Non-Covid-19 patients left in the lurch as virus swamps hospitals

A septuagenarian landed in Kolkata from Bihar due to age-related ailments. He was taken to two private hospitals. Both denied him admission alleging he had Covid-19 symptoms. After running around for several hours, he was finally admitted in another private hospital, where he died. He tested negative for Covid-19.

In Bengaluru, 58-year-old Arun K, a resident of Kathriguppe, met with a similar fate. A diabetic individual on insulin, his sugar levels spiked after drinking juice on April 2. His family rushed him to several private hospitals, but was turned away at each place because some hospitals thought Arun had Covid-19 and could not be treated in their set up, whereas others did not have medical services open for non-Covid-19 patients. By the time he was redirected to the general ward at Rajiv Gandhi Institute for Chest Diseases, it was too late.

“He died two hours after arrival at the hospital. It was a very sad thing to happen, because it was a death which could have been completely averted,” said his niece, Ashwini Masti.

These are not isolated cases, but a systemic malady seen everywhere in India since the beginning of the pandemic. In Kolkata, multiple big hospitals in the private and public sector were shut down partially or completely after detection of Covid-19 positive patients in their campus. Similar practice was noticed in other cities.

It is only in July that private hospitals in Mumbai, a city with a population of nearly two crores, opened up OPD services and admitted patients for non-emergency surgeries. A consortium of 33 private hospitals, including the big ones like Hinduja, Lilavati, Bombay Hospital, Jaslok, Fortis, Global, Breach Candy and Wockhardt decided to keep 2,800 seats reserved for non-Covid-19 patients (out of 6,500 beds).

Such neglect of non-Covid diseases now haunts the Indian healthcare sector as data emerging from the grassroots shows.

Last month, in a survey of 155 countries including India, the World Health Organisation showed that health services had been partially or completely disrupted in many countries.

Read: 'The medical community has learnt how to deal with Covid-19 over time'

More than half (53%) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49% for treatment for diabetes and diabetes-related complications; 42% for cancer treatment, and 31% for cardiovascular emergencies.

Rehabilitation services have been disrupted in almost two-thirds (63%) of countries, even though rehabilitation is key to a healthy recovery following a severe illness like Covid-19. Despite repeated queries, WHO officials did not share India-specific data from the survey with DH.

The most common reasons for reduced healthcare services are cancellations of planned treatments, a dip in public transport and staff shortage as regular health workers had been reassigned to support Covid-19 services.

The WHO survey red-flags the double whammy that individuals with such diseases experience. They are more vulnerable but couldn’t access the treatment they need to manage their illnesses. “It will be some time before we know the full extent of the impact of disruptions,” said Bente Mikkelsen, director of the WHO’s Department of Noncommunicable Diseases.

Several doctors and healthcare workers admitted that the situation was exactly the same in India. Take the example of a 50-year-old lady who lost her life because an ambulance could not be arranged to take her to a hospital after she suffered a fall in her home in Mumbai. The family members said they had managed to admit her to a hospital after 15 hours of the fall, but she succumbed to brain haemorrhage.

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In Kolkata, a doctor had a harrowing time to get one of his relatives, a cancer patient, admitted in a hospital. Two hospitals refused to admit the patient claiming that they were not admitting new patients.

According to a senior government official in Karnataka, nearly 200 people in Bengaluru died between late March and early June because they could not get care for non-Covid-19 diseases due to the lockdown.

Nurses fleeing the hospitals in big cities compounded the problem.

Were such panic reactions from the doctors and healthcare professionals justified, given the fact that the disease has only 3% mortality and if doctors start fearing a new pathogen where will the patients go? A section of public health researchers argued with 300 deaths among Indian doctors and sparse availability of the PPE there were valid reasons for doctors to get frightened.

“Doctors are fearful mainly because of lack of Personal Protective Equipment. In addition, there is no guarantee that doctors will be assured of treatment when infected. The state and central government should provide a minimum term insurance with the value of Rs 2 crore in addition to health insurance covering the actual medical expenditures,” said Giridhar Babu, professor at the Public Health Foundation of India and one of the advisors to the Karnataka government on Covid-19.

“Also, salaries for many healthcare professionals have not been paid or partially paid in the last few months. They have a justified reason in seeking to know what’s the worth of putting their entire family at risk in combating Covid-19 pandemic.”

Sajal Biswas, general secretary of West Bengal Doctor’s Forum felt patients might have been saved from such harassments, had there been proper infrastructure for quick testing of non-Covid patients for the infection.

Several experts suggested setting up dedicated Covid-19 facilities and allowing other hospitals to offer non-Covid healthcare services, but such separation was not carried out in most of the states.

But even in a state like Maharashtra, which bore the brunt of the pandemic in India, separation of hospitals didn’t solve the problems due to a skewed bed distribution.

“For instance, in Mumbai metropolitan region, there are designated Covid and non-Covid hospitals, but the problem still exists because 80% of bed strength is reserved for Covid-19 patients,” said Suhas Pingle, chairman, action committee, Indian Medical Association, Maharashtra.

Overshadowed

The non-Covid ailments could be broadly classified into infectious diseases and lifestyle diseases (noncommunicable diseases).

"With the onset of monsoon, malaria and dengue have been reported already in Mumbai. There would be incidents of leptospirosis and H1N1, which would also need attention. Due to reduced physical activity, lifestyle disorders like heart complications, diabetes, hypertension and arthritis are on the rise. Moreover, there are cancer patients who need medical attention,” Pingle said.

Some of the general practitioners with whom DH spoke to, pointed out that patients undergoing dialysis as well as TB and HIV patients too faced problems in accessing the medicine and testing in the first two months of lockdown as clinics began to open up only in June.

In May, a UN study concluded that for every month of lockdown, India may witness an additional 71,000 TB deaths and more than 232,000 TB cases over the next five years. The numbers will drop to 40,685 deaths and 145,000 cases in the months of restoration.

Within days a second UN study pointed out that India might witness death of additional 1.2-6 lakh children over the next one year from preventable causes as a consequence to the disruption in regular health services due to the Covid-19 pandemic. The government issued several directives to the healthcare sector requesting the doctors and other staff to resume duty, but changes on the ground are very slow as the underlying fear hasn’t yet ebbed.

“Doctors are humans too and have the same risk of getting infected while caring for those with Covid-19 as much anyone else. Health professionals would also need to protect themselves and their families while delivering care to the citizens,” noted Oommen John, a public health specialist at the George Institute, India.

(With inputs from Mrityunjay Bose, Akhil Kadidal, Soumya Das and Sagar Kulkarni)