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How corona has improved healthcare? A contrarian view

How corona has improved healthcare? A contrarian view

As soon as dreadful Corona struck the nation, authorities set up war rooms at various levels to fight the enemy virus, with Prime minister leading the warriors at the apex. Chandigarh administration and all other states joined the lockdown in a bid to isolate the infected and suspected cases and protect the people at large through mass quarantine.  Strong police bandobast on the one hand and commitment of the Indian people on the other is being appreciated all over the world. Latest strategy to seal the hotspots and achieve ‘cluster containment’ as announced by UP government. The onus to stave off the medical effects of epidemic fell on the country’s beleaguered, ill-prepared, under-funded and under-staffed healthcare system.  Doctors and others were deployed in the forefront to treat infected cases without adequate ‘protection to the protectors’, thus risking their health and life in the process. As per a report in LA Times dated April 7 2020, ‘Indian families say hospitals are rationing medical care’ for other life-threatening illnesses as India mobilizes its resources to fight the coronavirus.  No doubt, barring emergency services, all public hospitals like PGI, GMCH ,GMSH in the city as well as private hospitals were closed  in preparedness to deal with Covid cases.  While preparations to deal with ‘social emergency’ all over the country were essential, the question arises what happened to those thousands of patients who used to crowd to the PGI and other hospitals? Is there any arrangement made for online consultations by the hospitals? Did it lead to increased medical misery or deaths? It may be hasty to conclude that most of the patients thronging the hospitals were not genuine and the medical and surgical treatments being administered to them were un-necessary. But as we delve into records of past experiences and utterances that death rates fell whenever doctors went on strike, it gives some credence to the above cited observations.

In 2003 a SARS outbreak led to closed hospitals in Toronto, and consequently all non-emergency services were suspended. The result ? Toronto saw a dip in mortality rate compared to the prior two years. Israel noticed a 50% decrease in mortality in 1973 when there was a one month doctor's strike. Similar reports from US, UK, Finland etc are on record. Not a single study found death rates increase during the strikes, compared to other times. A funeral study found a decline in the number of funerals during the strike, compared with previous three years. Sermonizing on the phenomena Robert Mendelssohn, Chairman of the Medical Licensing Committee for Illinois USA, wrote: . . . Modern Medicine's treatments for disease are seldom effective and that they're often more dangerous than the diseases they're designed to treat.  I believe that more than 90% of Modern Medicine could disappear -and the effect on our health would be beneficial. Another observer from US noted that 2.4 million unnecessary operations are done annually and that this results in 12,000 avoidable deaths.  However, during 2014-2015 Ebola outbreaks, the increased number of deaths caused by measles, malaria, HIV/AIDS, and tuberculosis attributable to overwhelming of health system exceeded deaths from Ebola. If we rely on this premise that Corona or Ebola do not confer any immunity against other ailments, should the hospitals like PGI withdraw all other services and concentrate only on the virus? No way will other diseases take a hiatus as the pandemic spreads exponentially. In fact the hospitals should have functioned normally for other ailments and dedicated facilities to deal with corona should have been added over and above in an isolated ‘field location’. Similarly, recent order of the administration making mask- wearing mandatory for the entire population is neither practical nor protective.

Lessons learnt from the pandemic

  1. Overall death rate has fallen considerably since incidence of vehicular and other accidents and violence has touched almost zero, which was about 500 per day earlier.
  2. There has been an unprecedented reduction in all types of crimes; Rapes, murders, abductions, pollutions, killing of animals etc.
  3. Since sanitation and sanitization is in top gear to combat the spread of Corona, other infectious diseases are also under control.
  4. Until we get a viable vaccine or specific antibiotic to kill the virus, this unprecedented outbreak will respond to only social distancing within community.
  5. Drugs like tocilizumab (rheumatology medication), Azithromycin (antibiotic),  hydroxychloroquine (malaria medicine), and  remdesivir  (investigatory antiviral) have shown some promise but are not specific. Self-medication is not advised.

5 our dedicated medical warriors were booed and stoned by some of their beneficiaries, salutes from Prime minister notwithstanding. Hype for more ventilators is untenable, since over 84% of patients who need ventilators do not survive anyway.

 

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Looking beyond 14th April

The focus of government future strategies should be to identify, isolate, contain, treat, monitor, consolidate, clean and controlled functioning of the state. While saving lives is important economy cannot be forgotten altogether.

 

  1. Dr David Nabarro, the World Health Organization’s envoy opined that there should be extension of lockdown, in the clusters and hotspot zones, since about 50% of infected people have no symptoms.

 

  1. Both options should be on the table either to extend the lockdown or partial opening of certain areas for essential sectors to revive economy. It is important to start this process from the farm sector and log on to labor intensive real estate in due course.
  2. Production of medicines, soaps, disinfectants, masks and medical equipment must re-commence. In addition, stocks of processed food need to be built up and relocated where stocks are likely to fall short.
  3. Utilization of the armed forces in a staggered manner should be worked out. Utilization of robots or unmanned drone systems for hospital management also requires identification so that exposure of health workers and doctors is reduced to the minimum.
  4. Movement of people, especially foreign travelers be kept in abeyance
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