Fixing medical priorities in lockdown 3.0
DODUL MONDAL | 04 May, 2020
| Top Stories
So, we have entered the third phase of nationwide lockdown to contain
the COVID-19 pandemic. The initial turbulence has now settled down to a
great extent in terms of peoples' acceptance and willingness to follow
this lockdown. Apart from a few stray incidences of rule violations,
India has been doing much better than many other countries in the world,
better than many first world countries.
The rate of increase in
active cases is also not very high and we have been hopeful to see a
flattening of the curve in the near future. There is a steady increase
in the total number of positive cases and death albeit at a slow pace.
The time for doubling of cases is 11 days, and it is expected to
increase further. Some places are having active spread of the infection
and containment zones have been created based on the number of positive
cases in that area.
The lockdown has been extended for another
two weeks, and it is likely that it may last till May end. The new
guidelines have relaxed the activities allowed in three zones -- red,
orange and green. Let us discuss from a different perspective and share
my views. What should be the "priority" in this lockdown 3.0!
Resuming Non-COVID healthcare for acute illness: Although every health
facility is trying their level best to provide adequate emergency care,
it may not be equal to pre-lockdown state. I am concerned about
thousands of patients with stroke, heart attack, acute surgical
conditions, acute metabolic illness and many other emergency health
problems! It is a growing perception among the medical fraternity that
non-Covid healthcare is not getting adequate priority at this moment.
Resuming Non-COVID healthcare for chronic disease: As a cancer
specialist, I can see the difference of care being received by cancer
patients across the country compared to pre-lockdown time. Cancer
patients require different types of treatments including surgery,
radiation, chemotherapy, immunotherapy etc. Also, the treatment should
start and finish in a timely manner to provide adequate benefit of
treatment. I fear to see many premature deaths in cancer patients in the
coming days whose cancer will progress to advanced stage or end stage
in the absence of a timely treatment.
The same is true for other
life threatening chronic illnesses like renal failure where patients
survive depending on regular dialysis! People with hypertension or
diabetes also need proper care to avoid untimely death due to sudden
heart attack or stroke or renal failure or metabolic complications in
the absence of regular supervised treatment.
million kids under five years of age die because of malnutrition. This
number can increase to a great extent after this pandemic is over. They
also need priority to have access to food not only after lifting the
lockdown, but also during this phase.
These patients also have the right to survive and this is just the tip of the iceberg!
Resuming treatment and prevention of communicable disease: In 2018,
more than 1,40,000 people died of measles; in 2017, 13 lakh people died
from tuberculosis (data source WHO website). Measles is a preventable
disease with vaccination. Among tuberculosis patients, many are MDR or
XDR who require intense monitored treatment. Many other deadly
infectious diseases are preventable by vaccination only. Routine
immunization, including that of pulse polio, is heavily hit due to
lockdown. It is now important to safeguard millions of newborn kids and
other people by resuming vaccination, providing treatments (like DOTS in
tuberculosis patients or anti-retroviral treatment in HIV/AIDS
patients) at the right time in the right manner. Otherwise, there is
always a fear of seeing thousands of deaths from such conditions (many
will eventually go unnoticed as not all of these are so rigorously
screened or monitored for as in COVID-19).
4. Resuming blood
donation services: There is a crisis of blood and blood components.
Enough number of blood donations is not possible during this lockdown
due to fear of spread of infection. It will be important to resume such
activities with priority. The demand for the same will be high after
lifting the lockdown.
5. Resuming industry connected with
emergency care: Not only for money, industry and business need to run to
serve people in many ways including manufacturing essential items,
food, necessary machines for different sectors involved in emergency
care and routine livelihood etc. There is already a staggered plan by
the government. With time many more sectors will need to function. It is
important to lay down the structure of such functions to avoid
infection among these groups.
6. Restricted lifting of lockdown:
Wuhan in China followed a restricted lifting of lockdown model to
prevent further rise of cases. Public transports including rail,
airlines should frame and implement physical distancing norms even after
this lockdown is over. Meeting at public places, gatherings should be
banned for even a longer time till the virus is under control. Necessary
public awareness and preparedness campaigns should start beforehand to
7. Encouraging work from home: This lockdown
has proven that at least in few cases, work from home is a reasonably
valid option. That will not only reduce the risk of infection but also
reduce the load of cars and transport on road and subsequent pollution.
Studies show that pollution worsens coronavirus outbreak. Let the world
The world will not look the same after this lockdown is
over. It will look good in a few aspects; it will look terrible in
others. Priorities should be based on the need of a particular
geographic area, their people, their lifestyle etc. However, few things
remain basic as always. They have access to food, a roof over their
head, clothes for modesty and medical services to save life. And we have
to keep our compassion intact. Rest can wait.
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