Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 27175

Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Simple Search Advance Search Current Issue Past Issues
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Table of Contents - Year : 2020 | Month : September | Volume : 14 | Issue : 9 | Page : AB01 - AB03

Challenges in Delivering Optimal Healthcare to COVID-19 Patients: Focus on Delhi, India AB01-AB03

Published: September 1, 2020 | DOI:

Kaushik Bharati, Aarti Garg, Sunanda Das

Dr. Kaushik Bharati,
Public Health Consultant, New Delhi, India.


The public health scenario in India is grim. It is an open secret that India doesn’t spend adequate public money on healthcare. Interestingly, the public sector health expenditure is only 25%, compared to 75% in case of the private sector. In case of other countries, the public sector bears 50% of the total health expenditure.

The Government of India’s healthcare budget is deplorable, which currently stands at a meagre 1.15-1.5% of the Gross Domestic Product (GDP). In stark contrast, the United States health budget accounts for 18% of the GDP. Looking at the National Health Profile of India (2018), it is clearly evident that the per capita expenditure on healthcare is only USD 100 (after adjusting for purchasing power parity). In comparison, the US spends a staggering USD 10,224 per capita on healthcare annually. This dismal health spending in India has led to a severely weakened health system that is literally crippled and incapacitated (1).

When the current COVID-19 crisis is superimposed on the already fragile health infrastructure, one can easily imagine the immense strain that has been put on the health system as a whole. This is reflected in the available statistics for India on the prevailing pandemic. At the time of writing (28 August 2020; 11.00 AM IST), the total number of cases and deaths in India were 3,325,971 and 61,529 respectively. The corresponding figures for Delhi were 150,027 and 4,369 respectively. Importantly, Delhi is currently the sixth worst affected state in India, following Maharashtra, Tamil Nadu, Andhra Pradesh, Karnataka, and Uttar Pradesh (2).


The Delhi Government has planned a 5-pronged approach (3) to tackle the COVID-19 crisis in Delhi, which are briefly highlighted below:

Ramping-up bed capacity: The number of beds dedicated to COVID-19 patients have been ramped-up in Delhi over the past two months. In this initiative, banquet halls, hotels and private nursing homes are being acquired to boost the bed capacity in the National Capital. These include 11,000 beds in 80 banquet halls, 4,000 beds in 40 hotels, and 5,000 beds in private nursing homes (4). In this regard, 117 private hospitals have been instructed to reserve 20% of beds for COVID-19 patients (6). Additionally, 500 railway coaches have also been allocated to the Delhi Government by the Central Government, which has added a further 8,000 beds (6). Besides these, the Central Government and Delhi Government have jointly inaugurated the Sardar Patel COVID Care Centre and Hospital at the Radha Soami Satsang Beas, Chhatarpur, New Delhi on 27 June 2020. This COVID-19 centre is the world’s largest, with a bed capacity of 10,000 (7). However, since almost 78% of beds dedicated to COVID-19 patients are currently lying vacant (8), the Delhi Government is thinking of delinking the hotels from the hospitals (9).

Testing and isolation: Currently, large-scale COVID-19 testing is being carried out across Delhi. Delhi is currently conducting the third-highest number of tests in the country, only after Assam and Andhra Pradesh. The exact number is 7,210 tests per million per day (10). Moreover, around 600,000 test kits have been acquired by the Delhi Government so that testing is not hampered (3).

Serosurvey and screening: A comprehensive house-tohouse serological survey is being conducted in Delhi, which has a target sample size of 20,000. This will help to screen for potentially infected COVID-19 patients, as well as develop a better understanding of recent and past infections by measuring the levels of IgM and IgG antibodies, respectively (3).

Oximeters, oxygen and oxygen concentrators: One of the cardinal features of COVID-19 is a sudden drop in blood oxygen levels. Hence, close monitoring of the oxygen level of blood is crucial for preventing breathing problems. For this purpose, pulse-oximeters are vital, which are being supplied by the Delhi Government to all home quarantined COVID-19 patients (11). Also, oxygen cylinders can be ordered by home quarantined COVID-19 patients via telephone, in order to increase convenience and efficiency (12). The Delhi Government has procured 4,000 oxygen concentrators in order to ensure that sufficient oxygen cylinders are available (13).

Plasma therapy: Administration of plasma from cured convalescent patients have shown significant benefit in saving the lives of active COVID-19 patients. The Lok Nayak Jai Prakash (LNJP) Hospital in New Delhi has reported a reduction in the death rate by more than 50%. Other hospitals in Delhi that are conducting plasma therapy trials include the All India Institute of Medical Sciences (AIIMS), Ram Manohar Lohia (RML) Hospital and five prominent private hospitals (14).


Disparities in Healthcare Personnel in India (15)

Of the various categories of healthcare professionals in India, doctors and nurses make up 39.6% and 30.5% respectively, of the total health workforce. Of all the doctors, 77.2% are allopathic, while 22.8% fall under the category of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy), which constitute the traditional systems of Indian medicine.

There are significant disparities in the distribution of healthcare professionals across the country. The majority of healthcare professionals prefer to work in urban areas, with an urban to rural ratio of 1.45:1. In fact, it is quite surprising that of all health workers, 59.2% work in urban areas, where only 27.8% of the population resides, while 40.8% work in rural areas, where the majority (72.2%) of the population resides. There are also large variations in doctor density across India. For example, the high-income state of Punjab has 2.6 times higher doctor density than Bihar, which belongs to the low-income strata. The urban-rural divide is also evident in the educational attainments of the doctors. Many doctors do not hold the requisite degree (MBBS) for practicing allopathic medicine. In fact, one third of so-called doctors (quacks) are only educated till the secondary level. This lack of medical qualification is particularly rampant in rural areas. Whereas in urban areas, 58% of doctors have a medical degree, in rural areas this value is only 19%.

Severe Shortage of Doctors and Nurses in India (16)

The Centre for Disease Dynamics, Economics and Policy (CDDEP), which is a non-profit organisation based in Washington, USA, has recently conducted a study assessing the shortage of key healthcare personnel in India. Alarmingly, the study found that in India, there is only one government doctor for every 10,189 people, as opposed to the World Health Organisation (WHO) recommended doctor to patient ratio of 1:1,000. This translates into a deficit of approximately 600,000 doctors in India. The nurse to patient ratio is equally appalling at 1:483, which translates into a shortage of two million nurses. Putting these statistics into perspective with reference to the COVID-19 pandemic, the already low number of doctors and nurses could become even lower, as many of these key frontline health personnel are becoming infected by the virus, thereby putting them out of action.

Shortfall of Doctors and Paramedical Staff in Delhi

As per data published by the National Capital Region Planning Board (NCRPB), the total number of doctors in the National Capital is 3,594 (Government: 777; Private: 2,817). The total number of paramedical staff (including nurses) in the National Capital is 23,634 (Government: 11,469; Private: 12,165) (17). Therefore, the current doctor to patient ratio (doctors: 3,594; confirmed COVID-19 patients: 150,027) is 1:42. However, it must be kept in mind that not all doctors can be allocated solely for treating COVID-19 patients, as a certain proportion will need to be reserved for treating regular inpatients. Hence, the above doctor to patient ratio is likely to increase drastically.

High Cost of Hospital Beds- Hidden Expenses

The Association of Healthcare Providers of India (AHPI) has indicated that a super speciality private hospital in India spends approximately 28-32% of its operational budget on maintaining a bed, which amounts to INR 15,000 to 25,000 per day. In contrast, the cost of maintaining a bed in a tertiary care government hospital is INR 9,000 to 17,000 per day (18).

Some of the hidden recurring costs that contribute to the overall expenditure for running a hospital bed are briefly highlighted below (19),(20):

Employee and staff salaries: Besides salaries for key medical personnel, such as doctors and nurses, salaries for other employees also need to be allocated. These include hospital administrative staff, ward boys, pharmacists, pathology/Xray technicians, receptionists, clerks, security personnel, and sweepers, among others.

Building maintenance and utilities: These include premiums for hospital insurance, electrical installations, electricity/water bills, annual maintenance charges for high-end equipment, and fire safety.

Medical equipment: These form a large chunk of the expenses and include various types of fixed equipment, such as monitors, scanners/imagers, surgical instruments, operation theatre equipment and other associated paraphernalia.

Diagnostics and therapeutics: These include costs towards diagnostics involving pathological and biochemical investigations, X-rays, CT scans, MRI, as well as medications and other associated therapeutics.

Supplies for staff and patients: These include uniforms, aprons, surgical scrub suits, patient’s gowns, and footwear, to name a few.

Housekeeping, linen and laundry: Linen, such as blankets, bedsheets and pillow covers will need to be provided to all patients, which will require regular washing. Hence, an in-house laundry will be required. It is these and other housekeeping expenses that are often overlooked.

Power backup: Hospitals require 24-hour power supply, which require powerful generator sets, the running costs of which don’t usually come to notice.

Biomedical waste disposal: Disposal of hospital waste often require substantial investment, as huge amounts of biomedical waste is generated daily. These expenses also largely go unnoticed.

Logistical Problems

Installing and running a bed in a hotel, banquet hall or railway carriage is not the same as setting-up a bed in a hospital. The major problem associated with treatment of patients outside a hospital setting is associated with logistical issues, including the following:

Patient transfer: Transfer of patients in critical condition toand-from these facilities will be a major problem, considering the fact that there are only about 817 general and 206 trauma ambulances (Government and Private combined) in the National Capital (17). Again, similar to doctors (discussed under ‘shortfall of doctors and paramedical staff in Delhi’), not all ambulances will be available exclusively for COVID-19 patients.

Care of critical cases: Since transfer of patients may not always be possible, as indicated above, essential medical facilities, such as ICUs need to be installed. Also, emergency equipment, such as ventilators should be available. And of course, adequate designated medical staff will need to be at hand.

Patient monitoring: Regular rounds by doctors will take up an enormous amount of time. If we take the simplistic doctor to patient ratio of 1:42 (discussed under ‘shortfall of doctors and paramedical staff in Delhi’) and if a doctor devotes just 10 minutes per patient, then for 42 patients, the time required for one round will be 420 minutes or 7 hours. This will deduct a huge amount of time out of a standard 8-hour shift, leaving almost no time for emergency medical treatments. Therefore, more doctors will be required- the question is, where will they come from?

Diagnostic testing:Sending/tracking samples for testing could prove to be a logistical nightmare. Although rapid diagnostic kits that measure IgM and IgG levels could be used at the PointOf-Care (POC), these tests only provide information about past infection and not current infection. For detecting current infection, the Polymerase Chain Reaction (PCR) test is currently the only option, which can only be carried out in a specialised lab, and therefore, the samples need to be physically transferred to these facilities.

Oxygen supply: Supplying oxygen will be a huge problem in these facilities, unlike hospitals, where piped oxygen is available round-the-clock. Hence, supply of oxygen cylinders will require dedicated personnel. Moreover, one cylinder will need to be kept on standby while the other goes for refilling.

Sickness of Key Healthcare Personnel

A major factor that needs to be taken into consideration is- what will happen when key health personnel like doctors and nurses become infected and fall sick? In this regard, between March and June 2020, at least 1,200 doctors and nurses have tested positive for COVID-19 in Delhi (21). A simple calculation will show the loss of work-hours due to sickness for these frontline health staff. Since 1,200 doctors and nurses tested positive, they would all need to be quarantined for at least 14 days for observation. Taking 8 hours to be the duration of a standard work shift, the total work-hours lost is a staggering 134,400 hours (1,200×14×8=134,400 hours). Moreover, if some of them become seriously ill, they will need to be hospitalised, which will lead to more loss of work-hours. The million-dollar question is- who will replace this deficit of doctors and nurses?

CONCLUSION(S) Delivering optimal healthcare to COVID-19 patients amidst the ongoing pandemic is indeed a challenge for healthcare professionals, especially in an overcrowded and congested metropolitan city like Delhi. There are multiple impacting factors that hinder adequate healthcare delivery, which have been discussed above. From a holistic standpoint, the root cause for the lack of pandemic preparedness in India is the chronic underinvestment in healthcare, which can be traced back to the time of independence, over seven decades ago. So, the current rush to tackle the pandemic on a war-footing could be looked upon as a stop-gap arrangement. However, ending on an optimistic note, it must be mentioned that Delhi is fighting back impressively and slowly but surely, turning the tide.