Missing Millions: Collateral Medical Damage Of Covid-19

Missing Millions: Collateral Medical Damage Of Covid-19
Whenever we are hit with a significant event, whether a natural calamity or something positive, we are forced to evaluate situation in a different light and take actions that we may not have taken while in our comfort zone.

Covid-19 has brought forth similar issues. It has forced us as a specie and as a nation to look at medical care as a necessity of utmost importance rather than paying lip service to it. This is true not just for third world countries like Pakistan, India, Bangladesh but also UK, US and Europe.

Here, an analogy of a gym membership across the world comes into play. We all aspire to stay fit and do regular exercises as a new year resolution. We take up gym membership mostly with payments on monthly recurring basis but we go only 10 times in first month and then 5 times in second month and maybe 2 times third month.

Gym owners have nice shiny equipment on the show curiously with 1-3 people using it in the whole gym when you sign up for the membership. The question that begs an answer is where are the rest of members? If you look at their members list, you will be amazed to see a few hundred members on the list. It also makes one wonder: what if all these members decide to use the gym facility, some, at the same time?

In reality, the gym owners are banking on our psychology or habit to not show up. If all of the members show up, they will suddenly have insufficient space and machines, being unable to provide the services that they promised in the first place.

Interestingly, planners of medical care also known as politicians and civil servants, across the world were banking on us not getting sick all at once. Unfortunately, a huge percent of the population has already gotten infected or are at a high risk of getting infected, due to the virus.

The reason why all the governments of the world wants us to stay at home and avoid getting infected, is so that they can ‘flatten the curve’. What this means is that the rate of contagion will reduce. This reduces the number of cases coming to hospital at any given point. The limited number of beds and other facilities would need to be up-scaled, or the pressure on existing medical machinery will cause a collapse.

There is also a side-effect of flattening the curve. Although the curve might be flattened but the base may get widened. This means although not too many cases occur in short time, same numbers of cases may happen slowly over longer period of time. In this way, medical facilities will be able to handle the pressure of the pandemic but would be engaged in cure for a longer duration.

Unfortunately, the longer our medical facilities are busy dealing with epidemic or staying on standby for possible cases, they are practically shut down for rest of the diseases. In normal circumstances, our OPDs and wards are full of patients. That’s why we need appointments in clinics, and sometimes have to wait for our turn to get endoscopies or operations, etc.

So, the question that arises is while we are in state of emergency in hospitals across the world and not taking any other cases, what is happening to those ‘other’ cases? As we have less traffic on the road, we reduce the chances of road traffic accidents, but what about heart attacks, strokes, cancers. Do they stop happening? I doubt it!

I work in a department where we see liver problems including chronic liver diseases. As a consequence of chronic liver disease, a large number of these patients accumulate extra water in their belly. We call this water accumulation ascites. This means that their liver is too weak and patient may need medication to control this water accumulation and if not successful, patient may need this water to be drained to relieve their discomfort. This is done in our unit for 2-5 patients every day. Similar ascitic drains are done across Pakistan in most hospitals daily. As our hospital facilities are not enough, our hospital waiting rooms are crowded.

There is a risk of coronavirus transfer in crowded places, and our hospital like many hospitals across the world, has suspended our OPD and other services as advised by government. Some of the hospitals like ours have been earmarked to deal with corona patients. What’s happening to all my patients who need drains almost every 2-6 weeks? What’s happening to dialysis patients who get catheter infection or high potassium?

So, do we think, that all the rest of diseases in the world have decided to go on holiday while there is corona party? I am worried about all our patients who need follow up appointments. Every week, in our liver cancer board meeting we discuss, approximately 20-25 cases of liver cancers. We have not been able to see any patients with liver cancers and treat them for last 4 weeks.

Another cancer hospital in my city, Lahore, is closed due the same fear of transmission and has been reserved for treating corona patients only. They have their out-patient cancer services almost completely suspended. One of my dear colleagues’ son who is just 7 years old has been diagnosed with a rare cancer. He needs treatment urgently but cannot get treatment in that cancer hospital for the same reason. In fact, Royal College of Physicians of UK has raised concern regarding sharp decline in emergency attendance of all children as their parents avoid hospitals to prevent infection. Our pediatricians are suggesting that it’s good to stay away from hospitals but do come when it’s absolutely needed, before small problem becomes too big to handle.

We are lucky enough to have electronic records of patients in our hospital and can look up into the system to find different groups of patients. The plan is to start telephonic consultation for our patients with long-term illnesses who need regular and repeated clinic reviews.

Likewise, some private hospitals in Pakistan have started similar telephonic consultation services. Some hospitals are arranging delivery of regular medication by courier service. Some of the services who are treating conditions like viral hepatitis with pre-determined duration of treatment are letting their patients to come in and collect medicines directly from their pharmacies without causing delay or crowding in hospital grounds. I am sure there are many innovations that are being done and more will be, in the near future. This may reduce burden on hospitals. We can also use satellite clinics or primary health care clinics to provide medications nearer to patients’ homes reducing transportation times and costs plus long hours in waiting rooms.

I believe that with each difficulty comes ease and our present difficulty is leading us to think creatively to solve our longstanding problems with the help of available technology. But I am still worried about the missing millions we are unable to see and what state they are in.  It has become international sport to count active cases and Covid-19 related deaths like cricket score cards daily but obviously there must be deaths not directly related to this virus, occurring at homes or on roads who couldn’t get medical care in times as hospitals are shut for non-corona cases.

Dr Nauman Zakir is the Chairman Hepatology/Gastroenterology sections at the Pakistan Kidney & Liver Institute & Research Centre, Lahore, Pakistan.