Non-Covid patients need critical attention

SHRAVAN SUBRAMANYAM / PREETHA REDDY

Since March 2020, the surge of patients infected with Covid-19 has been a massive challenge on the health infrastructure around the world. This challenge was lot more pronounced in India, as the country’s public health system was not geared to address this unprecedented crisis.

The pandemic has severely impacted those in need of critical medical care for other ailments. Elective interventions and even reviews for thousands of patients have ben deferred. Over a year, the continued delays in planned procedures has created a massive build-up.

A growing concern is that patients ailing with cancer, cardiac diseases, orthopaedic and respiratory diseases etc. are continuing to avoid visiting hospitals and getting their elective procedures done. The misinformation around vaccines and restrictions on mobility due to government lockdowns has further exacerbated the situation.

It is vital that hospitals address these patients on a war footing, Delays in time-sensitive procedures like transplants or cancer treatments are leading to deteriorating health, poor quality of life, bigger medical bills, and potentially higher mortalities.

The Lancet study which compared Oncology data across 41 cancer centres between March 1 and May 3, 2020, with the same time period in 2019 showed a 54 per cent reduction in the number of new patients registered, follow-up visits decreased by 46 per cent, hospital admissions saw a fall of 36 per cent.

Not just cancer, but treatments across the board took a back seat. A British Journal of Surgery report estimated that the number of operations cancelled in India in 2020 was 48,728 per week or about 585,000 over 12 weeks.

These delays in elective surgeries have the potential of turning into emergency surgeries, thus reducing chances of survival. Experts fear that simple complications, small tumours and early indications which can be resolved with timely diagnosis worsen when preventive surgeries are delayed.

According to a BMJ study, across all three modalities of cancer treatment — surgical, systemic and radiotherapy — even a four-week delay was directly associated with increased risk of death.

Government restrictions on movements coupled with patient hesitancy saw a sudden shift from in-person doctor visits to online consultations world over.

In India, telemedicine has existed for over decades, but received a push only last year with the government formalising its usage in March. This surge in digital health was welcomed by practitioners as it was safe, convenient, and time- and cost-effective.

Remote monitoring solutions helped boost ICU capacities in urban and rural areas although connectivity continued to pose challenges. Unique CT solutions and AI chest x-ray applications aided quicker diagnosis and were deemed safer both for patients and for technicians.

In its current form, telemedicine and remote monitoring have their limitations. While they are “supplementary”, they cannot be a replacement to in-person consults. Specialists fear that patients may be in bigger trouble if fatal conditions are left without immediate medical or surgical intervention.

Way forward

A recent World Economic Forum report showed that the backlog could take at least 45 weeks to cover, as every extra week of disruption due to the pandemic directly correlated with 2.4 million procedure cancellations. Non-communicable diseases (hypertension, cardiac issues, stroke, lung diseases, cancers, and so forth) contribute to over 62 per cent of India’s disease burden — much higher than infectious diseases.

And now with the surge of Covid-19 cases being controlled, the world is gearing up to open its hospitals for elective surgeries. It is time for governments and private sector to work together in scaling up intervention for cancer and other non-communicable diseases. And, with all the additional capacity created for Covid, it is in patient interest to use the existing medical infrastructure like temporary critical care units, hospital-based care, trains, ships to clear the backlog. Alongside, there must be a sustained campaign by the government for allaying fears with regard to hospitalisation for non-Covid treatments.

Looking at the cases and urgency, it is imperative to reduce the time that patients spend in hospitals. Digital solutions can accelerate diagnostics through automated or AI-driven image recognition.

Similarly, virtual tumour boards could provide a common platform to visualise patient data and streamline patient interventions. Robotic surgeries are a good option as they allow distancing with fewer people around the patient and the robot doing the needful. Infection rates are lower when compared to an open surgery or a laparoscopic procedure and patient recovery is faster.

While we continue to fight the pandemic, another silent epidemic of NCDs, of much graver severity is in the making and there needs to be a concerted effort by both governments and multilateral agencies to tackle it head-on before it is too late.

Subramanyam is Managing Director, Wipro GE Healthcare and Sr Vice-President, NATHEALTH, and Reddy is Executive Vice Chairperson, Apollo Hospitals & Immediate Past President, NATHEALTH

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