Categories
Public Health

Covid 19: Reality check for India

By Dr Sumeet Kad

Today, India steps up its battle against Covid-19 by implementing a 12 hours self-imposed curfew across the nation, Many states have already declared the extended lockdown till March 31 and this could continue for even a longer period of time as the new cases keep rising. India’s approach has ranged from screening people at airport arrivals, evacuating citizen from foreign affected areas, shutdown of mass gathering and public places, requesting people with mild symptoms for undergoing self-quarantine and widening the criteria for testing to avoid spreading of community transmission.

But are these steps enough? The more important question being why India didn’t take any proactive steps to boost its healthcare system? India’s dismal health infrastructure can come under severe stress if the cases continue to rise. Clearly, with a bed: population ratio of nearly 1:1000 and less than 100,000 ICU beds, India is hardly prepared to confront this pandemic which can lead to severe consequences. Italy, the US, and China have 3.2, 2.8 and 4.3 hospital beds per 1000 people respectively and they are struggling to handle the coronavirus cases.

With inadequate insurance penetration, India population is largely dependent on public sector hospitals which are severely inadequate. Nearly, 75% of private corporate hospitals are located in less than 40 districts and over 80% of hospitals have less than 30 beds. Infection control, patient management and isolation standards are under severe doubts. There is also a huge deficiency of skilled healthcare professionals adding to the existing woes (doctor-populations ratio of 1:10000 which is way below the WHO norm of 1:1000).

India’s healthcare system is devoid of integrated and inter operable data systems and platforms. This along with non-standardisation and inadequate mobility of health records and data is a vital hurdle in deploying targeted, continuous and connected care. Digital infrastructure needs to be strengthened and monitored regularly. Such technologies can be very effective in isolating and diagnosing positive cases, as shown by state of Kerala.

From pharma side, India is overly dependent on China for bulk drugs or APIs (active pharmaceutical ingredients), around 70% of APIs need of India is catered by China. Now, with China being under indefinite lockdown, India will struggle to produce basic medicines for cancer, malaria, HIV and even antibiotics for its own usage. There is an imminent need to make India a manufacturing hub for APIs. India needs to invest in setting up R&D facilities and provide tax incentives to encourage API manufacturing within the borders.

For these steps to be implemented India needs to increase the budgetary spend on health from current 2% of GDP to 5% in next 5 years. This crisis does provides an opportunity to reflect on the failures and issues within India’s weak healthcare policies. A huge chunk of the government healthcare spending goes into urban-based infrastructure whereas the primary healthcare centers are being neglected since decades.

In this article, I have listed these challenges and measures that need to be taken by India to establish a robust healthcare ecosystem in the coming years. Time is right to evaluate and assess in these trying times and look into the future.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Public Health

Combating ‘infodemic’ to tackle a pandemic

By Dr Sumeet Kad

As the global population is marred by the pandemic coronavirus outbreak, a flurry of websites, dashboards, online services and apps related to COVID1-19 are being encountered across the globe. These tools developed by tech giants, start-ups, govt bodies, and healthcare organizations provides relevant information about the symptoms, prevention methods, screening steps, tracking virus spread and offer advice to limit the risk to exposure. However, it is important for us to be aware of which are the most authentic ones to be visited.

Here are some of the latest ones which are out for all us to utilize:

Tech giant Microsoft has launched a new interactive dashboard to provide information on the spread of the virus. The map highlights the total number of cases so far (218, 400 as of today with 8500+ deaths in over 164 countries) which is further broken down into cases per country. The tool pulls live data from variety of sources such as WHO, the US Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and Wikipedia.

Quro is a Covid-19 risk assessment tool developed by Medius Health, an AI digital health company in Australia. This easy to use online conversational platform is in accordance with WHO guidelines, and aids in determining  your level of risk based on your symptoms, medical & travel history. It thereby provides accurate education to the public on the virus and collects data for healthcare providers for early intervention.

As increasing number of countries are shutting down schools and colleges, there are various online tools available which can be used by students and educators. Ekstep, an on-demand open learning platform, that facilitates creation and consumption of educational content. Plenty of educational content is available on the app which can be used by students in a self-paced manner. Online tutoring platform Vedantu is providing free live classes for all its courses including IIT preparation modules. Latest ed-tech unicorn, Byju’s, is offering free access to its learning app till the end of April.

Apart from this pandemic, populations have to address another menace in the form of false news, videos and content that are flooding social channels. To counter these, Facebook owned WhatsApp has launched a coronavirus-related information website in partnership with WHO, UNICEF and UNDP. This page has latest and accurate info for general population, governments and healthcare professionals enabling them to communicate efficiently in these tragic times.

Regional language content start-ups have started publishing accurate content in local languages related to coronavirus in order to tackle misinformation. Josh Talks has added advisories to all its videos on eight different languages and has also initiated a series of videos by doctors and healthcare professionals spreading more awareness about the disease. These videos are dubbed in local languages for people to easily understand. Local news platform Lokal, which delivers local news, information and classifieds to 900 million non-English speaking users in India, is amplifying awareness through sharing relevant and accurate info, emergency contact numbers, videos etc.

The novel coronavirus global pandemic is a medical emergency that requires a substantial individual effort as well to combat its spread and impact. We should make sure that only authentic information is gained and spread for the benefit of all.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Public Health

The next 2 weeks are critical to stopping the spread of Corona Virus in India

As I write this the official government of India website is giving us the figures of 110 cases in India. Interesting the cases have doubled by the week. Most schools are shut and offices have been encouraging professionals to work from home.

Many in India feel that the worst is behind us but that’s not the case. Currently our testing rate is around 1.2%, this is higher than UK or France as we are specifically testing those coming from the affected countries, or those in direct contact with these individuals. Our next wave will come from those infected in India itself.

Source: http://truthdive.com/2020/03/13/covid-19-india-has-30-days-to-stop-the-start-of-stage-iii-says-dg-icmr-india-news/ and ICMR

If you refer to the diagram above you can clearly see that India is at STage 2 where we see local transmission from positive cases. But the next stage is where the infection spreads locally.

I had written a piece earlier on the similar guidelines for quarantine for keeping the infection in Stage 2 of STage 3. We also would have to stop mass gatherings, being prepared for the inevitable. Here is the link to the article. https://healthcare-in-india.net/uncategorized/key-steps-for-home-quarantine-during-the-corona-virus-epidemic/

Also, I believe it is important to refer to government sources when it comes to accurate data. I get most of my information from the Ministry of Health and Family Welfare Site or from other government sites like ICMR (Indian Council of Medical Research).

Most of our cases are in states like Kerala and Maharashtra which have a sound health infrastructure and would be able to prevent the spread of the disease. But at the same time, Awareness and Preparation are the two weapons we have that we have in our arsenal.

Please take care and please follow these simple steps to understand if you need testing at all.

https://www.mohfw.gov.in/FINAL_14_03_2020_ENg.pdf

Categories
Public Health

Key steps for home quarantine during the Corona Virus Epidemic

As I write this we have 83 cases of Covid (Novo Corona Virus) cases in India with 2 fatalities. So far I believe the government has done a great job considering the global nature of the epidemic and the fatalities.

Unfortunately during these crises I see many news and internet channels spreading misinformation and rumors. I would advise everyone only to rely on the government of India Sites. In this case the site of the ministry of health and family welfare site, https://www.mohfw.gov.in/

One of the things that I learned on the site is the procedure for self-quarantine. Here are some of the key steps.

  1. Stay in a well-ventilated single-room preferably with an attached/separate toilet.
  2. If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 meter between the two.
  3. Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.
  4. Restrict his/her movement within the house.
  5. Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc. He should also follow the under mentioned public health measures at all times:
  6. Wash hand as often thoroughly with soap and water or with alcohol-based hand sanitizer
  7. Avoid sharing household items e.g. dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people at home.
  8. Wear a surgical mask all the time. The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused.
  9. Masks used by patients / caregivers/ close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial. •
  10. The used masks should be considered as potentially infected. •
  11. If symptoms appear (cough/fever/difficulty in breathing), he/she should immediately inform the nearest health center or call 011-23978046.

For more details on the steps please visit the GOI site for the Ministry of health and family welfare. The link is on the side- https://www.mohfw.gov.in/DraftGuidelinesforhomequarantine.pdf

Please also note the following numbers and email for communication on Corona Virus

The Helpline Number for corona-virus : +91-11-23978046

The Helpline Numbers of States & Union Territories for corona-virus

The Helpline Email ID for corona-virus : ncov2019@gmail.com

Please stay safe and prevention is better than cure.

Categories
Healthcare Technology Public Health

Is India taking care of its senior citizens

Last week I was at Hyderabad for a conference where the focus was on the elderly. India has roughly 120-130 million citizens above the age of 60, and this number is going to rise further due to better healthcare facilities and greater awareness of health. I also got a chance to visit my aunt, who had just recovered from fluid in the lungs. The whole visit to Hyderabad was an eye-opener for elderly care. I think we have a serious challenge in this space and currently, we have more questions than answers.

During the conference, I spent some time connecting with other healthcare professionals like Varma from Intel Health Innovation Group and Vikas Bhalla from Philips. I also had the opportunity to lead a panel discussion on how technology is helping increase access for senior citizens.

In the panel with me were, Dr. Mahesh Joshi, CEO Apollo Homecare, Vikas Bhalla – Director (Ultrasound,) Philips India and Rajagopal G – Founder CEO, KITES Senior Care. Raj and Dr. Joshi have worked extensively in senior care, both at the hospital level and services. The crux of the discussion was the breakdown of the family system that has led to a serious problem, with regards to caring for the elderly. This is more of a social problem. But it gets compounded by the fact that there is no one to care for the elderly. No one to care includes no one to monitor if they have taken their medicines on time or if they are keeping up their doctor’s appointment.

Also, we just don’t have the right number of qualified people to care for the elderly. Medical and Nursing schools are producing professionals who mostly cater to emergency cases and those that need chronic conditions. We are grossly under-equipped to take care of the physical and mental wellbeing.

To add to this we just don’t have the process in place to take into account, continuous monitoring using wearable devices. Also, there is no structure to incorporate that data into the health data to make the right decisions.

While there are many questions there have been some efforts in this space. A leading hospital in Bangalore is working on a model for remote patient monitoring of senior citizens at an old age home.

Gurgaon based Suvida is another venture in this direction where the Suvida Care Manager accompanies the elderly care recipient to the medical facility, takes detailed notes, including a personalized Visit Summary, and accompanies the care recipient back home, Suvida to become the first end-to-end medical coordination company, with a built-in unified user-first EMR (electronic medical record) system, so users don’t have to depend on individual medical facilities for their records.

While these are all steps in the right direction, the scale is clearly not enough to meet the demands of the nation. So the question to you is, is India really taking care of its senior citizens?