This spring, as coronavirus cases swept across India, Anil Sharma has been visiting his 24-year-old son Saurav at a private hospital in northwest New Delhi every day for more than two months.

In May, as new COVID-19 cases in India broke the global record, reaching 400,000 cases per day, Saurav was put on a ventilator.

The sight of the tube sticking into Saurav’s throat imprinted Sharma’s mind.

“I have to stay strong when I am with him, but then I will collapse as soon as I leave the room,” he said.

Saurav has gone home now, still weak and recovering. However, the mountain of debt he piled up when he was ill affected the joy of the family.

With the decrease in coronavirus cases, life in India has temporarily returned to normal. But millions of people are now facing huge medical expenses. Since most Indians do not have medical insurance, they are heavily in debt.

Sharma ran out of his savings to pay for ambulances, tests, medications, and the intensive care unit. Then he borrowed from the bank.

As the expenses increased, he borrowed money from friends and relatives. Then he turned to strangers and asked for help online on the Indian crowdfunding website Ketto.

In total, Sharma said he has paid more than $50,000 in medical expenses.

Although he received $28,000 through the crowdfunding platform, he still needs to repay the lender $26,000.

“He is struggling for his life, and we are working hard to provide him with a chance to survive,” he said, his voice full of emotion.

“I was a proud father-now I am a beggar.”

Sharma visited his son Saurav who was treated for COVID-19 in a private hospital in New Delhi [Manish Swarup/AP]

The public health system is not sound

The pandemic has destroyed India’s economy and brought financial disaster to millions of people at the mercy of chronic underfunding and a fragmented medical system. Experts say that such costs will inevitably hinder economic recovery.

“What we have is incomplete public insurance and a bad public health system. The pandemic shows how fragile and unsustainable these two things are,” said Vivek Dehejia, an economist who studies public policy in India. ) Say.

Even before the pandemic, health care services in India were a problem.

Indians pay about 63% of medical expenses out of their pockets. This is a typical situation in many poor countries where government services are underserved.

It is difficult to obtain data on global personal medical expenses caused by the pandemic, but in India and many other countries, with hundreds of millions of jobs disappearing, COVID-19 treatment is a huge additional burden.

In India, many jobs have returned with the opening of cities after the severe lockdown in March 2020, but economists worry that about 12 million paid jobs will be lost.

Sharma’s marketing expert work is one of them.

When he asked his son’s friends to initiate a fundraiser on Ketto, Sharma hadn’t seen a salary for 18 months.

The company said that between April and June this year, 40% of the 4,500 COVID-19 events on the site were used to pay for hospitalization.

The 32 million Indian middle class: a study

According to a study published by the Pew Research Center in March, the new crown pandemic has driven 32 million Indians out of the middle class, that is, people with a daily income of 10 to 20 US dollars.

It is estimated that this crisis has increased the number of poor people in India—that is, those with a daily income of no more than US$2—by 75 million.

K Srinath Reddy, Chairman of the Public Health Foundation of India, said: “If you look at what causes people to fall into debt or poverty, the first two sources are usually out-of-pocket medical expenses and catastrophic treatment costs.”

In the northeastern city of Imphal, 2,400 kilometers (1,490 miles) away, Diana Khumanthem lost her mother and sister to the virus in May.

30-year-old Diana Khumanthem wiped tears as she told about her COVID-19 experience sitting at her home in Imphal, Manipur, in northeastern India [Yirmiyan Arthur/AP]

The treatment costs exhausted the family’s savings. When the private hospital where her sister died was unwilling to be discharged for a dying ceremony before paying about $5,000 in bills, she pawned the family’s gold jewelry to money lenders.

When this is not enough, seek help from her friends, relatives, and colleagues of her sister. She also owed about $1,000.

A medical insurance plan launched by Indian Prime Minister Narendra Modi in 2018 aims to cover approximately 500 million of India’s 1.3 billion population, which is an important step towards reducing medical costs.

But it does not include primary care and outpatient expenses that make up the majority of out-of-pocket expenses. Therefore, according to a working paper by Duke University researchers, it did not “effectively improve access to care and financial risk protection.”

Shawin Vitsupakorn, one of the authors of the paper, said the plan was also hampered by differences in the implementation of the state.

Another paper by the Duke Global Health Institute and the Public Health Foundation of India found that COVID-19 ICU hospitalization costs are equivalent to nearly 16 months of working hours or 7 to 10 months of salary for a typical Indian temporary worker Or self-employed workers. Employed workers.

Meager health care funding accounts for only 1.6% of India’s gross domestic product (GDP), which is proportionally lower than expenditures in Laos or Ethiopia.

At the peak of the epidemic in May, hospitals everywhere were overcrowded, but public facilities lacked the resources to deal with the influx of patients.

“The result is that the public health system has been hit hard, and medical services are often poor, prompting many people to flock to private hospitals,” Dehega said.

A public hospital treated Khumanthem’s mother, but her sister Ranjita was admitted to a private hospital at a daily cost of $1,300.

Last year, during the first wave of the virus outbreak, Khumanthem left her nursing job and returned home. Ranjita was the only breadwinner in the family. She is now taking care of her father and sister’s three-year-old son while working part-time.

Khumanthem plays with her 3-year-old nephew Hridhaan (middle). After his mother Ranjita died of COVID-19, she decided to raise him by herself [Yirmiyan Arthur/AP]

In her home in Imphal, Khumanthem remembered her favorite food-“chagem pomba”, a kind of porridge made with vegetables, rice and soybeans, and felt sad for her mother. Every few minutes, she would look at the front door.

“This is usually when Ranjita comes home from get off work,” she said. “I still think she can go through the gate at any time now.”

Back in New Delhi, Sharma breathed a sigh of relief when the ambulance took his son home from the hospital last week.

Saurav needs physical therapy to strengthen his weak muscles, a daily nurse and a long list of medications. It may take several weeks for him to stand on his own, and this ambitious lawyer is one of the best students in his class, and it may take several months before he can appear in court again.

The cost will continue.

“Our first task is to save him,” Sharma said. “Now we need to figure out the rest.”