CLINICAL EXPERIENCE AND OPINION
Year : 2020 | Volume
: 6 | Issue : 2 | Page : 24--26
Effect of lockdown on patient care during COVID-19 pandemic
Kiran Kumar, Ratan Jha
Consultant Nephrologist, Department of Nephrology, Virinchi Hospital, Hyderabad, Telangana, India
Dr. Ratan Jha
Department of Nephrology, Virinchi Hospital, Road No 1, Banjara Hills, Hyderabad - 500 034, Telangana
|How to cite this article:|
Kumar K, Jha R. Effect of lockdown on patient care during COVID-19 pandemic.J Renal Nutr Metab 2020;6:24-26
|How to cite this URL:|
Kumar K, Jha R. Effect of lockdown on patient care during COVID-19 pandemic. J Renal Nutr Metab [serial online] 2020 [cited 2021 Jan 20 ];6:24-26
Available from: http://www.jrnm.in/text.asp?2020/6/2/24/294183
Human civilization is not new to pandemics. It has witnessed many such outbreaks from biblical times to this date. The last pandemic that has caused large-scale destruction happened in 1918-the Spanish Flu. Since then, the world has seen many pandemics, including influenza, HIV, SARS, MERS, Zika virus, in the last century. However, none of these has led to systemic change across the spectrum of fields the way SARS-CoV2 has done. With the advent of increasing globalization, the world has become a single global village. Affordable air travel, increased business ties, improved cultural exchanges, Internet, and social media interface have shortened the distances between continents and led to the intermingling of people. This has led to the spread of different infectious diseases in the form of pandemics much faster than the previous ones.
COVID-19 pandemic has caused havoc in the lives of ordinary citizens and patients alike. To combat the coronavirus, most of the government's worldwide have imposed 'lockdown' although the amount of restrictions varies from country to country. In India, the lockdown was started as Janata Curfew-citizen driven curfew and later extended for around 3 months. It was lifted in phases so that economic activity is re-started. During this time, the activities in hospitals such as elective surgeries, transplants, and routine OPDs were restricted. Initially, only a few government-run hospitals were earmarked for both testing and treating COVID-19 patients. Later on, the care of these patients was extended to other government-run as well as private hospitals. Although few hospitals were running OPD services, the patients could only avail of these services if they had private vehicles. Public transports such as bus services, auto-rickshaws, Metro-rail services, cab/taxis were not permitted. Private vehicles also were restricted to 2 persons per car or 1 person per two-wheelers. Transport was a big limiting factor for patient care during the lockdown. Even these vehicles were stopped and questioned by the police authorities. Many patients got dissuaded from visiting hospitals because of these restrictions. Every patient visiting the hospital was screened for flu-like symptoms, travel history, contact with COVID positive patients and was referred to designated hospitals if they were found to have a fever and the above history. All the health-care units had to arrange isolated spaces for patients coming with fever-COVID related or not. Pediatric and geriatric patients were worst affected as they were not allowed to come out of their homes. Patients with chronic illnesses had to wait in long lines, as part of social distancing, outside medical stores to procure medicines. All the emergency rooms were renovated to segregate the patients based on their symptom profile. All the hospital personnel, including the doctors, nursing staff, orderlies, security staff, admin staff, were to be provided personal protective equipment. All these changes led to hikes in the expenditure incurred, and the same was transferred to the patients. There was a scarcity in the number of testing kits at the beginning of the pandemic, and hence, the screening for SARS-CoV 2 was done by radiography like chest X-ray and computed tomography (CT) scans. Any patient being admitted for a non-COVID medical or surgical problem was subjected to CT scan of the chest. This was being followed by almost all health centers across the country. This added to the financial burden to the patients. With the mushrooming of various social media options, fake news about SARS CoV2 has become a menace. Superstitions, obstinate ideas, and false religious beliefs have become obstacles in preventive steps in the fight against COVID-19. Sheer callousness or overconfidence that the disease will not affect themselves has led to increasing numbers of infected patients.
Patients with COVID-19 were the worst affected. Those with mild to moderate illness were quarantined for a minimum of 14 days. Their contacts were traced and were kept in isolation too. Those with severe disease had to be admitted to the intensive care unit (ICU), which were restricted to government-run hospitals. With meager resources and equipment like ventilators, these hospitals were overrun with the high number of patients, especially in metro cities like Mumbai and Delhi. Later on, the private-run hospitals were allowed to cater to COVID-19 patients. When the lockdown was lifted partially, the number of patients increased and the number of hospital beds for these patients had to be extended in all the centres. The expenditure incurred in managing a patient on ventilator with multiple supports and monitoring equipment like arterial lines, multi-channel monitors is huge and PPE kits also added to the huge hospital bills. The agents who are being proposed for treatment of SARS-CoV 2 like Tocilizumab, Remdesivir, Favipiravir are expensive and still out of reach for Indian patients. Patients needed long time ICU care and a long time for rehabilitation. Surgical procedures on COVID-19 patients were either postponed or referred to other centers. Patients on chronic hemodialysis were sent to centers for exclusive COVID patients or had to be done in isolation rooms. Patients on peritoneal dialysis were at an advantage because they do not have to come to health centers for their procedures. Nevertheless, these patients requiring chronic medical attention like dialysis patients, Oncology patients requiring chemotherapy, patients requiring blood transfusions faced hardships in view of the breakdown in supply chains.
The front line workers in the fight against COVID-19 include health personnel, police, and public health personnel, sanitation workers, pharmaceutical industry, and essential service providers. The doctors, nurses were directly involved in patient care and were the one directly exposed to deadly viral particles. PPE kits were limited, and these workers had to work with minimum protection. As a result, many hospital workers were affected by the virus, and some had to loose their precious lives. As the public transport system was suspended, even the front line workers faced hurdles in reaching their workplaces. These individuals were subjected to multiple checks at multiple police checkpoints put up to enforce lockdown. Some of them, especially the private sector employees, were not allowed to attend to their duties at their workplaces, possibly as a result of inadvertent police excesses. The violence against the doctors raised its ugly head, yet again with the increase in death rates among COVID-19 patients. Health-care personnel who were on-field duties for contact tracing were subjected to abuses, spitting, and violence. There were instances of the dead bodies of COVID affected doctors not being allowed for cremation at cemeteries near residential areas. The stigma attached to the affected health-care workers at their residences, housing societies has dampened the spirits of these workers in many ways. All these changes in the day-to-day life of health-care personnel added to psychological issues already plaguing in taking care of “end of life” patients. The use of thermal scanners, hand sanitizers, physical distancing in waiting halls, no mask-no entry policy, one patient-one attendant have become a norm in hospitals. The health workers are apprehensive, and hence many of them resigned from their jobs bowing to the pressure from their family members. As a result, there is a dearth of technicians, nursing staff, and other paramedical staff. In addition, the remuneration of all the employees in the private health-care industry has been slashed owing to the economic fall out of the pandemic. Mental and physical fatigue, financial worries, lack of enough PPEs and testing kits, dwindling number hospital, ICU, isolation beds has marred the patient care in these times. As the disease is new and was never treated before, the guidelines have changed almost daily, creating much confusion among the clinicians. As various aspects of the SARS-CoV 2 and pathogenesis of the disease are being discovered, we will be able to formulate investigative and treatment modalities on firm grounds.
The positive thing that came out of this pandemic is the use of technology in the field of medicine. The medical community, to say the least, has been very reluctant to embrace the electronic revolution. Almost 95% of private hospitals who have the wherewithal to engage in electronic medical records still depend on handwritten case files and physical record-keeping, which is slowly changing. Tele-consultations or telehealth was put on traction for doctor–patient conferencing. The government of India and the Medical Council of India have brought in changes in the law to allow online consultations and prescription writing. This added ease to the hassles being faced by the patients at the peripheries, chronic illness patients, elderly patients. Many start-up online platforms have been started to cater to these needs. Different mobile applications like Arogya Setu have been devised to track the corona positive patients and help in the containment process. COVID-19 also has changed the way medical knowledge is disseminated among the medical personnel. Webinars and virtual conferences have become platforms for medical interactions. Social media sites such as Twitter, Facebook, Whatsapp acted as conduits for quick sharing of experiences of treating COVID patients. Usage of proning in ventilated patients, steroids, anticoagulation, plasma from convalescent patients, Hydroxychloroquine, Remdesivir, Tocilizumab, Favipiravir, Azithromycin, Ivermectin in varied combinations in countries that experienced the pandemic first have all been widely shared across all these platforms. These media also served to share personal tragedies while encountering very sick patients and led to psychological soothing and the ability to move on. COVID-19 also helped in promoting digitization in the form of online payments, E-commerce, E-newspapers. COVID-19 also sparked innovations in the biomedical industry. The railway compartments are being engineered into isolation wards. Ventilator tubings are modified in such a way so as to use one machine for more than 1 patient. Face shields/visors, face masks are being made on “do it yourself” basis.
The society, governments, industrialists, philanthropists were quick in appreciating the efforts of “corona warriors.” Various activities like clapping, lighting candles, showering flower petals from helicopters, were conducted to honor the frontline workers. The role of certain corporate giants is commendable. For example, hotel rooms were let in for hospital personnel for isolation/quarantine. Manufacturing industries chipped in by making ventilators instead of cars and car parts. Some brave citizens have helped the hapless migrant workers in reaching their homes: some provided food materials and shelters, medicines for them.
Finally, this pandemic presented to us various opportunities to better ourselves both at personal and professional level. It has helped the governments and the society at large see glaring holes in our health infrastructure. The percentage of GDP earmarked for health in developing nations like India is minuscule, even in the 21st century. The importance of medical insurance is still not imbibed by common man in India. COVID-19 has helped us in realizing that the share of the State in health care has to be much more than what it is today. This disease has also taught us not to be complacent and be prepared for similar outbreaks in the future. Thus we face a humongous challenge as a medical fraternity and as a nation to save human lives though there are new opportunities to be explored for improvement in the health-care scenario in the country.