Need to reboot health care system to also focus on non-covid patients
Hospitals have and must adapt and evolve to treat patients with and without Covid-19... Elective procedures can be postponed for a while, but they cannot be postponed indefinitely
DR NARESH TREHAN, head Medanta-the Medicity, Gurugram
NEW DELHI: Many hospitals that had shut down non-essential care services and postponed elective surgeries to lower crowding and free up health staff to treat coronavirus disease (Covid-19) patients will begin working to capacity once the lockdown lifts, but operations are unlikely to return to what they were before.
“Hospitals have and must adapt and evolve to treat patients with and without Covid-19, to ensure no one dies because of lack of treatment. elective procedures can be postponed for a while, but they cannot be postponed indefinitely. We’re already seeing complications of gall bladder stones getting septic and people getting heart attacks, which could have been averted. Separated Covid-19 hospitals and wards, and infectioncontrol and crowd management protocols will ensure patients and health staff stay protected,” said Dr Naresh Trehan, who heads Medanta-the Medicity, Gurugram.
Non-communicable diseases (NCDS) such as heart disease, cancers, diabetes and chronic kidney disease account for around 61.8% in 2016, as compared to 37.9% in 1990, of all deaths in India, according to Indian Council of Medical Research (ICMR) report: India - Health of the Nation’s States 2018.
With social distancing being the new normal, reduced movement associated with social distancing and unhealthy snacking is threatening to aggravate risk factors for NCDS, such as obesity, high blood pressure, high blood sugar, and high cholesterol.
“A month of being cooped up indoors would not have caused irreversible health damage, but it will if it continues. Outdoor physical activity must be consciously re-initiated with basic precautions once movement restrictions are slowly lifted ,” said Dr Nikhil Tandon, professor and head of the department of endocrinology and metabolism, All India Institute of Medical Sciences.
What needs as much attention is the absence of routine, and anxiety about an uncertain future that will lead to undiagnosed mental health issues in millions. “A lack of structure can really damage health because regularity of when you eat, how much your exercise, when you sleep is critical to manage NCDS, such as obesity and depression,” said Dr Tandon.
Many states have halted immunisation and reproductive health outreach services as community health workers help with Covid-19 surveillance and contact tracing.
Missed immunisation may lead to a resurgence of potentially fatal vaccine-preventable diseases, such as childhood pneumonias and hepatitis B. This threatens to reverse the gains India has made by immunising children against vaccine-preventing illnesses to bring down infant mortality rate to 33 per 1,000 live births in 2017 from 34 the year before.
The national programmes to eliminate malaria, and treat tuberculosis and HIV have also taken a hit and will need a push to ensure they don’t derail. “Overall case notification (in India) has significantly declined due to reduced testing and though the lab services are open, people cannot come due to the lockdown. Once the lockdown is relaxed or completely removed, we think there will be a surge in people seeking services,” said Jamie Tonsing, Regional Director of The South-east Asia Office of the International Union Against Tuberculosis and Lung Diseases ( The Union).
Government officials are now realising the need to integrate health programmes, data systems and cross-departmental planning so that multiple agencies can work together. “What Covid-19 has taught us well is the need for coordination. The central and state governments should not go back to bureaucratic normal after the worst of the Covid-19 pandemic is over ,” said a senior health ministry official, who did not want to be named.