The world today is transfixed by the Covid-19 crisis, almost as if it is the only disease prevalent on the face of the earth and those unaffected by it are all hale and hearty. This singular focus on the pandemic has made us blind towards other patients with chronic diseases. The worst sufferers in the Covid-19 era would be people having chronic ailments, and during this period not many have bothered about them. They really deserve more attention and care.
With hospitals and ambulance services that provide dialysis to those with kidney failure being impacted by the Covid-19 outbreak, many are faced with potentially life-threatening situations.
For those with kidney failure, dialysis is essential as it removes toxins from their blood. If a patient misses out on his/her weekly dialysis, the toxins and fluid in the body get mixed with blood, which can even prove fatal.
Abida Siddiqui, 72, has been going to Shushrusha Hospital in Mumbai for dialysis twice a week, for the past year and a half. However, after two hospital staffers were diagnosed as Covid-positive, the institute closed down its dialysis centre for disinfection on April 8. Siddiqui missed her scheduled appointment and struggled to find a new hospital.
As the days passed, her condition deteriorated and she slipped into a coma (uremic encephalopathy) before being shifted to another Mumbai hospital where she was dialysed in an ICU setup. Also, she had to go through Covid-19 testing on three occasions and each time her reports were negative.
According to Prof Rajendra Pratap Gupta, global healthcare leader and revered public policy expert, “The post-Covid scenario will have a multi-dimensional impact on chronic disease management. For us to get this in complete perspective, we need to understand the impact of Covid-19. People in a lockdown for over two months will have PCTD (Post-Covid traumatic disorder). It will take time to bring back the normal due to the fear psychosis. Also, if people have lost jobs, it will lead to mental/psychological issues, which will need counselling and treatment. People with restricted physical activity during lockdown may show aggravated symptoms.
"Despite all, in the immediate future, I don’t foresee a normal ‘personal touch’ between the practitioner and the patient, which has been the hallmark of medicine since the ages. There will be a sudden load on clinicians into chronic disease management (CDM) practice, and given this, it may be worthwhile transitioning to patient portals and a decision support system. Also, in such a situation, patient support groups come in handy to manage routine but sudden flareups. Covid-19 will lead to a long-term change in how we manage chronic diseases, and technology will be an overarching theme in chronic disease management.”
Many patients who have had their routine care disrupted during the Covid-19 pandemic will see a relapse in their illnesses or new complications once the crisis subsides, warned Dr M Wasim Ghori, medical director, and consultant physician and diabetologist, at Heart and Diabetes Clinics, Mumbai.
"Chronic conditions are as broad as they are diverse, ranging from diabetes and hypertension to Crohn’s disease and depression. As the pandemic has overwhelmed the healthcare system, people with chronic illnesses have been forced to postpone much of their care which can be critical to keeping their most troublesome symptoms at bay. The country’s healthcare system is in for a second wave of crisis and that’s what is going to happen when people come out of this and all these urgencies all of a sudden become emergencies because care has been put off," he said.
“A study published by researchers at two universities in Taiwan and the Johns Hopkins Bloomberg School of Public Health following the 2002-2004 SARS outbreaks, for example, suggested that chronic-care hospitalisations for diabetes plummeted during the crisis but skyrocketed afterwards. I am worried that similar problems could crop up as a result of the Covid-19 pandemic. Even if you don’t get Covid-19, your chronic diseases are probably not being managed right now because of the scourge on the health system. Now, digital health companies focused on the chronically ill are preparing for the ripple effects of those delays — and trying to get ahead of them by doubling down on patient outreach through virtual healthcare,” said Dr Ghori.
An overburdened healthcare system has forced us to prioritise the treatment of patients with advanced symptoms of Covid-19, said Siddhi Trivedi, CEO of Beowulf Proof Works.
"As a result of lockdown and social distancing, this has put patients with chronic diseases on a lower priority. Studies have confirmed that these are high-risk patients who fall victim to Covid-19 and as a consequent physician should keep connected with them. The Centers for Disease Control and Prevention looked at a sample of US patients with Covid-19 and found that 89% of those hospitalised in March 2020 had underlying chronic medical conditions. The percentage rose to 94 for patient’s aged 65 years and older. The key is to keep connected and these patients are to keep up regular checkups. Physicians have adopted ways to communicate virtually with patients; the focus should be on dietary management, regular blood tests and checking Vitamin D deficiency. Finally, remember to stay hydrated, stay home and avoid the hospital,” he said.