Chronic illnesses rise in the aftermath of Covid-19

At the height of the pandemic in April 2020, a private neurological hospital in Dakshina Kannada district was identified as a Covid-19 cluster after some of the first Covid-19 cases were traced back there.

The hospital was sealed down for nearly two months, which left thousands of patients suffering from non-Covid diseases in the lurch.

This scenario replayed itself in hospitals across Karnataka in 2020, as Covid-19 patients edged out those suffering from other equally pressing health conditions.

But how much have things got back on track?

The data from the health department shows that from April to December 2019, there were 4.98 lakh registrations for major operations. The same period in 2020 saw 58% fewer registrations.

There was similar decline in overall outpatient consultations (56%) and minor operations (59%).

Even in December last year, just over 60% patients attended the government’s Non-Communicable Diseases (NCD) clinics compared to December 2019.

“NCD care really suffered. Many people died waiting for cardiac surgery. After the lockdown was lifted, we contacted our cardiac patients. We found that eight to ten of them had died,” says Dr C N Manjunath, Director of Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.

Dr C Ramachandra, Director of Kidwai Memorial Institute of Oncology in Bengaluru says that the number of patients visiting the institute dropped from 1,500 to 50 per day during the lockdown. “Currently, we are seeing about 750 patients per day, which means that patient numbers have not yet returned to pre-Covid levels,” he said.

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At the Kasturba Medical College in Manipal, the situation has not resolved even now, as an entire facility for gastroenterology and psychiatry has been converted to treat Covid-19 patients. Dr Avinash Shetty, the Medical Superintendent of the hospital, says their current inpatient numbers are 40% below usual.

At a cancer hospital in Dharwad, where an average of 700 people received treatment for cancer each day, medical staff found that nearly 70% of their patients ceased coming to the hospital during the lockdown.

Pathologist Dr Umesh Hallikeri, who works with the hospital, attributes this to two causes: the patient’s inability to physically travel to the hospital and panic among their caretakers who would accompany them.

Whatever the cause, the end result was disastrous. Dr Hallikeri added that without access to periodic treatment, the cancers of many patients had metastasised from Stage 1 to Stage 3 by the time the lockdown was lifted.

"Now there is a huge inflow of patients in a serious condition but the problem is half of our beds and staff are reserved for Covid care. So again the burden is huge for us," Hallikeri adds.

Purnanand Sanket, the treasurer of the Kidney Patients' Welfare Association, which works as a support group for kidney patients in Karnataka, estimates that at least 10% of patients undergoing dialysis have faced complications during Covid-19.

“We were struggling to treat the dialysis patients with positive infections. It was challenging shuffling these patients to different areas. We converted one ward to isolation ward where we had a dialysis machine,” says Dr Ravi Shankar B, a nephrologist.

“There was an increase in mortality among these patients. Some people had bad infections and died,” Dr Shankar says.

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Organ transplantations too have fallen to 5 to 10% of pre-pandemic levels. The Zonal Coordination Committee of Karnataka (ZCCK), the nodal agency for organ transplantation, said there were just 35 organ donations in 2020, compared to 105 in 2019.

“The problem was all the deceased were being tested for Covid-19 and most of the times we would get the report only after 24 hours, which meant it was too late to harvest the organs,” a source in the ZCCK said.

The persisting fear of Covid also means that cadaver organ transplants are virtually at a standstill, said a source.

Routine services disrupted

Perhaps the most worrying aspect is the disruption to routine examinations and screenings.

The most definite proof of this disruption comes from the government's programme — National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) — to prevent non-communicable diseases (NCDs).

The NPCDCS focuses on the screening, early diagnosis and treatment of these diseases through health centres and health camps.

The 62.45 lakh people screened for NCDs through the community health centres in 2019 had dropped by 98% to 1.16 lakh by December 2020.

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After the screening, at least nine lakh people suspected of having diseases like hypertension, heart ailments or even cancer were referred to treatment from April to December 2019. For the same period in 2020, that number dropped to 25,353.

Over 1.25 lakh people were referred for follow-up through health camps in 2019. The number has dropped to zero this year.

Dr Rangaswamy H V, the deputy director of the NPCDCS unit in Karnataka's health department says that though things have not returned to normal, services including OPD are gradually improving. "The health camps have also been started in a low-profile since August," he says.

The government and private cancer care programmes have also been slow to get back on track after Unlock was announced.

A study across 24 cancer centres of the HCG hospital chain showed a 49.1% drop in new consultations immediately after the lockdown was imposed last year.

“While we noticed a 9.9% increase in new consultations once the extension of lockdown was announced, the introduction of unlock resulted in a progressive 12.1% decline in new consultations,” says Dr Vishal Rao, Director, Strand Life Sciences, HCG Cancer Hospitals.

Data-based action

One of the gaps in tackling the issue has been the lack of clear data about various health initiatives in the state. Government facilities capture data along various parameters but the scenario in private medical establishments remains unknown.

Take dialysis treatments: the Pradhan Mantri Dialysis programme being run under public-private partnership has 4,125 patients enroled but doctors and activists say this covers 10 - 15% of total kidney patients receiving treatment in the state. Even this claim is hard to verify because no integrated database exists.

A source in the Health Department said the government is looking for ways to ensure that data from private hospitals is integrated with the government health statistics to provide a comprehensive view of the scenario in the state but the implementation will take some time.

Way forward

“We need to increase our health expenditure and also need to focus on improving NCD care such as diabetes, pulmonary disorders and cancers because they enhance the vulnerability of people in the face of a pandemic,” says Gurucharan G, the Director of the Public Affairs Centre.

“The National Family Health Survey-5 data shows that we have made substantial gains in public health indicators like anaemia and stunting. But they must not be squandered. We must consolidate the gains we have made, so we need to focus on immunisations and women and child health,” Gurucharan says.

“I think going forward we must strengthen mechanisms to allow people to come to hospitals even if there are travel or movement restrictions,” says Dr C N Manjunath.

Speaking at an online webinar, Jawaid Akhtar, additional chief secretary of the Health Department, said the pandemic gave an “impetus” to the health sector in Karnataka and various long-standing reforms were implemented.

“The availability of oxygen beds were increased due to the nature of the virus,” he said.

“During the pre-covid period, 5,300 beds were connected to oxygen in Karnataka. Now each district hospital must have 100 beds connected to oxygen. Each taluk hospital has 50 beds and CHCs 30 beds. In all, at least 28,000 beds are oxygenated,” he says.

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Regarding consolidating the gains made during Covid, Akhtar says they are thinking of operationalising six-bed ICUs in all taluk hospitals.

To deal with the shortage of staff, the relevant government officers were also given powers to recruit people on a contractual basis. “Society, authorities and the population in general have become more conscious about health issues. Karnataka has already spent 4.8% of the GDP on health. The norm is 8%. And I am sure this will give a fillip to this in the state," says Akhtar.

(With inputs from Manjushree G Naik and Srinidhi R)