Health-care in the midst of a global pandemic
Patients in need of critical care for cancer, aneurysms or other life threatening conditions are staying away from hospitals. Even potential life saving treatment is put off, often creating avoidable complications.
Recently, I participated in a symposium organised by a UK based NGO, Our NHS Our Concern, with the PHD Chamber of Commerce and Industry on Healthonomics that highlighted the adverse impact of Covid-19 pandemic on the private healthcare sector: a 70-80% drop in footfall and test volumes and 5070% drop in revenue. Some small hospitals and nursing homes, especially in Tier II and Tier III cities, have been forced to shut their operations due to dried up cash flows. Private hospitals and nursing homes which constitute more than 60% of beds, 60% of in-patients and 80% of doctors in India, are expected to witness short term operating losses to the tune of Rs 14,000 cr to Rs 24,000 cr for a quarter. Due to Covid-19, they have had to invest heavily in manpower, equipment, consumables and other resources to ensure preparedness for safety in their healthcare facilities.
Covid-19 has affected us in multiple ways. The most obvious is the immediate fallout for people who contract the dreaded disease. Self isolation or quarantine is the least of its consequences, even though frightening enough by itself. The disease can lead to hospitalisation; days, weeks or even months in ICU; and even long term complications. The dire medical and financial consequences are not the norm; they happen in a small percentage of cases. A large number of patients recover in a week, not much worse off than a common flu. The most celebrated patients initially were in the UK. The 71-year-old heir apparent to the British throne, Prince Charles, came out of self-isolation seven days after he was confirmed to have tested positive for coronavirus. UK’S Health Secretary, Matt Hancock, also returned to the frontline in a week’s time. UK’S most famous Covid-19 patient was Prime Minister Boris Johnson, who took six weeks to recover, following a lot of struggle by his doctors and medical staff. In India too, we have avidly followed the recovery of the father and son duo, Amitabh and Abhishek Bachchan.
The abiding images of this pandemic remain that of PPE clad medical professionals, overflowing hospitals, with patients on the floor and masked people on the streets. With social distancing being a new expression in our vocabulary, we have learnt to fear other human beings, staying at least six feet away from others! It is this fear that keeps people at home even when they are in need of urgent medical attention. The European Society of Cardiology (ESC) carried out an extensive worldwide survey and reported in June that heart attack patients seeking urgent hospital care had dropped by more than 50% during the Covid-19 outbreak. An Indian Express report of 13 July indicated that the number of living liver and kidney transplants in Delhi during April and June came down to 50 and 30, respectively from the normal of 100-120 and 250, respectively. Patients in need of critical care for cancer, aneurysms or other life threatening conditions are staying away from hospitals. Even potential life saving treatment is put off, often creating avoidable complications. Coronavirus is supposedly more deadly for the elderly and those with co-morbidities, a term that we have suddenly become familiar with. It is also the same category of people that require critical care for the very same co-morbidities.
We went through this fear and churning in our family too. For the last few months, my elderly mother had been complaining of abdominal pain. After much prevarication, my father got an appointment for an ultrasound at the nearby JP hospital. He was reassured by lack of crowds there. The ultrasound report showed need for medical intervention. We approached a doctor friend at Apollo hospital in New Delhi, who felt that surgery was required. We had faith in his ability and sincerity, but could not overcome the fear of hospitals in the midst of the Covid-19 pandemic. A surgery would require a stay at the hospital and for a person of advanced age, the risk seemed enormous. The doctor had a long and patient conversation with us over telephone, explained the measures that the Apollo hospital has taken to segregate Covid-19 patients from others and detailed the sanitisation undertaken by the hospital. He emphasised that this was vital not only for the safety of the patients, but also that of doctors, nurses, paramedics and other hospital staff working at the hospital on a daily basis.
Despite our apprehensions, my mother was taken to Apollo hospital. The hospital allowed in only one person with the patient. Sanitisers were readily available. Doctors and staff were sympathetic. She was given a Covid test along with other blood tests required by the doctor. We were told that no patient is admitted to the hospital without it. Following necessary examinations, she was operated upon the next day and discharged a day later. Simultaneously, my father too required medical attention. With the help of the hospital administration, his tests were clubbed with my mother’s admission to the hospital. We are now reassured that the urgent medical needs of both my elderly parents have been attended to.
Over the years, India has become a hub for medical tourism or medical value travel. Countries in our neighbourhood, West and Central Asia and Africa have all relied on the advanced but affordable healthcare available in India. Visitors from various parts of the globe, including the developed world visit India to avail of world class modern medical treatments as well as for rejuvenation through traditional medical practices especially Ayurveda. Availability of skilled medical professionals in what is become known as the “Pharmacy of the World”, with ease of communication and tourism options have made India one of the world’s most popular medical tourism destinations. The medical tourism industry, which was worth about US $3 billion, was estimated by some to grow to US $9 billion in 2020. However, following the arrival of Covid-19 Pandemic, flight bans and travel restrictions, this entire sector is badly affected, not unlike other tourism related activities.
The capital-intensive hospital sector is constrained with liquidity. Enormous capital expenditure is required to build a speciality hospital and regular infusion of capital is needed to keep it abreast of the fast paced global technological and medical advancements. The estimated impact of massive operating losses and additional investments could cripple this sector unless there is some liquidity infusion into the sector, indirect and direct tax benefits, and fixed cost subsidies from the government to address the disruption. A robust plan for strengthening the existing public sector health services is also desirable. An additional challenge for policymakers and healthcare professionals is to allay the fear of hospitals pervading our societies, without undermining the need for continuing precautions.
As we live with precautions during this pandemic, it is useful to remember that regular life at hospitals has been going on, though at a slower pace. Children are being born, critical care and other urgent requirements are also being seen to. While remaining cautious and following protocols, we should be mindful not to let paranoia take us over. A balanced outlook is difficult, but necessary. Ruchi Ghanashyam is a former Indian High Commissioner to the UK.