers’ shoes. The Central Industrial Security Force (CISF), which is responsible for the security of airports in India, has proposed, among other things, a sit and wait policy for the security clearance wherein a passenger will be called for a security check, rather than queueing up — the security check itself being conducted without any physical touch. The CISF expects a delay of 5 to 7 minutes per passenger, which means reaching the airport more than a few hours ahead of the scheduled departure time. Moreover, passengers, who have to necessarily wear face masks and gloves, will be allowed entry only after thermal screening — after possibly passing through sanitisation tunnels at entry points, which will also be mandatory for crew and airport staff.

Why India can’t afford Covid-19 in its villages

In his fifth video conference with the chief ministers, PM Narendra Modi warned against the spread of the pandemic to India’s villages and while the most obvious reason is the lack of adequate healthcare facilities in the villages, there are other concerns as well.

The risk: Several lakh migrant workers have either left cities for their native villages or are on the way back home. All of them are supposed to be tested before being put on trains or before entering their state but given their sheer numbers, are slipping through the cracks. Bihar, with a comparatively limited testing capacity, recorded the largest single-day spike with 85 fresh positive cases and sixth deaths on Sunday. Almost all new cases are those who had returned to the state by special trains from Delhi, Gujarat, Maharashtra and other states last week.
Saving the elderly: Given that 48% of the population in India’s 6 largest metros — Delhi, Mumbai, Kolkata, Chennai, Hyderabad and Bengaluru — comprises of migrants, a mass exodus, of the kind seen during the lockdown, puts at risk India’s elderly population, 71% of whom reside in its villages. This is the same segment that’s at a greater risk of not just contracting Covid-19 but also succumbing to it — 75.3% of the deaths due to the pandemic were those aged 60 years and above.
Saving the weak: Also, while the prevalence of heart disease is higher in urban India than in rural — at close to double — in terms of absolute numbers, rural India outweighs the urban. According to a study published in the Lancet in 2018, more Indians in rural areas are dying of coronary heart disease and other cardiovascular diseases — defined as co-morbidities that make recovery from Covid-19 extremely unlikely.
Missing link: India is facing a shortfall of 22% in the number of primary health centres (PHC) and 30% in the number of community health centres (CHC) — the first points of contact for India’s rural populace to avail of healthcare facilities. The highest shortfall is in the states of West Bengal, Uttar Pradesh, Bihar, Jharkhand, Rajasthan and Madhya Pradesh — which also happen to be the chief ‘supplier states’ for migrant labour across India. According to this Mint report, only 11% of sub-centres, 13% PHCs and 16% CHCs meet the Indian Public Health Standards. 60% of PHCs have just one doctor while 5% have not even that, according to the Economic Survey 2018-19 — meaning, that should there be an outbreak of Covid-19 in rural India, it may well be impossible to contain it.

Was lockdown about human rights too?

Is law too harsh? With thousands of migrant workers desperate to return home even by marching on foot, the Maharashtra government has decided not to be “harsh with them” and let them go on humanitarian ground despite violation of lockdown norms, state Home Minister Anil Deshmukh said on Monday.
Freedom of movement? Delhi high court has observed that the order by Haryana authorities preventing movement of doctors, nurses, court staff and trucks to and from Delhi to Sonipat prima facie infringes the right to freedom of movement. The court also issued notice to the Centre and Haryana government on a petition challenging the order of Sonipat authorities on the restriction. It will hear the case today.
Is detention lawful? Last month, the Punjab and Haryana high court had said that any person cannot be held to be in illegal or unlawful detention if they have been kept in quarantine by the authorities due to the Covid-19 pandemic. The petition was filed by some residents of Assam and Bihar, who were kept in quarantine/isolation by the Haryana health authorities. The petitioners had claimed that as they were found to be Covid-19 negative, their confinement in the quarantine centre amounted to illegal custody/detention.
Right to livelihood? A PIL filed in the Supreme Court last month, asking the government to pay minimum wages to migrant workers argued that the national lockdown declared under the National Disaster Management Act had deprived workers of their right to livelihood under Article 21 of the constitution (right to life and liberty). The SC said it “didn’t want to interfere in government decisions for the next 10-15 days”.

NEWS IN CLUES

In which city is the world's largest and busiest container port located?

Clue 1: It serves as the headquarters of the New Development Bank, formerly referred to as the BRICS Development Bank.
Clue 2: With a population of more than 27 million, it is the world's thirdmost populated city behind Tokyo and Delhi.
Clue 3: It is also home to two major airports: Pudong International Airport and Hongqiao International Airport.

Scroll below for answer

With regard to deaths, when is Covid-19 …

… a confirmed cause? Test results are positive, but symptoms may be absent, present or present with comorbid conditions like heart disease, asthma, chronic obstructive pulmonary disease and Type 2 diabetes.
… a probable cause? Test results are inconclusive, but in which coronavirus symptoms are present.
… a suspected cause? Test results are awaited but, again, symptoms are present.
… clinically-epidemiologically diagnosed? Those testing negative but have symptoms.
… an underlying cause? When leading to pneumonia, cardiac injury and clotting in the bloodstream, among others. Now, death often results from the combined effect of two or more independent or related conditions — one condition may lead to another, which in turn leads to a third condition and so on. Where there is a sequence, the disease or injury which initiated the sequence of events, is called the underlying cause of death.
Patients may be present with other pre-existing comorbid conditions such as asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes mellitus. These conditions increase the risk of developing respiratory infections, and may lead to complications and severe disease in a Covid-19 positive patient.
However, "These conditions are not considered as underlying causes of death as they have not directly caused death due to Covid-19. Also, a patient may have many comorbid conditions but only those that have contributed to death should be recorded," a guidance document issued by ICMR stated.

Hit by oil crash, Saudi announces austerity measures

Saudi Arabia on Monday announced a slew of “painful” austerity measures to tide over the crisis of cheap oil. The measures include:

Suspending the cost of living allowance to citizens, amounting to 100 riyals, from June
Increasing value added tax from 5% to 15% starting July
“Cancelling, extending or postponing” expenditure for some government agencies
Cutting expenditure on projects under the ambitious “Vision 2030” pushed by Crown Prince Mohammed bin Salman.

The state media said the austerity measures would save state coffers 100 billion riyals (US$26.6 billion).

The reason:

Oil contributes 70% of Saudi economy. But a demand shock due to the pandemic has caused oil prices to fall — the benchmark Brent crude is around $30 a barrel. According to the IMF, Saudi Arabia needs to sell crude oil at $76 a barrel to break even.
The kingdom’s oil revenues in the first three months of the year fell 24% from a year earlier to $34 billion, pulling total revenues down 22%.
The deficit for the first three months alone was a whopping $9 billion.
Saudi central bank’s net foreign assets fell by $27 billion in March, the biggest fall in 20 years.
The International Monetary Fund projects Saudi economy to shrink 2.3% this year.

Mega city under cloud:

Though not specified, the measures raise doubts over the $500 billion mega city called NEOM the kingdom is building in its barren northwest region.
The futuristic city covering 10,000 square miles was being planned as a hub of technology, entertainment and leisure — Silicon Valley, Hollywood and the French Riviera all at one place.
The first section of NEOM was expected to be completed by 2025.

Players begin isolation as Germany eyes kick-off

Germany’s first and second division football players began their mandatory one-week isolation as part of the plan to restart football matches from May 16. If the plan goes ahead, Bundesliga will be the first major sporting event to resume activities since the pandemic hit the world.
Top division clubs such as Bayern Munich and Borussia Dortmund have bulk-booked hotels to house the players and staff. Some have accommodated players in hotels within the stadium.
Players are to make their own bed and tables will be kept at a distance during team lunches.
As per the hygiene plan, no fans will be allowed in stands during training or the matches.
Players will be tested for coronavirus at least once a week and will only be allowed to play if they are negative twice in a row. Even the ball will be disinfected before and during the game.

But...

Two players of second division Dynamo Dresden tested positive on Saturday. The entire team has now been placed in a two-week quarantine.
Bundesliga CEO Christian Seifert, however, said the plan to resume competition is on. “For the second division that means at the moment that from 81 games, two Dynamo Dresden games can’t be played. We have to see how we deal with that. We are not changing our aim and we are not changing our plans,” he said.

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Source: Various

BEFORE YOU GO

Covid interrupts world's longest-running cartoon

The production of Japanese animated TV series Sazae-san, recognised as the longest-running cartoon by Guinness World Records — it first aired in 1969 — has been interrupted by the coronavirus, forcing the broadcast of reruns for the first time in decades. Broadcaster Fuji Television Network said animation dubbing had been halted to keep staff safe. "We will halt broadcast of new episodes of Sazae-san for the time being from May 17 and instead air reruns," it announced.
The network said upcoming broadcasts would feature episodes from two years ago, adding it would announce a date for the resumption of new episodes as soon as possible. It is the first time the network has been forced to air reruns since 1975, when the economic effects of an earlier oil crisis lingered.
A mainstay of the Japanese weekend, the series revolves around the life of Mrs Sazae, a cheerful but klutzy full-time housewife who lives with her parents, husband, son, brother and sister. The 30-minute episodes aired Sunday nights are very popular, and for many in Japan have come to denote the end of the weekend.
The outbreak in Japan has been comparatively small with nearly 15,800 infections and 621 deaths. The country is under a state of emergency that was extended last week until the end of May, though the government is considering lifting the measures early in parts of the country.

Answer To NEWS IN CLUES

Shanghai. Mickey Mouse welcomed thinned-out crowds in Shanghai Disneyland on Monday, the first Disney theme park to reopen, with a strict limit on tickets. Parades and fireworks were cancelled, and workers and guests had to wear face masks and have their temperatures screened. Shanghai Disneyland and Disney's park in Hong Kong had closed on Jan. 25 as China isolated cities with 60 million people to try to contain the Covid-19 outbreak. Tokyo Disneyland closed the following month and parks in the US and Europe in March.