How to Meet the Health Needs of People in the Time of Covid-19?

This is the first in a series of blog posts by ACCESS Health India Country Director Dr. Krishna Reddy. Dr. Reddy is a board certified cardiologist with a long and distinguished career, marked by his leadership of the CARE Hospital Group which he helped create. The hospital group is now recognized as the most advanced, complete cardiac care center in the country. In this new series of posts, Dr. Reddy will reflect on the impact of the novel coronavirus outbreak on health from his perspective as the director of ACCESS Health India and as a healthcare provider. Read other posts in this series: Part 2.

As long as we do not have vaccines to prevent and drugs to treat the ongoing Covid-19 pandemic, the only tools we have to prevent getting infected is social distancing and personal protection. When people visit clinics and hospitals, they do run the risk of contracting the virus. Yet avoiding doctor’s offices and neglecting preexisting diseases and new illnesses may adversely impact the health of people today and in the future. While entire country is focused on Covid-19, it is time we address the non-Covid essential health needs of people.

Telemedicine: The acting governing board of the erstwhile Medical Council of India has released guidelines for the use of telemedicine as a means to meet healthcare needs for all people. The practice of telemedicine has been in use in India to a limited extent even in the absence of any guidelines. However, the majority of these practices were being provided as part of an ongoing long-term relationship between doctors and patients, and were usually not billed separately. However, given the new normal of social distancing for an extended period of time, it becomes an important means to partially meet the health needs of the population. Physicians can use few online platforms to address the issue of scheduling and billing for these services. Many hospitals have already launched paid telemedicine services. The government can also contract private physicians, if needed, to provide free telemedicine services to its beneficiaries. Government can also launch public awareness campaigns regarding these services.

Mobile Clinics: These can be equipped with healthcare professionals, point-of-care diagnostics, and drugs. Mobile clinics have the advantage of going to where people reside rather than asking people to come to clinics. Mobile vegetable vans have been put to best use in providing essential goods while preventing people to come out of their localities or to crowd in shops and markets.

Online Services: Many primary care services – consults, drugs, diagnostics – can be sourced through online platforms, subject to regulations. Drugs and sampling are being delivered at home. However, people who deliver these goods at home should be fully trained in maintaining social distancing and following personal protection methods.

Clinics and Hospitals: People should avoid visiting clinics and hospitals unless essential. These places should make arrangements for screening and segregating suspected Covid-19 patients from others right at the main entrance. Separate examination rooms, hospital beds (preferably single rooms if dedicated wards are not present) should be earmarked for Covid patients with full isolation precautions. Every healthcare professional on the frontlines handling Covid suspected or confirmed cases should be provided appropriate personal protection equipment (PPE). Healthcare professionals, who have recovered fully from Covid infection or who have established immunity and had it confirmed through an antibody test, can be preferred to be in the frontlines.

Financial Protection: People who have insurance protection should be given a full understanding of whether they are covered for Covid-related health needs. The Insurance Regulatory and Development Authority of India has specifically issued orders to offer products for Covid-related health needs. The nationwide public health insurance program (PMJAY under Ayushman Bharat) has issued guidelines to all empaneled hospitals regarding Covid-19 related admissions. Free mobile clinics are the ideal solutions to meet health needs of people who hitherto depended on free public healthcare services.

Regular Vaccination Programs: Covid-19 should not distract the ongoing vaccination program. Mobile vaccination clinics will prevent people from coming out of their localities.

TB Program: All efforts should be made to deliver drugs to patients suffering from tuberculosis at home. They are at increased risk if they contract Covid. Interruption in treatment will further increase drug-resistance, in addition to flare up of the disease.

Patients on Dialysis and Chemotherapy: Groups of patients who are on maintenance dialysis and chemotherapy face peculiar challenges both medically and logistically. Special guidelines have been issued to handle these groups of patients.

Pregnancy: Antenatal care is immensely suffering due to shut down of clinics and elective services. In the absence of antenatal care, complicated pregnancies are coming to hospitals late, thereby putting both mother and the fetus at risk. Special arrangements should be made to take care of pregnant mothers.

While the country is grappling to meet needs of essential goods and services, to revive the economy, to provide livelihoods, and to care for Covid patients, non-Covid health needs of people should not be forgotten.