‘There Is A Need To Revisit And Revise Our COVID Management Guidelines’

Kamal Solanki, CEO, Venkateshwar Hospital; Dr D.K. Gupta, CEO and Director, Felix Hospital; Dr Sonia Lal Gupta, Director, Metro Group of Hospitals; Dr Girdhar Gyani, Director General, Association of Healthcare Providers (India); and Deepak Sahani, Founder & CEO, Healthians, speak with Dr Annurag Batra, Chairman & Editor-in-Chief, BW Businessworld & Exchange4Media; and Sudhir Mishra, Founder and Managing Partner, Trust Legal, talk about surge of COVID19 cases, new guidelines and the future of healthcare.

Dr Batra: Have we seen the peak of COVID yet? Or do you think the peak is far from where we are right now?

Dr Gyani: The next few days are very crucial and that is why we have the lockdown. The peak may be 10 to 14 days away.

Dr Batra: What can patients infected with COVID19, those who are searching for beds, do during this time?

Dr Sonia Gupta: Beds are just not available. The way the virus mutation infectivity is, the cases might go up to 5 lakh cases a day. At the same time panic is also at its peak level. People must know, that, if their fever is under control and saturation is more than 94%; they should stick to home isolation. Online consultations with doctors are available. Every hospital is providing home care packages right now. We need to prioritise the sicker patients.

Dr Batra: Not all patients with COVID have the same symptoms. For instance, some patients are asymptomatic. Bearing this in mind, what kind of new protocols need to be brought in?

Dr D.K Gupta: We need to revisit and revise our COVID Management guidelines. We need to make facilities available at people’s doorstep. We can have resident doctors, working elsewhere, spare time in the morning and evening for each COVID facility in their societies. People are so panicked right now that several are booking beds, in hospitals, in advance because they fear beds will not be available should they fall sick. There are many primary staff workers who are also helping their societies. The Government of Delhi has acted very promptly and released these guidelines. I believe in a few days Noida authority will also release their SOP.

Dr Batra: Healthcare providers and workers, themselves, are under immense pressure. How are we taking care of Healthcare Professionals and managing the risk to them?

Kamal Solanki: Right now, we are not in a position to have a rotation policy. Given the current load it is simply not possible to give doctors, nursing staff, paramedics, and other healthcare providers enough rest.

Dr Batra: The industry has been talking about ramping up testing. Has the result of increased testing, increased the number of hospital admissions?

Kamal Solanki: Absolutely. There is not a single ICU available in the city [Delhi] right now. The Government is keeping the data updated, but there is nothing available, whether it be government or private.

Dr Batra: Now, testing is supposed to be one of the solutions because if you are COVID positive and detect it early, you are preventing the spread of the virus. Is the testing ramping up the way it should? And is the turnaround on testing coming down?

Deepak Sahani: The testing ramping is not happening the way it should be. Especially in the last four weeks with the surge of patients. It takes time for new machines to get validate, to train new staff before testing can be done. Even if you can get the machines to run in 48 hours, you cannot arrange for staff in that time. Furthermore, over running a lab puts the staff at risk. 

Dr Batra: Mr Mishra having heard the experts speak, what would be your own solution to deal with the second surge in cases?

Sudhir Mishra: I feel we do not appreciate the healthcare sector in India and the amount of pressure they are under. The fear among people is a fragmented split, as in, it only comes up when it affects us personally. People are still attending events, weddings, socialising, etc. The government is asking for more beds, how can we find healthcare professionals to man those beds?

Dr Gyani: Delhi has the highest density of beds in the country, despite that, we have a big problem on our hands. In this new wave we are seeing much more patients whose lungs are being affected, as early as, day three. This has never happened in the past. I think we must be grateful for the private sector, the way they have come to the rescue. Furthermore, we must think about how the government should make up the public health system.

Sudhir Mishra: Absolutely, just as we have fought for CGHS and other schemes in Delhi High Court.

Kamal Solanki: There are a lot of private institutions that only have DNB courses running. We need to suggest that these institutions are also allowed to offer MBBS courses, so that we can create good quality doctors.

Sudhir Mishra: There is this breach of trust between private and public hospitals. That is the reason why people are willing to travel farther to go to a private hospital. How can we rebuild this trust in the public sector?

Dr Sonia Gupta: Our biggest problem is that we do not spend money on health infrastructure. The only way people can come to trust the system is when there are actual facilities available.  In government hospital there is one nurse assigned to 10 patients as opposed to one nurse assigned to 3 patients in private. The government needs to step up and invest in healthcare, in infrastructure, in education by setting up smaller programmes in rural areas. We need to think about healthcare on every level.

Sudhir Mishra: How can we raise this as a priority for the government?

Dr D.K Gupta:  Just last year, we spent around 1.25% of our GDP on healthcare. While 10% of developing countries are investing 10% to 18% of their GDP. Most counties in the west spend more than 5%. India is the only BRICS member spending this low on healthcare. This year it has gone up to 2% to 2.5% of the GDP. Even if we convert all community centre, schools, and dormitories into COVID facilities, there will remain a shortage of oxygen, and essential medicine. We have one of the poorest doctors, medicine, bed ratios in the world. There needs to be a change in the political mindset, and we all need to contribute to that.

Sudhir Mishra: I have wealthy friends, who are not able to find a bed [hospital]. In this situation, the middle classes are hit with the realisation that they are not even a priority. How are you dealing with this pressure under these circumstances?

Kamal Solanki: There's a lot of pressure, you get calls from ministers, the high-end people, asking for a bed. And trust me, it is not easy to say no to them. It is a very difficult situation right now and we always blame government. But let us understand that this mess is created by people, too. In last three months, we have not taken due precautions, the COVID appropriate behaviour was never followed. And at the end of the day, all we talk about is that the budget, the GDP, and everything is too low. Right now, the complete owner of this failure lies on every individuals of this country. 

Dr Batra: There are three stakeholders. So, one, as citizens, we must be disciplined. Second is the government, we must put more money into health care and encourage the behaviour. We seem to think COVID had gone away, that was not the case. And third, the private sector must invest more in healthcare. 

Sudhir Mishra: When entrepreneurs like, Mr Deepak Sahani, start a business which has a consequence of reaching to the lowest denominations, there is somehow always those handicaps which try to stop your organic growth. So, what are the challenges you face in this COVID crisis?

Deepak Sahani: I think apart from managing your own space and business, there are a lot of other challenges. Specifically, when it comes to regulatory. A lot of times the new models are not accepted. When the online things are coming in, a lot of traditional businesses do not like it. Teleconsultation was finally approved in the last March, despite being around for a long time.

Dr Sonia Gupta: I agree that the onus is on the people. Last year when the whole lockdown happened, you had your leader standing there with a mask. This affects people. When the government has let go, for example allowing political rallies to happen. Local people cannot help but wonder: Why should we be scared? So, I think that the onus is on the people. But you still need a leader to push that onus.

Dr Batra: The plan is to be able to find solutions together. I want to ask what should one do when they have been infected with COVID? What are some steps they can take?

Dr Sonia Gupta: The most important thing is to not panic. I do not know what is wrong with this mutation. But it is not that straightforward as it used to be. There is data coming in to show double masking is effective in a study done by University of North Carolina. They should consult a doctor because self-treating is not the way to go. At the same time, you want to isolate yourself, start monitoring your temperature and start monitoring your saturation. Of course, wash your hands and practice social distancing from everyone in the family. 

Dr Batra: People are facing oxygen shortage, what can be done to procure oxygen? And is there a way to be able to improve your own oxygen levels?

Dr D.K Gupta: If your oxygen saturation more than 94%, there is no need to be watched and we should not store oxygen if we do not require it. If your saturation keeps falling from 92% to 90%, if you have pneumonia or persistent fever, then you may require oxygen therapy. I would recommend oxygen to be given through supervision in a hospital or institutional setup.

Dr Batra: What is your advice to the health care advisor providers?

Dr Gyani: One of the advice, that was issued last week, was that a 100-bed hospital can create 50 beds. Those 50 beds should be at the homes. So that doctors through telemedicine and very occasional visits, treat patients staying at home. Otherwise, it is not possible to create more beds in the hospital. Another thing is, the Prime Minister had asked in 2018 to set up 3000 hospital in tier 2 and tier 3 cities. Not a single hospital has been set up. People are not coming forward to invest in healthcare. This is because there is a loss of faith.

Dr Batra: Entrepreneurs are exiting the hospital, particularly on the ground. We need to look at the positive and one of the positive is the government’s resolve to build better healthcare infrastructure, both through public and private initiatives. What do you think needs to change from the policy side to spark more investment into healthcare?

Kamal Solanki: We need to ensure that this is a profitable sector. The mindset needs to change, that healthcare organizations also need to make money to invest back into the system. Right now, government focus has become to squeeze the margins. When the government is not investing then let private hospitals have the capacity to go to tier 2, 3 and 4 cities.

Dr Batra:  In terms of testing for the next two weeks. Do you expect the capacity to be ramped up? And if yes, explain to us how.

Deepak Sahani: Definitely, it will ramp up. What you see right now is the people who have privilege of testing, test themselves three times a week, even though the protocol states to wait 14 days. It is not useful and just because you have the facility available, does not mean you exhaust it at the cost of others.  So that awareness needs to go to people. Second, it needs time to scale up.

Dr Batra: Can we address the reasons why so many children are getting infected?

Dr D.K. Gupta: In the first wave, there was complete lockdown, and everyone was following all the guidelines. That is why our children were not exposed. Infection rate is same in all age groups, the exposure rate is different. This time the exposure is very high because guidelines were not followed. The transmission rate is a lot higher now. These factors are contributing to children getting the virus. Any children with pre-existing conditions are at high risk. So, I would ask parents to keep their children isolated.

Dr Batra: If you had to say one thing as an advice and say one wish for the people, what would it be?

Kamal Solanki: Follow COVID guidelines. 

Deepak Sahani: Just because the vaccination has come, does not mean you can do anything you want. You still need to follow the guideline. My wish is that this will go away. 

Dr Sonia Gupta: We must follow the protocols even after vaccines. My Wish is that everyone learns from this and we create better systems, because them next pandemic will not take 100 years.

Dr Gyani: My wish is that education and healthcare become the next agenda, health and economy go hand in hand. A healthy population will boost the development and the economy.

Dr D.K. Gupta: I think government and people should focus on a 5-point strategy to control the pandemic: 1. Prevention and ramp up the vaccine; 2. Precaution: COVID appropriate behaviour should be strictly implemented; 3. Partial lockdown by government and full lockdown on ourselves; 4. Increase testing for early diagnosis; and 5. Early, aggressive treatment wherever it is required.

Sudhir Mishra: We need to always make sure that people, who are in a position to create a narrative, speak out, on the importance of policy and advocacy, to Right to Health. Right to health is what will propel our economy forward and should be the focus in the future.