Month: March 2020

On 15th March 2020, the Ministry of Health & Family Welfare issued guidelines on dead body management of people suffering from COVID-19, since it is a new disease and there is insufficient knowledge regarding the disposal of the dead body of a person having, or suspected to have had, COVID-19.

The guidelines state that since the transmission of COVID-19 mostly happens through droplets it is unlikely that any healthcare staff or family member handling the dead body shall contract it. However, the lungs of a patient being handled during autopsy can be infectious.

Precautions to be followed by health care workers while handling dead bodies of people having COVID-19 are:

1. Hand hygiene.
   
2. Use of personal protective equipment (e.g., water resistant apron, gloves, masks, eye-wear).
   
3. Safe handling of sharps.
   
4. Disinfect bag housing dead body, instruments and devices used on the patient.
   
5. Disinfect linen. Clean and disinfect environmental surfaces.

Training in infection and prevention control practices:

All staff who will be required to handle dead bodies in the isolation area, mortuary, ambulance and the workers in the crematorium/burial ground should be trained in the infection prevention control practices.

The guideline further speaks about the procedure to remove the dead bodies from the isolation rooms or areas and cleaning and disinfection of the isolation area. It speaks about the transportation of the dead body and the precaution to be followed at the crematorium or burial ground.

The guidelines also state that autopsies of dead bodies of people suffering from COVID-19 shall be avoided. If an autopsy has to be performed due to special reasons the precautions and practices given in the guidelines shall be followed, like:

a. Limited number of forensic experts and support staff shall be present in the room.

b. To reduce the chances of prick injuries, PM40 or any other heavy-duty blades with blunted points shall be used.

c. Only one body cavity should be dissected at a time.

d. After the autopsy procedure is complete, the body should be disinfected with 1% Sodium Hypochlorite and placed in a body bag, the exterior of which will again be decontaminated with 1% Sodium Hypochlorite solution.

In the wake of the prevailing COVID-19 pandemic, the Ministry of Health and Family Welfare has issued guidelines for notifying COVID-19 affected persons by Private Institutions.

A “suspect case” has been defined as one of the following:

1. “A patient with acute respiratory illness (fever and at least one sign/ symptom of respiratory disease (e.g., cough, shortness of breath) and a history of travel to of residence in a country/area or territory reporting local transmission (See NCDC website for updated list) of COVID-19 disease during the 14 days prior to symptom onset”
2. “A patient / healthcare worker with any acute respiratory illness and having been in contact with a confirmed COVID-19 case in the last 14 days prior to onset of symptoms”
3. “A patient with severe acute respiratory infection (fever and at least one sign/symptom of respiratory disease (e.g., cough, shortness breath) and requiring hospitalization and with no other etiology that fully explains the clinical presentation”
4. “A case for whom testing for COVID-19 is inconclusive”
5. A Laboratory confirmed case has been defined as “A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms”.

As per the Guidelines, the following are to be kept in mind for notifying COVID-19 affected persons by private institutions:

1. All government and private hospitals; medical officers in government health institutions; and registered private medical practitioners including Ayush practitioners, are to notify the concerned district surveillance unit, of any person(s) affected with COVID-19.
2. Practitioners shall get self-declaration forms, where they have knowledge of persons having travel history of COVID-19 affected countries and are falling under the case definition of COVID-19 (Suspect/Case).
3. In case the person has had any such history in the last 14 days and is symptomatic as per case definition of COVID-19, the person must be isolated in the hospital and will be tested for COVID-19 as per protocol.

Information of all such cases should be given to the national helpline 1075 and/or to the State helpline

(https://www.mohfw.gov.in/pdf/GuidelinesfornotifyingCOVID-19affectedpersonsbyPrivateInstitutions.pdf).

Emails may be sent to [email protected]

The Ministry of Health and Welfare issued a Standard Operating Practice (SOP) for airport screening of COVID-19 based on a categorization of passengers coming into India from China, Democratic Republic of Korea, France, Germany, Spain, Italy, and Iran”.

The SOP classifies passengers into three risk categories:

(i) Category A (High Risk): A passenger with fever, cough, shortness of breath, with a history of travel to, or residence in, a country/area or territory reporting local transmission of COVID-19 disease during the 14 days prior to symptom onset; or a patient with any acute respiratory illness who has also been in contact with a COVID-19 patient in the 14 days prior to the onset of symptoms

(ii) Category B (Moderate Risk): An asymptomatic passenger coming from China, the Democratic Republic of Korea, France Germany, Spain, Italy, Iran who is also elderly (above 60 years of age) hypertensive, diabetic, and/or asthmatic

(iii) Category C (Low Risk): An asymptomatic passenger coming from any COVID-19 affected country, including passengers coming from China, Democratic Republic of Korea, France Germany, Spain, Italy, and Iran.

The Government of India has taken several measures with respect to cross-border passengers travelling to or from India, in order to contain the spread of the disease. All the detailed measures along with FAQs can be accessed at http://tourism.gov.in/covid-19-travel-advisory

The Ministry of Home Affairs also issued various visa restrictions. As of 13 March 2020, all visas except a few categories (diplomats and employment visas) have been suspended till 15 April 2020.

Indian nationals who wish to return to India will be quarantined for 14 days if they have visited certain countries (China, South Korea, Iran, Italy, Spain, France and Germany) on or after February 2020. However, this does not apply to passengers who transited through these countries. Foreigners currently in India can extend their visas to avoid international travel. They can also leave the country and return back, but if they wish to return before 15 April, they would require fresh visas.

All types of passenger movements through all the immigration land check posts located at India-Bangladesh border, India-Nepal border, India-Bhutan border, India-Myanmar border have been suspended until further notice. The restrictions imposed are on foreign nationals.

The Bureau of Immigration has also issued instructions regarding visa and other general travel restrictions to avoid unnecessary travel at this point in time. India has also banned travel from EU and the UK to tighten its preventive measures.

(Restrictions on travel change periodically – please refer to https://www.mohfw.gov.in/travel_ad.html for the latest information. Also, check back in at https://allaboutcovid2020.blogspot.com/ for updates)

One of the key concerns during the management of any pandemic is the economic impact it will have on the residents of affected countries. With businesses and factories halting work, and the imminent threat of an economy slowed by the pandemic, a further possibility of high healthcare expenses for diagnosis, treatment, and/or hospitalization form a deadly combination that increases vulnerability to financial distress.

Keeping in mind the necessity of mitigating the financial strain posed by COVID-19, the Insurance Regulatory and Development Authority of India (IRDAI), on 4 March 2020, issued guidelines on handling of claims caused by or resulting from COVID-19 and all insurers are obligated to follow these guidelines.

The key provisions of IRDAI’s directive are–

(i) Where hospitalization is covered by an insurance product, insurers shall ensure expedition handling and processing of cases related to COVID-19;

(ii) The costs of admissible medical expenses during the course of treatment, including treatment during quarantine, shall be settled in accordance with the policy’s applicable terms and conditions, read with the extant regulatory framework;

(iii) All COVID-19-related claims shall be thoroughly reviewed by the claims review committee before being repudiated; and

(iv) Insurers were encouraged to introduce specific products to cover vector-borne diseases, with the aim of providing need-based health insurance coverage

Further, in order to meet health insurance requirements of various sections of the public, insurers were also advised to design products specifically covering the COVID-19 treatment costs.

However, there is no consensus in how insurers have interpreted circular, with several carving out certain exceptions for the applicability of the circular. One insurer has declared that claims due to COVID-19 were payable only if the concerned person was hospitalised for at least 24 hours. Another has stated that if the person proposed to be insured has been suffering from any respiratory system-related disease prior to the contraction of COVID -19, then claims under a regular indemnity-type health insurance policy or a specific coronavirus insurance policy may not be settled.

A special coronavirus insurance policy has been launched by online insurer, Digit. However, this policy has a waiting period of 15 days which would mean that if a person is diagnosed with COVID-19 within this period of 15 days, his claims will not be settled by the insurer. Further, a person will not be able to claim expenses on treatment of the disease where such expenses were incurred during the waiting period of the policy.

Keeping in mind the growing seriousness of this pandemic, the importance of providing a financial safety net for those at risk of infection, and, above all, respecting the spirit of IRDAI’s circular, it is incumbent on all health insurance providers to honour bona fide COVID-19 claims; to liberally interpret policy terms; and to design products that will serve the at-risk population. This commitment towards IRDAI’s intent, and not the hunt for loopholes, will contribute toward greater economic resilience, both in the people and in the country.

The outbreak of COVID-19 has posed a series of intricate policy challenges to legislators, the government and public health professionals.

According to the World Health Organization (WHO), health is a state of complete physical, mental and social well being and not merely the absence of disease. The WHO goes on to clarify that it is the state’s legal obligation to ensure uniform access to “timely, acceptable, and affordable health care of appropriate quality as well as to provide for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality” to all its people. In India, this right, which is a natural corollary to promoting public health, is protected under the Constitution of India in multiple ways.

The Directive Principles of State Policy (DPSP), enshrined in Chapter IV of the Constitution of India, require the state to, among other duties,

· promote the welfare of its people (Art.38);

· protect their health and strength from abuse (Art 39(e));

· provide public assistance in case of sickness, disability or “undeserved want” (Art 41);

· ensure just and humane conditions of work; and

· raise nutrition levels, improve the standard of living and consider improvement of public health as its primary duty (Art 47).

In addition to the DPSP, some other health-related provisions can be found in the 11th and 12th Schedules, as subjects within the jurisdictions of Panchayats and Municipalities, respectively. These include the duty to provide clean drinking water, adequate healthcare and sanitation (including hospitals, primary health care centers and dispensaries), promotion of family welfare, development of women and children, promotion of social welfare, etc.

The Constitution of India does not expressly recognize Right to Health as a fundamental right under Part III of the Constitution (Fundamental Rights). However, through judicial interpretation, this has been read into the fundamental right to life & personal liberty (Article 21) and is now considered an inseparable part of the Right to Life. Article 23 of the Constitution of India also indirectly contributes to protecting the Right to Health as it prohibits human trafficking and child labour.

The role of Indian Supreme Court in protecting the health of the public at large is noteworthy. The Supreme Court has repeatedly observed that the expression “life” in Article 21 means a life with human dignity and not mere survival or animal existence (Francis Coralie Mullin vs The Administrator, Union Territory of Delhi AIR 1981 746). Right to life has a very broad scope which includes right to livelihood, better standard of life, hygienic conditions in the workplace & right to leisure. Right to Health is, therefore, an inherent and inescapable part of a dignified life. Article 21 should also be read in tandem with the directive principles of state policy, cited above, to truly understand the nature of the obligations of the state in this respect.

In the case of Bandhua Mukti Morcha v. Union of India AIR 1984 SC 812, the Supreme Court held that although the DPSP are not binding obligations but hold only persuasive value, yet they should be duly implemented by the State. Further, the Court held that dignity and health fall within the ambit of life and liberty under Article 21.

In the case of Paschim Banga Khet Mazoor Samity v. State of West Bengal (1996) 4 SCC 37, the scope of Article 21 was further widened, as the court held that it is the responsibility of the Government to provide adequate medical aid to every person and to strive for the welfare of the public at large.

Further, the Supreme Court in the case of Parmanand Katara v Union of India AIR 1989 S.C. 2039, held that every doctor at Government hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life of a patient.

In the subsequent case of Consumer Education and Research Centre V. Union of India AIR 1995 SC 922, held that right to health and medical aid to protect the health and vigor of a worker, both while in service and post-retirement, is a fundamental right under Article 21.

Further, According to Article 19 (1) (g) of the Indian Constitution, the fundamental right of all citizens to practice any profession, or carry on any occupation, trade or business is subject to restrictions imposed in the interest of the general public under Article 19(6). The Hon’ble Supreme Court in the case of Burrabazar Fire Works Dealers Association and Others v. Commissioner of Police, Calcutta AIR 1998 Cal. 121, held that Article 19 (1) (g) does not guarantee any freedom which is at the cost of the community’s safety, health and peace.

Right to Health is a part and parcel of Right to Life and therefore right to health is a fundamental right guaranteed to every citizen of India under Article 21 of the Constitution of India. We owe the recognition of this right to the fact that the Supreme Court of India, through a series of judicial precedents, logically extended its interpretation of the right to life to include right to health.

Therefore, it is the duty of the State to care for the health of the public at large and the Central Government and various State governments have, rightfully and proactively, taken various measures to contain the entry and spread of the COVID-19 pandemic.