By Dr Amit Malviya
The novel coronavirus pandemic originated in Wuhan, China and has spread across the globe causing loss of precious lives and livelihoods. The severe social and economic impacts have ridden the people in a manner which has never been witnessed before by the current generation. It is almost a year now and sadly, the beginning of the end is still not in sight. India has seen a tremendous increase in the number of cases as well as mortality in the preceding few months. The sagacious and logically appropriate responses from the Government of India (GoI), the Indian Council of Medical Research (ICMR), various State Governments and other medical organizations have been towards the mitigation of this epidemic by employing certain preventive strategies, public health education and uplifting of healthcare infrastructure. While all these efforts have resulted in some positive effects in terms of curbing the Covid menace but we must be prepared for the unseen; a second wave of suffering and distress which is just around the corner waiting to stress our health care system and to affect the suffering of people at large.
The second wave of non-Covid patients who are currently not able to access health care services due to restrictions and other factors are discussed below.
The unwanted, unintended and unforeseen indirect effects of this pandemic and subsequent mitigation measures including lockdown on the non-Covid patients’ healthcare delivery is going to be very challenging and significant. As of now, most of the resources have been redirected towards waging a war against the corona pandemic but in a country like India with striking health inequities, weak health infrastructure and tremendous dependence on private health sector along with absence of a proper social security system it is almost sure to adversely impact the care of non-Covid patients. I believe that while it is justified to prioritize the current pandemic, in the same breath the healthcare stakeholders must not turn away from a wider perspective on health.
Patient- centric issues:
There are many reasons as to why non-Covid patients are going to suffer and I apprehend will have worse outcomes if the situation continues. The first and foremost reason is the apprehension of patients in visiting hospitals due to the fear of catching corona virus infection. The amplified message of social distancing on one side and fear of being quarantined or staying alone in hospital on the other, leads these patients to choose to ignore or bear worsening symptoms of the disease, stay at home and avoid the obligatory care they require; they consequently suffer severe complications or come to hospital in advanced stage of the disease. The second reason is the economic impact of the policy responses by GoI (like the lockdown) which has resulted in unavoidable downstream effects, especially economic slowdown with loss of jobs and livelihoods. It is expected that out of pocket expenditure is likely to come down and drug compliance by the patients will be doubtful. Thirdly, the social carnage caused by the Covid19 pandemic has been very heart wrenching. The actual or virtual distancing from care providers, the social stigma associated with Covid19, loneliness and changes in lifestyle have been the forerunning causes of disturbed mental health among the population. “Coronanxiety” is the new phenomena affecting huge number of people. Mental disorders are a well known factor for worse prognosis in patients with chronic health disorders. Another issue which crops up is the promotion of digital healthcare including tele-medicine by GoI but the actual chances of availing such technology by poor and low socio-economic strata (who are the majority sufferers) is not particularly encouraging. Lastly, the structure of health care delivery in India is largely dependent on private health care providers and with most of the Government resources directed towards Covid mitigation, the patients are forced to go to private health sectors which are more expensive and may be not affordable by the majority of healthcare seekers.
Healthcare delivery issues:
The daunting task of delivering quality health services to patients while maintaining safety for all is a very challenging issue all over the globe. Both doctors and health care workers are under extensive strain and stress because of the physical risk of contracting the infection. The death rate among doctors due to Covid19 is higher than for the general population. With restrictions in non-essential contact, the physical examination (with Personal Protective Suits on) and many routine clinical tests are difficult to perform. The stethoscope seems to be distancing from the patients unintentionally. Along with this, the resource reallocation has burdened the routine care for stable patients including surgeries which more or less are postponed in most of the hospitals. For instance in the United States of America the volume of non-Covid related procedures has gone down roughly by 50%. If we see the example of our hospital(NEIGRIHMS) , the number of elective surgeries has also come down drastically. It is notable that incidence of other diseases has not come down but the treatments for them have been deferred. Ultimately, it is the patients who are suffering. The disruptions in the routine health care delivery to patients will finally lead to disruptions in optimizing medical therapies and delay in care of non-Covid acute medical conditions, possibly leading to worse outcomes which cannot be forecasted but surely the lack of timely treatments will lead to great suffering. Added to this is the shameful and despicable trend of violence against doctors at work places, which, of course, is not new to India. This has resurfaced and is discouraging the health care workers to put their foot forward. Physical violence against healthcare workers who are being thrown out of residential colonies, being termed as corona spreaders and so on and the corona stigma is bound to affect the care of non-Covid patients adversely.
Conclusion:
Although speculative, the issues discussed above are significant in a way which can only be explained through the eyes of a person who is involved in such health care delivery. All three levels of the health care system, the patient, the doctor and the delivery infrastructure have been transformed by the cascading, adverse economic and social impacts of the corona pandemic. In the near future, when the lockdown measures are fully relieved and other restrictions are parted away with, a second wave, which has been accumulating all these days will put an unprecedented stress on hospitals and doctors. More and more patients will be requiring hospitalization and thus overwhelming the capacity of hospitals to deliver elective services. In India there are approximately 0.7 government beds per thousand population and even a marginal increase will exponentially stress the system especially when all resources are being directed towards Covid related cases. Therefore, it should be in our conscious mind that currently a second wave of non-Covid patients is waiting but out of sight and we must be prepared to deal with it and continue providing quality health care.
(Dr Amit Malviya is DM. FACC. FSCAI, Department of Cardiology NEIGRIHMS, Shillong Email: [email protected])