Hospitals committed to Covid cases, all other patients put on hold

Radhakrishnan (name changed) suffers from stomach cancer and his frail body — he is over 70 —has undergone multiple surgeries in recent months. Last week, when his pain shot up to unbearable levels, he went to the hospital in Nungambakkam, a Chennai neighbourhood, to see his regular doctor. The doctor was not there. He had refused to come to work fearing the coronavirus. Radhakrishnan had to consult a resident doctor who gave him some medication.
 

A 60-year old widow living in the northern fringes of the national capital went for her regular dialysis at a government hospital but found the unit closed because some nurses and doctors had tested positive. She was referred to a private hospital which was going to charge Rs 2,500 per session. It was her poverty that had made her get the free dialysis at the public hospital. Her family were in a quandary.  Rs 2,500 was too much. Her two sons, whose shops are now closed, finally convinced the hospital to reduce the fee to Rs 1,200.
 

Such stories reverberate from every corner of the country. Public health experts warn that unless a protocol is designed to handle the medical necessities apart from Covid-19, the country is set to see a sudden spike in deaths from preventable illnesses.

Cancer patients like Radhakrishnan are poised on a knife’s edge. “If we don’t treat cancer patients at  an advanced stage, they will die. On the other hand, if we treat them, they are exposed to the greater risk of coronavirus infection as all medicines used in cancer treatment are ‘immunosenescence’, which means they weaken their immune system," said Dr Prantar Chakrabarti, senior hematologist-oncologist who has earlier worked at AIIMS. The doctor is now associated with several private hospitals.

The biggest challenge is that the Covid-19 virus is active inside the body for days. Even if a person tests negative now, it is very difficult to start, say, cancer treatment as he may turn positive after a couple of days.

“It is becoming nearly impossible to take a call on cancer patients. So, unless a patient is on the verge of death if not treated, we are trying to delay the treatment of cancer patients which under normal circumstances we would not have”, said Dr Chakrabarti.

Blood banks are drying up. Hardly any voluntary blood donation camps have been held recently, resulting in an 80 per cent drop in blood collections. This has left critical patients such as those suffering from acute leukaemia who require fresh blood regularly at the mercy of the gods.
 

The traumas caused by the lockdown are endless in their variety. A senior officer in a private firm who is a cardiac patient suddenly complained of breathlessness during last weekend. His wife and daughter rushed him to a leading corporate hospital in Navi Mumbai. The hospital did not even let the patient enter.
 

Its emergency ward was not functional and it would not even be able to check his vitals.  “We were panicked that breathlessness is a respiratory illness and my husband could be corona positive. We showed his ECG reports to convince them to check him but they wouldn’t budge," his wife said. She rushed him to a small nursing home in the neighbourhood where he was seen.

 

Archana, a bank employee, is worried about missing the regular weekly check -p for her premature baby, born at 32 weeks. In her case, the paediatrician is ready to meet the child at the hospital. Vaccination, eye and brain tests and other checks have been pending for three weeks now but how to reach the hospital?  "We don’t have a car and there are no cabs available. Besides, it is a hospital - the child may be exposed to the virus" she said.
 

The government is doing its best to offer the best care to Covid-19 patients but other patients with serious conditions are left high and dry. This has prompted Kirit Somaiya, a BJP MP, to write to Maharashtra Health Minister Rajesh Tope to plead for non-Covid-19 patients to be looked after.

Somaiya said that with hospitals shut and travel restrictions in place, other patients were being denied access to treatment and the situation was only going to get worse.

In making space for Covid-19 patients, the number of beds and ICU beds available for other critical patients has fallen significantly. "A leading hospital in Delhi has asked some patients who were admitted to go home as they had to earmark beds for Covid-19. This got worse after the Tablighi Jamaat cases started coming to the fore and there was a sudden panic in the capital to create hospital infrastructure for coronavirus patients,” said a New Delhi health care activist.
 

Right now, no elective operations are happening. Anyone needing a pace-maker or hernia surgery cannot have it. No one knows when, even if the lockdown is relaxed in phases,they might resume.

 

Nor is it the case that only a small number of people are suffering as a result of the focus on dedicating healthcare facilities to those who have the virus. According to a 2014 study by the National Centre for Biotechnology Information, the ‘age-standardised prevalence of cancer is estimated to be 97 per 100,000 persons with a greater prevalence in urban areas’.
 

The study goes on: “Approximately, over 200,000 people die every year of tuberculosis. According to the India TB Report 2019, the estimated TB incidence in India is 2.7 million. Advanced kidney failure kills an estimated 225,000-275,000 a year in India.”
 

Health expert Anant Bhan said that immunisation drives have also taken a back seat.  “This means we can expect a rise in diseases that can be avoided through vaccination. There will also be a rise in infant mortality rates with pre and post-pregnancy cares going for a toss,” he said.
 

Even as patients suffer, the health care workers too are at risk.

Sample this: frontline doctors and nurses at a public hospital in Ahmedabad are buying N95 masks from the market at double the usual rates. "There have been instances where 7-8 doctors were sent in a single ambulance for COVID duty in containment zones without proper kits with most sharing whatever equipment they had within themselves," said a medical personnel at the hospital on condition of anonymity.
 

Amidst lack of sufficient PPE kits which include complete body suits or coveralls, personnel on COVID duty treating positive cases at the hospital are being provided HIV protection kits instead which is not as efficient as a PPE kit. "These HIV kits include a long plastic-like apron with paper-like sleeves, plastic footwear cover and head cover but it does not cover or protect one's neck, face and lower part of the legs," another medical worker at the hospital said.
 

Ironically, while India has now begun hydroxychloroquine (HCQ) to other nations, its own medical workers on COVID-19 lack supply. "Resident medical workers who are not on COVID duty are staying within the hospital and share rooms and floors with those on COVID duty. In such cases, all medical workers need administration of HCQ to reduce the risk but the drug is not available in plenty and is being rationed for only those who are in COVID duty," the medical personnel stated.
 

It seems the COVID19 ironies are here to stay.
 

(With inputs from Gireesh Babu, Vinay Umarji, Sachin Mampatta, Dev Chatterjee, Samreen Ahmad, Arnab Datta, Virendra Singh Rawat and Sohini Das)