In India, the numbers continue to rise in many cities and the peak is yet to be seen. Healthcare and almost every conceivable body is involved in the planning and execution of COVID care to help the nation through this crisis.
We are amidst the worst pandemic in living memory. In India, the numbers continue to rise in many cities and the peak is yet to be seen. Healthcare and almost every conceivable body is involved in the planning and execution of COVID care to help the nation through this crisis.
The Wuhan model of handling patients with COVID was to create a massive COVID care center and ensure that the care of COVID patients did not mix with the care of non-COVID patients. While this is a good model as long as the viral infection is not in community spread; it is near impossible to identify COVID positive from COVID negative when a large number of patients are asymptomatic and positive or have immunity and therefore are at no risk. Is there a case to provide both COVID and non-COVID care in the same facility? This has been done in many Indian hospitals. The antagonists permitting such a policy claim that doing so, would raise the risk of non-infected patient admitted in the hospital from contracting the infection. The protagonists have a different story to tell. They claim that non-COVID care is equally important and should be provided to the population in equal measure within the facility; the reasons are as below.
In India we deal with a huge burden of NCDs (non-communicable diseases). Even as early as 2013, an article in BMC Nephrology states that the incidence of end stage renal disease was 229 per million population and every year another 100,000 cases are added. This is only one example. To this we need to add other NCDs including diabetes, heart ailments, hypertension and so on. There are other healthcare services that are so important to continue: immunization programs for children, the treatment of TB.
This is true for countries as well. A WHO study of 155 countries showed partial or complete disruption in many countries for non COVID care, 53% of countries showed disruption in the treatment of hypertension and 49% in the treatment of diabetes.
This is because of several reasons, all related to the pandemic. Lack of transport, lockdown, fear of contracting the COVID, inadequate healthcare personnel because of diversion to the pandemic prevention and care; the list goes on. The lacuna is not a good sign with regards to the long-term status of health of India and the global population.
While there is no readymade answer, it is pertinent to state that nations should continue to treat non-COVID conditions in these times. Non-COVID conditions can be classified into the following: Emergency care: like myocardial infarction (heart attacks), strokes, Trauma (RTA), etc. Semi elective: cancer treatment, transplants, pregnancy.
Elective: managing NCD’s; joint replacement, cosmetic procedures. Health planning should address these conditions differently. There is no doubt that emergency care for non-COVID conditions should get priority and there should not be any delays in such treatment. The same applies to all conditions that are NCD’s. It is best that this care is in the same center visited by the patient as continuity is vital. For example, a kidney failure patient will need dialysis typically thrice a week – this is a life sustaining treatment and missing even one session can have dire medical consequences. Continuity is also equally important in preventive and planned care for children and expectant mothers for the long-term health of mother and child.
On the care for NCD’s and maternal/child there is the option of telemedicine which enables a consultation with the doctor and prescriptions. However, for procedures like hemodialysis patients have no choice but to come to a center with dialysis infrastructure.
Others procedures may be semi elective. For here the conditions are such that some need to be on priority and others can wait. This includes interventional cardiology, bypass, transplants etc. Lastly, there are conditions that can wait, and should be low priority. Examples include joint replacement, cataract, and cosmetic surgery.
Thus, above stated is an opinion in favor of treating COVID and non-COVID in the same facility, I am sure others will argue against. I rest my case with the following fact: The virus will no doubt be with us for some time; diabetes, kidney disease, hypertension stay with us for life. Failure to control NCDs also costs lives. The only difference is that it is not so obvious.
We should have healthcare facilities handling both COVID and non-COVID care. There needs to be segregation of COVID and non-COVID areas, with suitable air changes and other measures to ensure that there is no cross airflow between such areas. The protocols to achieve this are workable and can be defined, for manpower, area segregation, patient flow, etc., this will minimize the disruption of vital care for emergency care, management of NCD’s as well as maternal and child care.
Nandakumar Jairam is Former Chair — FICCI Health Services Committee; Former Chairman- NABH; and Chairman, CEO & Group Medical Director, Columbia Asia Hospitals India.