Non-Covid patients can’t be left in the lurch

COVID-19 has shaken the entire world. Even the superpowers seem quite helpless. The confidence initially exhibited by some world leaders has thinned. No less than the UN Secretary General, Antonio Guterres, described the crisis as the ‘fight of a generation’, and has gone to the extent of stating that the “weaknesses and lack of preparedness exposed by this pandemic provide a window onto how a bio-terrorist attack might unfold”.

Closer home, the limitations of India’s public healthcare system and the visible experience of the developed economies, which have advanced healthcare facilities at their disposal, have exacerbated the sense of disquiet. A regrettable undercurrent of stigma can be sensed, in regard to persons who have contracted the virus. The lockdown and other social distancing measures, which are perhaps the only method of controlling the spread of this highly contagious virus in a country with as large a population as ours, are taking a heavy toll on the poorer sections of society. However, other options available with the authorities are limited, in the absence of a vaccine or an effective line of treatment. Union Health Minister, Dr Harsh Vardhan, therefore, fittingly referred to the lockdown as a ‘social vaccine’ for protecting Indians from this disease. It also bought us some time, to augment our healthcare facilities in order to better handle the crisis.

Medical science, with all its advances, has so far failed to provide a satisfactory answer to Covid-19 virus. However, medical and allied health professionals, despite all the existing limitations, are courageously fighting this health war with an invisible enemy. Many, across the globe, lost their lives while performing their duty.

Quite apart, a pressing and disturbing development needs to be highlighted and urgently addressed. An unfortunate collateral victim of the Covid-19 virus is the availability of timely and adequate medical care to patients suffering from ‘non-Covid’ diseases. The immense fear, bordering on panic, generated by the highly contagious nature of this virus has adversely affected the healthcare delivery apparatus in respect of patients suffering from other diseases. This kind of fear not only deters patients from actively seeking medical care, it also appears to have impacted the readiness and willingness of doctors and hospitals to make the medical care available. Many hospitals, large and small, both in the private and public sector, have closed their out-patient departments (OPDs) and restricted the ‘in-patient’ facilities. This is a virtual denial of medical care to a significant segment of our population suffering from serious or debilitating ailments, albeit ‘non-Covid’. While all necessary precautions and measures must be taken in the case of Covid-19 patients, the feeling of dread created by this virus must not result in delay or denial of medical care to ‘non-Covid’ patients.

Telemedicine may help some patients, but has its own limitations. A proper clinical examination and evaluation is not possible in a video call, and is essential in some cases.

It should not be forgotten that Covid-19, in the short experience we have had so far, has proved to be a rather unpredictable virus. It does not appear to conform to any known patterns or rules. A more complete understanding of the virus and its effects will take time. Patients are showing up with unusual manifestations, such as stroke, acute heart attack, abdominal symptoms or sudden renal function deterioration. Consequently, doctors and hospitals are, rightly, suspecting the hand of Covid-19 in patients presenting such symptoms, whether as medical emergencies or otherwise. Even patients with chronic diseases who exhibit a sudden or marked deterioration are suspected to have contracted the Covid-19 virus. These indications for Covid testing would be fully justified, in view of the highly contagious nature of the virus, and should be permitted by the ICMR. Reliable molecular tests are available which give results in a matter of a few hours, and these can be used even in emergency cases. A negative Covid test result will thus help to avoid any delay in surgery or intervention in the treatment for the non-Covid ailment or disease. Many of these diseases and ailments are, by themselves, serious and agonising, if not life threatening. As such, their progression, with the consequent medical complications, cannot be permitted.

Unfortunately, in the past couple of months, cases of patients suffering from ‘non-Covid’ chronic diseases being unable to access the required medical care facilities have come to light. Some have even succumbed and lost their lives. The closing of services like OPDs and surgical or other facilities requires a relook which can brook no delay. Going by recent scientific predictions, we will have no choice except to live with the Covid-19 virus for a substantially longer period of time than originally believed. Medical care to the needy cannot be compromised for any prolonged period. In these testing times, creating a sense of confidence in the system is vital. Medical professionals and administrators must act to protect and care for all patients suffering from any kind of ailment.

In addition, a long term and holistic assessment of our healthcare system is necessary. Never let a serious crisis go waste, as someone once said. There is no gainsaying that this pandemic has exposed the sad neglect of the medical and healthcare sector, and its professionals, over the years. Instead of prioritising expenditure on healthcare delivery, and empowering institutions and professionals, the powers that be in India have done the opposite. Covid-19 must serve as a wake-up call for all of us, and it is imperative that we learn the right lessons from this pandemic. Once the worst is behind us, we must take a long and hard look at the issues ailing the medical and healthcare sector in our country. No stone should be left unturned to address these issues. All necessary steps must be taken in future to equip and strengthen our medical institutions, infrastructure and professionals. Only then can we have the confidence of being adequately prepared whenever the next such challenge knocks on our door. If we act in the right earnest, the goal is within reach.