Hospitals too need 'lockdown' relaxation

When the extension into its third phase of the lockdown, enforced to prevent the spread of Covid-19,  there is much for Kerala to feel relieved about.  In the period so far,  the state has been able to put a block on the social transmission of the virus and create an effective prevention of the virus, almost as a model for other states.  The recovery rate in the state is 81 per cent.  And it is when this is placed against the record of below 20 percent in states of Gujarat and Maharashtra that Kerala's record will stand out. This also vouches for the vigil and care displayed in the field of public health.   In that sense,  the government and the health department deserve kudos for surviving the health crisis of the time.   But even amidst such feats, the loopholes in our famed health model are coming to the fore too.

When nearly the entire health machinery and its preventive facilities have been dedicated exclusively for Covid defence,  reports have been emerging that patients who seek treatment for other ailments are being ditched.   One of the reports shows that in the last 40 days,  the medical college hospitals and major government hospitals in the state have not been performing any surgery other than of emergency cases.  Over ten thousand such patients are languishing in their homes waiting for their turn to undergo surgical treatment.  Although many of them may not be 'emergency cases'  of such pressing nature,  it carries a clear pointer about the pain suffered by the sick segment other than the Covid-affected ones.  All the same,  the report also brings out the flaws in the planning adopted for Covid defence.  Many in the know of things in this area have raised an observation that it was a folly to set apart the entire facilities of medical colleges for prevention of Covid,  even bringing the speciality departments to a halt.  

As a matter of fact,  the majority of the nearly 400 patients who were diagnosed with Covid-19,  were not in need of the type of tertiary case that is offered in medical colleges.  Of these,  only  a minority were in need of care with sophisticated equipment including ventilator.   The remaining could have been treated with the medical facilities available at taluk hospitals (and many could even have been managed at primary health centres).  It was in this situation that whole medical colleges were converted into Covid care centres.  This may be abundant caution for Covid defence, but it also created a corresponding – and no small – crisis in regard to other patients. For example,  the  Medical College in Manjeri, Malappuram district,  with 550 beds, was made into a Covid care centre.  On the very first day, many patients  including 30 obstretic cases, had to be discharged.  On the following days,  the out-patient and casualty departments came to a halt.  As a result, those who approached it for snake-bite,  had to seek help from a private hospital nearby. The chemo-therapy unit,  that treats cancer patients, also has been dysfunctional for the past 40 days.  Those who had been treated there were directed to approach the district hospitals in Nilambur and Tirur.  It is also to be borne in mind that this hospital is an intermediate point for patients,  who receive treatment at more advanced facilities like the Regional Cancer Centre in Thiruvananthapuram.

Similar is the case of Medical College Hospital in Kozhikode,  the biggest medical centre in Malabar.   Except for the fact that the OPD there is functioning for two hours every day,  most of the equipment in major departments like nephrology,  cardiology,  neurology, surgery and orthopaedics is gathering dust.   Add to it the statistic that in KottayamMedical College,  the number of operations during the lockdown period has dwindled by 90 per cent.  This points at not any proportionate fall in the number of patients or diseases,  but a serious lapse in Covid strategy.

In a situation where the state has not shown signs of social transmission,  a question is also being raised whether such a stiff lockdown itself was required at all.   With the virus having been tamed to a great extent, public spaces could have been opened up even with curbs on social contacts.  This could have earned the community a 'herd immunity'  without which a complete freedom from disease is not achievable.   That has to be either acquired by taking on the disease,  or achieved through vaccination,  and the latter has to wait long.  For us, the summer which is half over, would  be a golden opportunity for acquiring herd immunity.   What will follow is the monsoon season,  which in Kerala is a also season for seasonal diseases.  And it is most likely that relaxations in lockdown will come into effect in this period which will also coincide with the scheduled arrival of expatriates en masse.   In any case,  we have to face this crisis.  What is required now is the preparedness for that.  The cardinal question at this hour is whether our health department has been getting geared up to face this scenario.    But instead of that,  by imposing a special kind of 'lockdown' in the health sector,  authorities are continuing a kind of treatment denial, a policy that needs correction.  This also is a question involving the lives of tens of thousands.