Where have all the PATIENTS gone?

The lockdown has also increased the faith and trust in ‘family doctors’ and general physicians whose first line of action is medical management, not surgeries!!

Covid 19 has recalibrated the earth, our lives, plans and the way we think and act. Abnormal is the new normal – from people staying at home, working from home to eating at home while offices ‘flew’ to the Cloud.

While there are many developments triggered by the virus that has foot-printed itself across the globe, one striking feature is that non-Covid patients have suddenly vanished during the lockdown period. Where have these patients gone to?

For all the people in the Healthcare sector or related sectors & even for ‘general analysts’, this topic has been intriguing and become a part of ‘Chinese Whisper’ that—Was the load of patients at Hospitals (the Govt. & the big ones) an ‘over capacitated’ situation which was created due to the ‘fear tactics mastered by the Medical Meditators (comprising mostly of Referring Drs themselves) OR is it just merely the ‘fear of Covid’ which stops all medical cases to land up & make a cue at Hospitals & at Drs OPDs!! This question will only get a complete appropriate answer once it is answered by itself, that is possibly in next 2 months when the ‘Covid Fear’ is almost at the edge & these Hospitals & the OPDs are ‘back to normal’.

But facing the brunt are multi-speciality hospitals in the private sector and super-speciality corporate hospitals. Once a beehive of activities with patients coming in droves, the corridors of these hospitals are enveloped in an eerie stillness; the corridors used to echo with anxious footfalls, but today it is silence that tip-toes through these polished disinfected walkways.

So, coming back, where have the patients gone during the lockdown? There are two reasons: one the obvious and the other mysterious.

The obvious ones are Four:

1. The Covid 19 lockdown has seen a drastic dip in accidents and crime. Data from municipal records in central Mumbai comprising more than 10 million people, the number of deaths fell by about 21 per cent in March compared with the same month of 2019.

And in neighbouring state of Gujarat, overall deaths due to accidents or crime nose-dived to more than 60 per cent in Ahmedabad.

In 2018, road accidents in India claimed more than 1.5 lakh lives. In 2020, which includes the coronavirus lockdown, there was a dip in such accidents by 15 percent.

Death on tracks have also dropped drastically as passenger services came to a screeching halt. In Mumbai alone, figures show that more than half a dozen people die every day on the rail network.

Reports also claimed that there were fewer victims of crime being brought in to hospitals.

2. Air traffic grounded, patients who come from abroad for medical tourism have either postponed their trip or gone to other countries. In fact, Kerala sees the maximum number of medical tourists thronging Ayurvedic centres during Karkidagom month (July-August) when treatment and rejuvenation procedures are supposed to be very effective. This year, all the bookings have been cancelled.

3. Mid-size hospitals are cautious and are insisting that patients who come in should be Covid free and prove the same. If a Covid patient enters the hospital, the entire set-up gets shut and doctors and paramedical staff have to undergo quarantine. This will be financially back-breaking.

4. There could also be a case of non-reporting of non-Covid cases. For example, last year, over 8 lakh infants died due to malnutrition, infections, poor sanitation etc, according to a UN report. In 2020, so far no such cases have been reported from poor states because Covid has been taking the limelight, time and media space.

Now the mysterious reasons.

Major multi-speciality and corporate hospitals have seen a sudden disappearance of patients with cardiac ailments. There has also been a major dip in heart attack cases.

Studies have shown that cardiac ailments are the biggest killers in India, claiming three million lives every year. Where have these patients gone during lockdown?

Dr Ajit Mullesari Sankardas, Director of Cardiology at the Institute of Cardio-Vascular Diseases, Madras Medical Mission in Chennai, was quoted in the press as saying “We normally see 4-5 patients with symptoms of cardiac diseases a day. Now it is just 2 a day.”

The consortium of state government hospitals too has recorded a 40 percent decline in patients with complete blockage of a major heart vessel. This is technically known as ST Elevation Myocardial Infarction (STEMI). In case of Non-ST Elevation Myocardial Infarction (NSTEMI), where the blockages are partial, there has been a whopping decline of 70 percent.

Kerala hospitals have recorded a 30-50% drop in patients with heart attacks. Prior to March 25, hospitals in the state with advanced cardiology units used to record around 10 to 15 heart attack cases every day. This has come down drastically.

Punjab and Gujarat reportedly recorded a dip in 30 percent in heart attack cases during lockdown.

So, that begs the question: Where have these patients gone?

Cardiologists say that the decline in numbers may be due to reduced pollution levels, no traffic induced stress, reduced physical activities or they may be keeping away due to fear of getting infected with Covid if they visit a hospital, especially since heart ailment is considered as a co-morbidity and these patients may easily get infected.

There could also be the issue of lack of transport. Patients from other states without frontline cardiac units may not be coming. For example, New Delhi and Gurugram used to cater to a large volume of patients from Uttar Pradesh, Bihar and Bengal. But with the lockdown, they are unable to travel long distances. Moreover, with record unemployment, many may just not be able to lay their hands on money needed for healthcare.

This has driven many to local clinics. The lockdown has also increased the faith and trust in ‘family doctors’ and general physicians whose first line of action is medical management, not surgeries, if the symptoms are not alarming.

With emphasis on ‘natural living’ and shoring up the immunity levels, many patients have started opting for Ayurveda. ‘Going Green’ is the new mantra for health.

Some senior cardiologists held a webinar on the issue recently on the mystery of vanishing patients. Besides reduced stress and pollution, they highlighted the fact that people have improved their diet and junk food consumption has dropped; also they are eating and sleeping on time. People are also taking their medicines regularly now.

Dr A George Koshy, cardiologist at Thiruvananthapuram Medical College Hospital, who took part in the webinar was quoted in the press as saying: “Heart attacks are also triggered by infection, but now overall infections have come down and as a result people are taking lower amounts of antibiotics.”

This trend has also been recorded in US, Italy and other countries.

But there are other cardiologists who have taken a different stand. Coimbatore based Dr Thomas Alexander, director of STEM India, an NGO that develops modules and protocols for management of heart attacks, says patients may be ignoring or managing the minor symptoms. Some may be going to smaller clinics.

“It is safe to treat patients with medicines than take them for a procedure if it is not essential,” he was quoted.

Following divergent views, the Cardiological Society of India is now planning a countrywide study by comparing data during the lockdown period with that for the same period last year.

This has triggered a debate in social media if major hospitals were wheeling every patients with minor symptoms for an angioplasty. Some have even accused some major hospitals of fixing a ‘target’ for angioplasty and using the costly equipment if needed or not.

Unrealised costs of buying expensive medical equipment and servicing loans have left private hospitals in gasp for desperate breath.

“With the current Covid-19 crisis, the private healthcare sector is faced with a twin predicament—while the sector is investing additional manpower, equipment, consumables and other resources to ensure 100% preparedness for safety in the hospital(s)... eventual treatment of patients, when needed... is also experiencing a 90% drop in its revenue with sharp drops in out-patient footfalls, elective surgeries and international patients," said Dr Naresh Trehan, chairman, CII Healthcare Council and managing director, Medanta hospitals, was quoted in the media.

The ‘empty hospital corridor syndrome’ and dip in OPD walk-ins is expected to continue for at least 3-6 months. This could majorly impact cash flows as 80% of the sector’s costs are fixed. In India, 72% hospitals and 60% of hospital beds are in the private health sector, the fourth-largest employer in the country.

Private hospitals have started scaling down their elective case load while still maintaining a full workforce and stocking up on extra inventory. This is squeezing them financially.

Private sector has requested the government for a financial package in order to pay salaries and vendors. Some proposal on the table are that this package can be in the form of an emergency assistance loan for 10 years at 0% interest, tax waivers, clearing pending dues from government schemes like ESI, CGHS, etc.

But not everything is down and out. Lockdown period has seen a steep increase in lifestyle diseases like obesity, depression, anxiety etc. These should become part of statistics to get a wholistic picture of the Covid Lockdown Syndrome.

As said earlier, Covid has changed everything, including our hearts and heads.

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