COVID-19 pandemic is an overwhelming global crisis. Most of the attention and response is obviously drawn towards COVID 19- social isolation, containment, testing, and above all earmarking beds in various hospitals. As a cancer surgeon, I have also kept my patients, waiting for surgeries, over 3 weeks because of lockdown as they should not be exposed. I am sure this is true of chemotherapy, radiation and other fields at all centres. Cancer patients are vulnerable. Some hospitals are functioning on a partial basis to provide services. The real problem is that the other supporting infrastructure like nurses and ward boys, who are already strained by the epidemic, will be put through additional strain if there is a sudden increase in the cases and need for ICU beds, for non-COVID 19 patients. So far, and I say this with fingers crossed, we do not have a flood of sick COVID-19 patients in the ICU. At the same time, we also know that the current situation is not going to end on 14th April and that the lockdown is likely to be extended may be by 2-3 weeks. In this period, we have to ensure that non-COVID-19 patients do not suffer.
Now, what is the magnitude of this problem? 30% of surgeries in any multispecialty hospital are cancer-related. Besides, we also have patients who could develop additional problems. For example- chest pain, which can sometimes be managed with medication, but could also need angiography. Similarly, children are waiting for surgeries which cannot be delayed for too long and so on and so forth. Every single discipline has patients waiting. Of course, there are guidelines for prioritizing patients in each of the disciplines and that includes cancer. The category of semi-emergency surgeries is available.
One of the major shocks in Mumbai is that two major hospitals in Mumbai are declared as containment zones, Jaslok and Wockhardt. These are major multispecialty hospitals treating not just infectious diseases but many other diseases by various disciplines. If these major hospitals are closed, we are taking out a huge chunk of healthcare infrastructure from the system. We must remember that while the coronavirus pandemic continues, other healthcare needs persist.
What is the Pragmatic Solution for This?
Looking at what the other countries have done, particularly in China and in Italy, non-COVID-19 hospitals and COVID-19 hospitals are clearly separated. I think it is time to look into that for India as well.
Say the geographic area around a hospital where staff are infected, for eg., Wockhardt hospital is already declared as a ‘COVID containment zone’, the hospitals in the neighbouring areas can be declared as ‘non-COVID hospitals’ preserving the balance of the beds which are earmarked for the COVID emergencies.
It is difficult to contain COVID patients within the hospital treating non-COVID patients and there is likely to be cross-infection of staff leading to isolation of a critical resource. The hospitals must have to have strong protocols in place. As COVID is highly infective, the spread within the hospital is very likely.
Then comes the question of revenue. Yes, the private hospitals have to also pay salaries, maintain infrastructure and also compensate for the professional services in addition to buying most of the equipment for protecting their staff. Most of them do not have large surpluses as the public believe. They depend on their earnings to deliver the care. In our hospital, doctors have been asked to defer their professional fees, which is fine. I want my nurses and ward boys to be paid rather than me.
A functioning hospital not only generates employment for a good number of people and also can take care of non- COVID patients.
The healthcare workers and the patients should be offered testing to protect the hospital facilities, the staff and other patients
I feel that at least by 14th April, when we try to have a staggered lifting of the lockdown, policy needs to be framed on designating hospitals for non-COVID 19 patients, otherwise, we will be caught between the devil and the deep sea. On the one hand, we have a disease which has to be treated early. We have always said that early treatment is important. On the other hand, we have a health emergency to deal with. We need to find the right balance so that no one is compromised in this pandemic.
Believe me, it is not just next couple of weeks, it may even take a couple of months, so planning healthcare and essential service is of utmost importance.