Covid-19: The Healthcare Industry’s Outlook

By: Neelam Jhangiani

Novel Coronavirus Disease (Covid-19) outbreak, a declared pandemic by the World Health Organization, has taken India too by a storm, and the country now stands at an important inflection point in its fight against the virus.

With the total number of confirmed infected patients crossing 1 lakh and still counting, the country has been taking all necessary steps to control the spread of the virus and ensure safety of its citizens.

If we take in account the mortality rate, it is just 2%, which is less than many other diseases. But the speed at which it is spreading is a major cause of concern, and even if it has less mortality, with this speed it can affect a large number of people. The increase in numbers is has already put a burden on the healthcare system. With such high number of patients, the healthcare community, irrespective of them being government or private, have come together as one to battle it out.

Current scenario

Some time back, the centre directed private hospitals across India to designate dedicated wings to treat the affected patients, prepare for sample collection, discharge patients who are stable and divide medical staff into two groups so that even if one group gets infected, the other can work.

Advisory guidelines have been issued by the center and state to local municipal corporations/district administrations about isolation/quarantine rooms in private hospitals. However, there is still a wide gap between the demand and supply of hospital beds vs. patient requirements. Private healthcare institutions in collaboration with government institutions are an additional help to fight against coronavirus. As per latest figures, there are over 347 government-run laboratories and 137 private laboratories currently conducting Covid 19 testing, along with numerous hospitals.

“Health tech institutions, through online counselling, can assist patients in breaking the coronavirus myths and increase the awareness about testing of coronavirus,” says Dr. Inder Maurya, Founder and CEO, Foreign OPD.

When the world faces such a huge crisis, it becomes the responsibility of every citizen to play his/her part. Private healthcare can keep contributing to the system in terms of technical manpower, equipment and facilities, research and development and meeting the increasing demand of pharmaceutical products.

Another way in which they can contribute immensely is by spreading the right information. Using their resources and manpower, they can reduce panic and misinformation spreading around and actually make people more aware. In times when even cities like Mumbai are seeing a high spike in infection rates, such awareness spreading initiatives become all the more vital.

“Doctors and paramedical staff can volunteer their services to institutes that are helping the Covid-19 patients, to reduce the burden solely on government professionals,” says Dr. Bharat Champaneria, Superintendent and Chief Coordinator, Kaka-Ba Hospital. In addition to the services, these organisations can also volunteer their equipment, facility and instruments.

For hospitals in the rural areas, there need to be extra preparedness to handle the influx of patients. They should have all the necessary equipment and manpower to handle the cases. Also, they should have a good number of ambulances at their disposal in case of emergency transfers.

A number of private hospitals have opened online consultation facilities to deal with the surge in cases as well as address other health needs of patients virtually at a time when social distancing is critical. “We are providing online assistance to people by assessing their symptoms, gauging their conditions through video consultations and advising them the future course of action – whether they must get tested or they must just stay at home and monitor their situation,” informs Dr. Shankar Narang, COO, Paras Healthcare.

Isolation areas have been identified in preparedness for treatment for the Covid 19 patients at Columbia Asia Hospitals as well. All the processes are in place at the hospital wherein all patients and companions are screened upon entry to the hospital. If there is a suspect, the health department in the state governments is immediately informed. “Some of our hospitals are identified as first responders and are permitted to collect samples and send to designated centers for testing,” shares Dr. Nandakumar Jairam, CEO, Chairman and Group Medical Director, Columbia Asia Hospitals. These hospitals on government directions admit suspected Covid 19 cases in isolation, he further adds.

As a hospital in the rural area of Hansot (Gujarat), no cases of Covid-19 had come to Kaka-Ba Hospital, at the time of filing this story. However, the hospital was taking precautionary measures and creating awareness amongst the staff, the people working in the hospital and those staying inside the campus.

“We have been spreading information amongst the people such as how to properly wash hands and at what frequency, how much distance to maintain between two people, what exactly is Covid-19, how it spreads, signs, symptoms, management etc.,” Dr. Champaneria says. This is not limited to their staff, but also for anyone visiting the hospital for consultation of any ailment. Kaka-Ba has also communicated to the government bodies about their present capacity, and if need be, they can house at least 20 patients affected from the disease. The quarantine ward has been newly created, which is completely separate from the main building. The staff has been trained in handling patients and the unit is also sanitized regularly as a precautionary measure.

Aditya Birla Memorial Hospital in Pune is also following the recommended guidelines provided by the government with a separate screening room to scan patients/visitors along with a set of questions to understand their travel history. Patients who come to the OPD and come across as a susceptible case, have to go through the screening. A specific ward has been dedicated in the emergency department for screening within the department. All patients are screened before getting further treatment.

During initial designing stage itself, Aditya Birla Memorial hospital had created isolation zones at the hospital as it needs technical measures including positive and negative pressure to be maintained. In addition, they have a separate fully functional isolation facility for both kids and adults.

Government support

No country in this world can ever be prepared for such extreme situations. “The best way to protect the health of citizens from a community contagion is a threefold strategy-isolation/quarantine, social distancing and extensive Covid 19 virus testing,” Dr. Maurya says.

Considering the population of India, if there is a bigger sudden spurt, the country would be facing shortage of protective equipment and this may increase the exposure and infection of health workers. Already, the healthcare workforce has started to get infected, which puts them out of action for some days, and creates a further shortfall of healthcare active workforce.

“We have been fortunate till now that we have not seen a major spurt of infections,” Dr. Jairam says. As per latest figures issued by the Union Health Ministry, India has about 7.1 cases per lakh population whereas the average of the whole world is 60 cases per lakh population.

Keeping in mind the concern of safety, the whole sector along with the government has pushed the agenda of mass production. Till the time of filing the article, the highest single-day production of PPE kits was recorded at around 2.06 lakh kits, on May 2, 2020. While, the average domestic production is about 1.5 lakh per day; wherein 17 companies have been asked to assist for the 38 mn unit PPE shortfall.

“All stakeholders are involved in doing their bit. To cite an example, the Kerala government has roped in prisoners to produce masks and hand sanitizers to address the market shortage,” says Dr. Narang. This can be replicated across states.

Additionally, the government bodies and the regulatory bodies should take a hard stance on squashing misinformation, which is a major problem. During this critical time, it becomes very important to manage the crowd.

“We are sensitizing the patients while doing these sessions with our staff. We are also running knowledge sharing videos across the facility for people to understand the situation and take necessary actions. The hospital is continuously monitoring and auditing the number of patients being admitted, requesting families to maintain distance and avoid crowding. Furthermore, every space within the premises is being utilised effectively thereby giving enough space to each and every patient,” says Rekha Dubey, CEO, Aditya Birla Memorial Hospital.

Diagnostically equipped?

Test, Test, Test is the mantra.  A correct and early diagnosis with the help of a rapid or fast-paced and reliable molecular diagnostic test for Covid-19 is the need of the hour.

While at the start of the pandemic, India was dazzled with the issues at hand, but swift actions have helped make the scenario better.

As of today, local companies authorized by the Central Drugs Standard Control Organization for producing test kits are Mylab, Medsource Ozone Biomedicals, Voxtur Bio and Alpine Biomedicals.

Additionally, the Union Health Ministry also gave approval to 6 organisations, including 3 indigenous firms, to develop commercial Covid 19 test kits for analysing nasal and throat swabs. Overall, India is locally producing 10 lakh kits per month each of RT-PCR testing and rapid antibody detection tests for Covid from this month.

“Unfortunately, there are still very few labs in the country that have the necessary infrastructure to support Covid-19 testing. Although, the government has taken strong and urgent steps and hopefully, that will hasten the speed of the whole diagnostic process,” says Dr. Ravi Gaur, COO, Oncquest Labs.

“All the ICMR (Indian Council of Medical Research) approved government laboratories and private laboratories are fully equipped to test for Covid-19. They have the required infrastructure and also network of collection centres to do this task at a large scale,” informs Aishwarya Vasudevan, Group COO, Neuberg Diagnostics.

ICMR has laid down strict guidelines for testing for Covid-19 in both the government and private labs approved by it for the same. The approvals were given post a thorough check of the various labs and their facilities. Covid-19 testing in all labs must follow the guidelines from ICMR and other competent government agencies. Within the limitations and time constraints, the government has done a very commendable job say industry experts. Quality testing is must and one needs to avoid false positive and false negative. It’s a very sensitive issue and organisations should be very careful on the accuracy of reports.

As per the guidelines issued by ICMR for Covid-19 testing in laboratories can be provided only for an individual with a valid prescription from a qualified physician, while adhering to the sample collection and testing protocol set by ICMR. All Covid-19 positive samples will have to be transported to ICMR-NIV (National Institute of Virology), Pune under suitable Biosafety and Biosecurity precautions as laid down by ICMR.

Time to step up measures

India is a country harbouring a population of more than 1.3 billion. To quickly set up an infrastructure that will facilitate testing across this wide a spectrum is certainly not an easy task. Let’s face it, our healthcare system is far from perfect – both the government and the private institutions have their flaws – but by joining hands, they can cover for each other’s shortcomings and help devise a solution to the problem at a much quicker pace.

“We must appreciate that both the government and private providers are now working at a very fast pace and have shown great cohesiveness in this hour of crisis to address Covid 19 challenge. However, it’s time to relook at our systems, based on today’s experience and ensure that we are fully geared up as we move ahead into the future,” Dr. Gaur opines.

As a part of stepped-up measures, various start-ups in India have invented indigenously-built testing technologies and capabilities validated, while a few others are in the final stages of approval. These kits cost around Rs. 900 to Rs. 1,200 per patient, as against the original cost of Rs. 4,500 at the beginning of the pandemic. Some of these have also started manufacturing and scaling up. 

Additionally, Mobile BSL-3 VDRL Lab for Covid-19 sample collection has made testing easier and far more reachable. This Lab has been developed by Defence Research and Development Organization (DRDO), Ministry of Defence, Government of India in collaboration with ESIC Medical College & Hospital, Sanathnagar (Hyderabad). 

“All these factors combined can help alleviate the problems that the diagnostic sector is facing currently,” suggests Dr. Gaur.

Furthermore, approvals to more fully equipped state-of-the-art labs (both government and private) will increase proximity for people and serology-based test for initial screening and RT PCR test for confirmatory analysis can be used. This will help the government to empanel a greater number of labs and a greater number of samples can be tested given that high throughput of serology-based tests.

“While approved testing and treatment centres are on the rise, the government’s decisions aimed at substantially reducing the spread through ‘social distancing’ and ‘breaking the chain’ are praiseworthy,” Ms. Vasudevan says. Educating the masses to move from a casual approach to a more responsible approach towards combating Covid-19 is the key, wherein non-adherence can lead to disastrous results for individuals and the country.

Staff safety in healthcare

Healthcare profession is beyond doubt one of the most rewarding careers one can choose, however, healthcare workers face an elevated risk of exposure to infectious diseases, including the novel coronavirus. It is imperative to ensure the safety of healthcare workers, not only to safeguard continuous patient care but also to ensure they do not transmit the virus.

Coronavirus emergency management guidelines are issued by different medical bodies like WHO, CDC ATLANTA USA. Most hospitals have already instituted isolation wards to ensure that if a suspected patient does land up, he/she is immediately isolated. Similarly, doctors and medical staff in OPD and emergency units have been asked to wear masks and other protective gear such as gloves. “But on the ground, there’s a lack of PPE, which is definitely compromising the safety of doctors and nurses,” says Dr. Maurya.

Paras Hospital has devised strategies to reduce crowding at their hospitals, by giving online appointments in such a way that too many people are not waiting in queues in OPDs at any given point of time.

“In a situation like this, hospital staff is the most at risk. Apart from regular training and awareness campaigns, we have ensured that we get adequate supply of PPE,” informs Dr. Champaneria.

“Apart from trying to provide adequate PPE, we have created and are airing small knowledge sharing videos of healthcare experts like a pulmonologist, the medical director, infection control officer. The video includes messages from these experts on how to avoid panic, what should be done to enhance immunity, messages on washing hands and how to overall take care of oneself. We are daily training our staff to manage corona cases, says Ms. Dubey.

AI-based diagnosis for Covid-19

• An innovation of VNR Vignana Jyothi Institute of Engineering and Technology (VNRVJIET), Hyderabad
• To predict with over 99% accuracy, makes use of chest X-ray/CT scan
• Team led by Radha Krishna Vangipuram, Assistant Professor, Department of IT. Currently being patented in India and the USA.
• Same system can be used to predict other respiratory diseases & has a much higher precision than radiologists.

Economic concerns

Coronavirus has created an outrage globally in a short span. The impact of the Covid-19 pandemic on the global economy has placed business leaders in an unprecedented state of uncertainty. Decision makers in companies and governments are struggling to understand the new challenges and determine what course of action needs to be taken. According to a latest UN trade report, the world economy will go into recession this year with a predicted loss of trillions of dollars of global income due to the coronavirus pandemic, spelling serious trouble for developing countries.

Back home, the pandemic has severely affected our economy, bringing many businesses to a halt, causing shutdowns in sectors like travel and tourism, hotel industry and more.

“Even in the pre-Covid 19 time, barely our economy grew. GDP showed marginal improvement from 4.1 % to 4.5 %,” Dr. Maurya says.

The pandemic brought with it a big economic slowdown. To counter the balance, very recently, PM Modi announced a 2-lakh crore relief package for various sectors of the country. The package focuses mainly on 4Ls: land, labour, liquidity and laws. It is designed to cater to various sections, including cottage industry, MSMEs, labourers, middle class, and industries. The stakeholders across the nation are hoping for some revival due to this package.

Healthcare sector too is getting affected, with halting non-emergency cases and procedures, which is ultimately affecting the business of the sector.

Even if regular hospital proceedings are on pause, patients who need medical assistance will have to see a doctor. Thus, there is a shift towards virtual consultations. “At Paras, our virtual consultations through web-based links have gone up by 30%,” says Dr. Narang.  Similarly, other online consultation providers have also registered a spike. So, the business has shifted to another platform. For the convenience of patients, Columbia Asia Hospitals have also introduced teleconsultations for many specialties, however for procedures like dialysis and radiology, the patients will have to come to the hospital.

“We are seeing a dip in the number of OPDs as people are visiting the hospital only in an emergency,” Dr. Jairam says. He further adds that the effect on business will be temporary because the moment there is a return to normalcy, people who have been postponing their visits or surgeries would get themselves treated.

A hospital like Kaka-Ba, which is a non-profitable hospital and works on external funding, primarily by Cadila Pharmaceuticals and other partner organisations, it is the only multi-speciality hospital for many of the nearby villages. “The concept of profit or business is out of the question for us. For everyone working here, our primary goal is to provide the best healthcare facility to anyone who cannot afford it. Hence, it becomes all the more important for us to stay prepared for any adversity,” says Dr. Champaneria.

Looking ahead

As the country braces for the rapid spread of the coronavirus, its health care system offers limited comfort. The country spends only 3.66% of its GDP on public health.

Also, India has just 0.5 hospital beds for every 1,000 people and the World Health Organization (WHO) recommends at least 5. India has on an average 0.8 doctors for every 1,000 citizens; even Italy, which has been badly hit by the coronavirus outbreak, has five times as many doctors per capita. There is ample reason to fear that if the coronavirus disperses rapidly through a country as densely populated as India—it could overwhelm the country’s medical infrastructure, even more than it is overburdening right now.

The need of the hour is to contain viral clusters, to prevent and break chains of transmission. With its 1.3 billion inhabitants and high population density, India will have difficulty in taking care of contaminated patients in the event of a major spread of the coronavirus. 

The only way ahead is if all stakeholders realise their responsibility and act accordingly to slow down and eventually reduce the spread of the virus.