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Covid vs non-Covid patients: How to balance requirements and provide holistic healthcare for all

An Expert Explains: Non-Covid-19 patients have been paying the price of India’s efforts against the coronavirus. At least 25 per cent of these deaths could have been prevented had we been able to take care of non-Covid patients as well.

Written by Manas Panigrahi , Edited by Explained Desk | Hyderabad | Updated: July 7, 2020 6:27:44 pm
coronavirus, covid 19, hospital patients covid 19, non covid patients hospitals, indian express covid 19, corona cases hospitals, coronavirus deaths india, express explained covid 19 A health worker removes takes off his PPE kit at the Rajiv Gandhi Super Speciality Hospital in New Delhi. Express Photo Praveen Khanna

Amidst the chaos of the novel coronavirus pandemic, there is the parallel threat of misinformation being circulated in massive volumes. It is the responsibility of health professionals and concerned authorities to bust myths and to impart scientific and ethical knowledge to society.

Also, we cannot wait for Covid-19 to subside, and ignore patients who are suffering from chronic illnesses like cardiac problems, renal diseases, brain tumours, cancer, etc. The crude death rate in other diseases has increased significantly. The estimated number of deaths over the past six months is 25 lakh. Non-Covid-19 patients have been paying the price of India’s efforts against the coronavirus. At least 25 per cent of these deaths could have been prevented had we been able to take care of non-Covid patients as well.

We are focussed more on Coronavirus even after the lockdown has been lifted. The lockdown was enforced so that we could prepare, and develop the required health infrastructure to deal with the increasing number of Covid patients. But during this period, we did not attend to people who were suffering from other diseases. Now, with all the piled up pending cases, plus the new Covid cases, the load on the health industry is enormous.

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How do we tackle this situation? This is the biggest challenge. As per a publication by Harvard University, Covid could persist until 2022. We cannot be locked down indefinitely; we need to find a way to deal with the circumstances, and bridge the gap between healthcare needs and capacity. We need to implement strategies by which we can manage both Covid and Non-covid patients.

A few studies suggest that people should be tested for Covid before treatment begins in elective cases. If the patient is Covid positive, then we first treat them for Covid, wait for a month, and only then take up the treatment required for the other disease.

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The risk of lung complications is high if we operate on a Covid-positive patient. Hence it is important to perform Covid test in all patients where surgery is planned. In emergency cases, there is no choice other than to attend to the patient and impart life-saving procedures.

The advantages of pre-operative Covid testing are clear. It protects the patient, healthcare workers, other patients, and their relatives.

But still, Covid testing is done in only 15 per cent of people. The other 85 per cent who come for operations may or may not be infected with the coronavirus — we cannot ascertain it. Some may have very mild symptoms or be asymptomatic.

Healthcare professionals are always at risk, irrespective of the current condition of the patient. We must take proper measures such as N95 masks, single-piece biological protection suits, etc. The principal problem with the suits is that they cannot be worn for more than 3-4 hours. The suits that astronauts wear have inbuilt oxygen cylinders in them, so they can be worn for 24 hours; biological protection suits with oxygen supply are very expensive, and cost up to Rs 5 lakh. Their use is not feasible — not just in India, but in western countries as well.

The only solution is to complete surgeries within 3-4 hours, or involve more surgeons and divide the work. It is not an easy task to treat both Covid and non-Covid patients. A doctor who is treating a Covid patient has a 10 per cent – 15 per cent chance of getting infected. So, a hospital that intends to continue operations needs to double its personnel, so they can work in cycles — such as a week’s work being followed by a week’s quarantine. Besides procuring equipment, PPE kits, ventilators, etc., governments should focus on recruiting larger numbers of healthcare workers. It is indeed the need of the hour.

The proposed model to run a hospital is to divide Covid and non-Covid beds exactly in a 50-50 ratio. If X number of personnel are required to manage the 50 per cent non-Covid beds, we need 2X that number to manage the other 50 per cent Covid beds. If we increase the size of the team, the existing health infrastructure will be sufficient and adequate to address the increasing cases of both Covid and non-Covid patients.

Dr Manas Panigrahi is consultant neurosurgeon and head of the Department of Neurosurgery, KIMS Hospitals, Hyderabad.

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