By Dr. Sandeep Arora
COVID-19 has evolved into the world’s most significant healthcare and economic crisis witnessed in the last century. The crisis that it triggered has already affected millions of lives, causing a substantial number of deaths and testing the most robust healthcare systems. No country has been immune to the crisis, and so has been the case with India. Within two weeks of the announcement by WHO, India announced a complete lockdown across all its states.
Subsequently, India’s health systems diverted all the infrastructure and resources towards COVID-19 containment. In a densely populated country like India, local health authorities had already anticipated the virus’s potential spread early on. They undertook several proactive measures quickly, including ensuring the availability of testing facilities,
disposable Personal Protective Equipment, and expansion of bed capacity in hospitals.
Despite these stringent measures, the number of cases continued to rise at a quick pace. While India’s actions in taming the virus are praiseworthy, there has been an adverse impact on non-COVID-19 patients due to this unexpected and sudden shift in focus and subsequent transition of healthcare delivery.
The focus of healthcare professionals, resources, and infrastructure shifted quickly towards managing COVID-19 patients, resulting in increased pressure on the overall system. Given the perceived risk of contracting the virus from a single visit to a hospital, patients with major non-communicable diseases, such as those involving heart, kidney, liver, or even rare blood disorders like Hemophilia, had no or limited access to most facilities at the time.
A report by the Ministry of Health and Family Welfare identified that 70-80% of patients who developed a severe form or died due to COVID-19 had underlying co-morbidity, such as diabetes, hypertension, or other chronic conditions. Due to high patient anxiety and fear coupled with the risk of contracting the virus, hospitals in large metro cities choose to postpone elective surgeries, reduce physical visits, and dedicate healthcare workers towards
COVID-19 care, resulting in a drastically reduced attention to non-COVID-19 patients.
A nation-wide survey conducted by IQVIA assessing the impact on patient care has shown a nearly 80% drop-in surgeries accompanied by a 70% delay in operations owing to COVID- 19. The results alone anticipate an increased workload of doctors’ post lockdown, leading to a scattered focus across both COVID-19 and non-COVID-19 patients. Self-managed avoidance of non-urgent visits or inadvertent delays due to the pandemic can cause a further surge. The aftermath may result in advanced stages of complications in cases related to acute or chronic medical conditions, further creating a significant blow to patients and the already burdened healthcare system.
India has been considerably lacking behind in public healthcare gross domestic product for decades compared to other developing nations. There is a dire need to build a multi-pronged disruptive strategy to enable a “healing touch” to non-COVID-19 patients during these unprecedented times. Only deliberate measures will prove instrumental in the long run to ensure sustainable healthcare delivery and avoidance of late-stage complications that may require urgent care.
Insights gathered from managing the COVID-19 crisis this way can catalyze investments to future-proof our public health system. It is also critical to leverage India’s information technology strength to shift from human resource-intensive specialty care to cater to the shortfall required for non-COVID-19 patients.
It is essential to improve non-clinical staff’s efficiency to take on necessary yet crucial activities, thereby unlocking clinician capacity for more direct patient care, such as redeploying clinical staff across specialties. The healthcare model involving “ASHA” workers has been a tremendous success in community health settings. It can be scaled-up to manage non-COVID-19 patient care and the implementation of remote consultations and telehealth, to help manage routine and chronic conditions.
Private healthcare organizations play a role in facilitating this transformation by expanding traditional on-site departmental specialty-based care to integrated healthcare delivery with a hub-and-spoke model to address non-COVID-19 patients’ needs. Patient care pathways, clinical protocols, and standard of care need to be based instead on this model. The importance of public-private partnerships to enhance healthcare delivery for
non-COVID patients, notably in peripheral centers, cannot be overlooked.
To segregate patient monitoring, hospital admissions, and intensive critical care, the scope of these partnerships can be expanded to include real-time data mining on patients with COVID- 19 and non-COVID-19 conditions. Emerging resurgences in COVID-19 and the degree to which hospitals can provide non-COVID-19 patient care can thus be determined.
The above steps will not only improve the global ranking and perception of India’s healthcare sector but also help in gaining momentum in the overall healthcare research and technology fields, including data science, ultimately leading to a faster access to innovative medicines for patients.
We have perhaps never witnessed such a catastrophic disruption as the one caused by the COVID-19 pandemic. It has tested our communities’ resilience and strength. Unfortunately, the worst may not be over yet. On the positive side, we have witnessed unprecedented collaboration between payers, providers, local communities, government agencies, and non-healthcare enterprises. The learnings from COVID-19 will mean a redrawing and reimagining of the very scope of “healthcare” with one single aim – an aim that is engraved by the father of modern medicine, Hippocrates, i.e., “to treat the ill to the best of one’s ability.”
(The author is Medical Affairs Head, Takeda India. Views expressed are personal.)