On the evening of April 13, a diabetic, 40-year-old man was admitted to Ariston Multispeciality Hospital in Delhi’s Chittaranjan Park. “He had ketones in his urine and since he was running a slight fever, we tested him for COVID-19,” says general physician and hospital board member Dr Ish Kathpalia, who has been treating the patient for 15 years. Three days later, Dr Kathpalia received the results of the patient’s COVID-19 test. He had tested positive for the virus. The patient has been shifted to Lok Nayak Jai Prakash Narayan Hospital and Dr Kathpalia, his family and the Ariston staff, are all in quarantine. The hospital shutting down has been a huge blow for the residents of the neighbourhood who depend on it for emergency care. “The impact on residential clinics and smaller hospitals is significant. If there is one case, we have to shut down completely. We’ll now have to reduce services till the hospital is fully sanitised,” says Dr Kathpalia.
While there is no available data on how the lockdown is impacting those with other illnesses, such as cancer, diabetes, critical pregnancies and thalassemia, or the long-term health of the marginalised, stories of individuals affected are pouring in from across India. In Karnataka, which had 554 cases as of April 22, cancer patients have had to put their chemotherapy on hold. “We are performing chemo but on a much smaller scale. Aggressive chemotherapy is being delayed if possible because we don’t want to immunocompromise a patient,” says Dr Vijaykumar M., director, Kidwai Memorial Institute of Oncology, Bengaluru. Early studies from Wuhan have shown that cancer patients with COVID should first be treated for the virus before receiving chemo.
The lack of public transport, too, has been a major roadblock. Kidwai Hospital, frequented by patients from across the state, has seen its numbers dwindling. In Maharashtra, which has 5,943 COVID cases, pregnant women are being advised to stay at home, even when reporting signs of distress. “We had a woman in her third trimester call our helpline saying she was leaking fluid and had been advised by a hospital to stay at home. We told her to go to a hospital immediately. She had to have an emergency C-section,” says Dr Aparna Hegde, urogynaecologist and director of Armman, an NGO which works with children and pregnant women. “We offer a voice calling service in 10 states and, for the lockdown, we have set up a tele-consultation service with 28 doctors.”
In the early days of the lockdown, blood was a major concern. Now blood banks have found ways to connect with donors. But if demand for blood were to rise, the current supply would not be enough. “We have about 50 per cent less demand for blood right now since only critical cases are receiving blood,” says Vanshree Singh, director of the Indian Red Cross Society (IRCS). The collection of blood has come down from 200 units per day to 40-50 units and is mostly from long-time donors who have been given passes and transport to come to a collection centre. The National Blood Transfusion Council of India has stated that the viral load in donated blood is too little for it to be high risk; however, if anyone does develop symptoms after donating blood, they are asked to immediately let the blood bank know. The IRCS also held a donation drive for around 40 donors in Delhi with social distancing norms enforced. Digital outreach has helped them greatly. This has also worked with other hospitals, including Kidwai. “We reached out to all our patients via phone or email to reassure and inform them of how we can all cope,” says Dr Vijaykumar. Inhouse patients at Kidwai include 60 children, some as young as five, and six end-of-life-care patients at present. For them, the hospital now advises against outside visitors and has assigned a single permanent attendant.
On April 15, Raju Gilgittia, an assistant section officer with the ministry of health and family welfare (MoHFW), rushed his 50-year-old mother, Ratnamma, to Yatharth Hospital in Noida after she developed a fever and had difficulty breathing. In January, Ratnamma was diagnosed with renal failure and had received her last dialysis two days earlier. The hospital, going by the MoHFW guidelines, insisted she get tested for COVID-19 before receiving treatment. Ratnamma died the next morning. NephroPlus, which runs 203 dialysis clinics across India, says the COVID-19 outbreak has led to a 12 per cent fall in their sessions. “The lack of affordable public transport could be one reason,” says Vikram Vuppula, founder and CEO, NephroPlus. Dialysis is one of the most routine treatments and halting it can lead to toxins in the body and eventually death.
Across India, 586 public hospitals with 100,000 isolation beds and 11,500 ICU beds have been turned into COVID facilities. Public hospitals that are not dedicated COVID centres but where the general OPD has been shut as a precaution, like AIIMS in Delhi or King George’s Medical College, are making exceptions for old patients to follow up on routine consultations. Still, with more resources being channeled towards the virus, there is certainly a fall in the number of hospital beds, ICU care and healthcare services available for non-COVID individuals. “Availability of PPE and COVID testing kits is every hospital’s biggest concern. If patients are being asked to put routine care on hold in larger cities, imagine the situation in smaller towns,” says Dr K.K. Aggarwal, cardiologist and former head of the Indian Medical Association. He adds that heart patients who have stocked up on medicines haven’t reported many problems, but those suffering from diseases which need monthly, or even weekly check-ups need extra help.
Health concerns which do not need emergency care, such as dental problems, wounds, burns or cataracts, are being postponed or dealt with via ‘virtual’ consultations. However, not everyone can video call a doctor or reach a district hospital for emergencies. There are close to 25,000 primary health centres (PHCs) in India, each servicing between 40,000 and 80,000 people. With limited transport to the closest PHCs, community health centre doctors are taking only emergency cases and Asha workers are being engaged for COVID outreach. “Asha workers usually deal with dozens of villages, now they have no transport to visit them,” says Rajat Kumar Das, chairman of Asha India, which works alongside Asha workers to fill gaps in nutrition in 100 villages of West Bengal. “Food is available but the poor have to make do with basic food, low in nutrition.”
Healthcare workers not directly involved with COVID-19 care are doing their best to fill in the gaps wherever possible, but even as e-consultations mitigate some risks, more outreach needs to be done for those pockets where the internet cannot reach. Compromised nutrition and unattended health complications, even for what seems like a few short weeks, are silent killers in the long run.