Impact of Corona Pandemic on Healthcare: Lockdown or Unchained?

While the 1.3billion people went into a prolonged lock down, initially for 3 weeks and later extended by two more weeks, this time period was well envisaged to escape the initial wrath of Corona virus pandemic, while preparing the infrastructure to tackle the load of patients expected. Stringent public health measures were put in place with an intention to flatten the curve and not let the resources be overwhelmed.

During this period, the regular patients coming to the hospitals for the out-patient visits and non-emergency ailments were stopped, and only emergencies were entertained. This was done to avoid crowding of patients and their relatives in the hospitals and also letting the healthcare machinery to focus on the task at hand.

Handling humans, that too the sick ones is a challenge. Unlike files in an office, which can be prioritized and less essential ones set aside for later, such things are a challenge when one deals with human beings. Patients who are on regular follow up, for chronic conditions and lifestyle disorders like Diabetes, hypertension, thyroid disorders, chronic systemic conditions, need to see their doctors atleast once every 1-2 months, more so if not optimally controlled. Dispensing medicines also becomes a difficult issue in these circumstances.

With over sub-specialization of medical practice, its become even more difficult to handle such patients at primary and secondary care levels. Partial solution to this has been a prudent use of tele-medicine which has become convenient with the use of smart phones and social media.

At the same time, there is an interesting observation that is likely to make the healthcare fraternity sit back and introspect, as to their role in health or sickness in the society. 

Working in one of the busiest tertiary care hospitals in the capital, with daily footfall far exceeding a thousand every day, in various OPDs and emergency department, which is suddenly closed for all but most emergent of these patients, common sense would predict that there would be a barrage of patients coming with worsening of their condition, in emergency state, or some might even deteriorate at home or enroute, leading to increased mortality and hospital casualty visits.

Obviously, where would all those patients who thronged the corridors of the hospitals, with their myriad complaints of aches and pains, coughs, fevers, diarrhoeas and many other such, seek their treatment. Won’t they suffer and worsen before landing up at the hospital doors in ambulances with their sirens wailing and calling out to the same healthcare system that was always open to all their cries, however minor. Haven’t the doctors been their saviors, curing them of all ills, or atleast alleviating their agonies and pains?

During the period of lockdown, what was observed said something else.

While all specialty and sub-specialty OPDs were closed, except for obstetrics, pediatrics and all emergencies, the overall visits to the hospital casualty department, admissions to ICU and other acute wards in critical state and deaths in hospital/Out of hospital deaths, neither of these had alarmingly increased during this period. There are fewer patients coming with chest pains due to heart attacks, only to be wheeled into cardiac cath labs and stents placed into their coronaries.  Even the diabetic patients on insulin who are on my telephonic follow up, seemed to show good numbers on their glucose readings. 

What could be the reason for this unexpected observation?

The real answers would require a more scientific investigation, however my guess, put simply are:

1.       Most illnesses, especially the minor ones are self-limiting and would pass off peacefully if just the symptoms and general health are taken care of.

2.       When seen by doctors, its common practice for them to advise some investigations and drugs, either for ruling out the possible causes, symptomatic relief and often for patient’s satisfaction.

3.       Cross-referrals to concerned specialty as per symptoms is also rampant, especially in this age of sub-specialization, which would further add to more investigations and drugs.

4.       Additional drugs in an already voluminous prescription would mean added chances of prescription errors, dosing errors and drug interactions which may be detrimental to the health of the patient.

5.       Greater visits to the hospital and hospitalization in some cases, would also mean increased chances of cross-contamination, infection by aerosols, and other means of infection by organisms which are often resistant to antimicrobials.

6.       Lockdown has also meant less pollution, lesser traffic accidents, lesser exposure to food consumed out of home, and hence lesser infections.

7.       The stress of work, travelling through traffic to and from workplaces, and the peace and comfort of staying at home with one’s family must definitely have brought down the blood sugar levels and Blood pressure levels, the two biggest killers in the times we live in.

8.       Timely meals and rest with regular drug intake are likely to have ensured a better glucose control in my patients despite there being a lack of outdoor activities, which has been compensated well with scheduled indoor exercises.

9.       Elderly persons, getting the much-needed company of their working kids, forced to stay home now, who were earlier hardly seen, and never in a relaxed frame of mind to converse. This might have contributed to better mental state in these veterans, a much-needed factor in good health.

10.   On the flipside, its likely that sinister events like heart attacks or strokes are being missed and if patients do survive, they are likely to end up in complications later.

 Does it mean we got it all wrong, all this while when we thought that as doctors, we were custodians of health of the population.

Are we really the life-saving god-equivalents or did we hype our importance by downplaying the simpler albeit important aspects of health?

Is overall wellness and preventive health aspects, often pushed to the corners of teaching syllabus or healthcare priority, the real key player?

Is it time to give these not-so-glamorous aspects, their well-deserved place in the first line of healthcare?