As lockdown starts easing up across India, what is the plan to deal with the massive surge of people who have been deferring care for all sorts of conditions? Undiagnosed TB, severe diabetes, cancer, mental health, you name it.

A plan for the "big surge" must be in place.

When people begin seeking care, there several big challenges for them to get adequate care:

1. There will be fewer private facilities operating, given the impact of COVID

2. Public systems will still be dealing with COVID-19, as cases will occur even after lockdown lifts

3. Private facilities that come back online might charge more to make up for revenue losses over the past 2 months; supplies will cost more

4. Both public and private sectors will take several weeks to recover and resume regular services

5. Since disease spectrum will be shifted to more advanced presentation, the need for tertiary services will likely increase, and these were expensive in the private sector, even before COVID-19

6. I suspect pharmacies & informal sector utilization will shoot up

7. In addition to increasing all-cause mortality, I worry that access to medical care will be even more inequitable in India

8. As I argued in this @htTweets piece, I don't think we can code our way out of this mess. Mobile apps, telemedicine, digital health are all great and welcome, but cannot help any country leapfrog fragile and under-resourced health systems. https://www.hindustantimes.com/cities/telemedicine-set-to-transform-healthcare-in-a-post-covid-world/story-j79r1yEDFxYaE4nlcFNL3I.html

9. I hope the biggest issue with public health delivery post-Covid is the recognition that universal health coverage is critical for any country to face a pandemic. Many countries are learning that you cannot build healthcare capacity during a crisis.

10. It takes time & investment to build a good public health system. India has failed to invest in health for decades and this must change post-Covid19. Health spend must at least increase to 2.5% of GDP, at a minimum.

Nothing new - people have been saying this for decades!

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