Non-Covid in Covid times
While it was indeed inhuman for the hospitals to refuse treatment in the wake of medical emergency, we must also consider the apparent fear even among doctors and nurses in view of rising infections among them, and the aspect of pressing conditions faced by health professionals in terms of lack of proper equipment, infrastructure and qualified manpower.
The recent death of a pregnant woman after she was allegedly refused treatment in some hospitals, both state-run and private, has once again brought to the fore questions about state protocol regarding treatment facilities for non-Covid patients in the state and medical ethics as against the crisis of effective management of Covid care and prevention. While it was indeed inhuman for the hospitals to refuse treatment in the wake of medical emergency, we must also consider the apparent fear even among doctors and nurses in view of rising infections among them, and the aspect of pressing conditions faced by health professionals in terms of lack of proper equipment, infrastructure and qualified manpower.
A WHO study of 155 countries showed partial or complete disruption in many countries for non COVID care, 53 per cent of countries showed disruption in the treatment of hypertension and 49 per cent in the treatment of diabetes. The study says, it is because of several reasons, all related to the pandemic. Lack of transport, lockdown, fear of contracting the COVID, inadequate healthcare personnel because of diversion to the pandemic prevention and care; the list goes on. No doubt, the state government is putting in all possible efforts. But, the real challenge lies in how you do it or are managing it.
Opening of more Covid Care Centres in Imphal and the districts and recruitment notices for health professionals including doctors are steps in the right direction. But, these centres are for treatment of asymptomatic or mild symptomatic cases. In case of critical cases, the right equipment and infrastructure with specialists or super-specialists are required, which is available in the major hospitals only.
The Wuhan model of handling patients with COVID was to create a massive COVID care center and ensure that the care of COVID patients did not mix with the care of non-COVID patients. While this is a good model as long as the viral infection is not in the stage of community transmission, it is almost impossible to identify COVID positive from COVID negative when a large number of patients are asymptomatic and positive or have immunity and therefore are at no risk.
In India, there are two schools of thought. One says, both COVID and non-COVID care should be provided in the same facility. This has been done in many Indian hospitals. The other says, permitting such a policy would increase the risk of non-infected patient admitted in the hospital from contracting the infection. The former again says that non-COVID care is equally important and should be provided to the population in equal measure within the facility. While there is no readymade answer, it is pertinent to state that we should continue to treat non-COVID conditions in these times. The virus will no doubt be with us for some time; diabetes, kidney disease, hypertension stay with us for life. Failure to control non-communicable diseases also costs lives. The only difference is that it is not so obvious.
We should have healthcare facilities handling both COVID and non-COVID care. Well, there needs to be segregation of COVID and non-COVID areas. Protocols has to be worked out for effective and safe management. This will minimize the disruption of vital care for emergency care, management of non-communicable diseases as well as maternal and child care. Lest we forget, the prompt response of state Health department by instituting an inquiry into the circumstances leading to the recent death of the pregnant woman and instructing all hospitals to compulsorily attend to all patients, including emergency and time-bound cases are to be lauded.