Covid-19 fears forcing many to give vital treatments a miss
After having beaten breast cancer, Santosh Batra (72) was a bit concerned when she felt pain and uneasiness on the left side of her chest in mid-June, but she postponed a visit to the hospital for fears of contracting the coronavirus disease (Covid-19) infection.
“I took Santosh to a friend, a doctor, and he prescribed an ECG (to assess her heart function). I considered taking her to a neighbourhood hospital but she refused because that facility was treating Covid-19 patients. We came home but that night, her pain and uneasiness got worse and her blood pressure began fluctuating, I kept checking it throughout the night. The next morning, when we went to a hospital, they said she had had a severe heart attack and there was some damage to the heart. We were asked to rush her to a bigger hospital,” said Batra’s husband Bal Kishan Batra, who works as a consultant in a private company.
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Batra was then taken to Indraprastha Apollo hospital’s emergency department. “By the time the patient came to us, she had a ruptured septum (heart wall that separates the left and the right side). When a person has a heart attack, there is a 1% chance of complications such as a leakage of the heart valve or rupture of a chamber wall, but if they delay treatment the risk increases to 5%,” said Dr Mukesh Goel, senior cardiac surgeon at Indraprastha Apollo hospital who treated her.
“Because of the delay, she had to undergo a complex surgery instead of a simple angioplasty (a procedure where a tube is inserted through the blood vessel to remove the arterial blockage). The surgery that had to be performed was also very risky as the tissue around the heart became friable and the stitches wouldn’t hold,” he said.
Since the onset of the pandemic, many like Batra have been missing out on crucial treatment for fear of contracting Covid-19 at hospitals. A Delhi-based doctor, not wishing to be named, says half of his patients have been coming in with complications resulting from delays in treatment.
Dr AK Singh Rana, medical superintendent of Dr Ram Manohar Lohia hospital, said, “With hospitals flooded with Covid-19 patients in June and July and public transport not being available, the general tendency among people to was to wait for symptoms to resolve themselves -- patients were not coming to hospitals even they needed to. Even after the lockdown has been lifted, the number of patients in the OPD is a fraction of what we got before March. This is leading to people needing life-saving emergency surgeries that could have been avoided with timely treatment.”
Open surgeries, longer hospital stays
Initially, it was on account of the lockdown and then out of fear that patients were postponing elective surgeries resulting in further complications and longer hospital stays.
In the last three months, Sir Ganga Ram Hospital has seen at least 31 such cases in the emergency, including those of ruptured gall bladders, intestines and appendices.
“The number of such cases that we have had to perform in the last three months is probably what we would have done over two years pre-panedmic. When we say a procedure is elective, it means that it can be planned in advance, but it cannot be postponed indefinitely. Some of the procedures were cancelled when the lockdown happened but even after restrictions were lifted, patients are reluctant to come in because of the fear of Covid-19. This results in complications such as gall bladder ruptures, or blockage of the intestine, or the appendix bursting,” Dr Vinod Bindal, vice-chairman of minimally invasive surgery, Sir Ganga Ram Hospital, said.
He narrated the case of a patient who had initially been diagnosed with gall stones and insisted on just tele consultation thereafter. Bindal said, unfortunately, the patient had gall bladder cancer that had already metastasised and could not be removed surgically.
Many patients also had to undergo open surgeries. “All these procedures are fairly simple and can be done using minimally invasive techniques. But because of complications, at least 10 patients had to undergo open surgery. The complications also led to a longer hospital and ICU stay,” Dr Bindal said.
Delays in reaching the emergency
Patients with routine problems such as high fever and stomach ache have vanished from the hospital emergencies these days and have been replaced with complicated cases.
“In the emergency, we categorise patients as priority 1, 2 and 3 – with priority 3 patients being those who come in with fever, headache, tummy ache, gastroenteritis and suchlike and can wait till we manage the more severe cases. This category of patients is completely missing right now. Earlier, even with a full out-patient clinic running, we used to see these cases in the emergency department,” Dr Priyadarshini Pal Singh, head of emergency department, Apollo Hospitals, said.
Instead, they have been seeing patients with complications arising out of not coming to a hospital sooner. “Patients with fever had waited till they got pneumonia and were breathless. Diabetes patients who were not able to regularly monitor and maintain their blood sugar levels ended up with diabetic ketoacidosis (a severe complication where the body starts releasing high levels of blood acid called ketones),” Dr Pal Singh said.
“With a person suffers a stroke, we need the patients to come to a hospital as soon as they see some slurring of speech or facial deviation or something as simple as dizziness. In case of a stroke, we need to act fast to prevent further damage. But now we get cases that come in only after half the body is paralysed,” she said.
Patients also come in with fractures days after the injury. “Usually, in cases of orthopaedic injuries, people tend to reach hospitals immediately because of the severe pain. But we have seen a few cases wherein patients waited days before coming to the emergency -- a fracture needed surgery or resulted in embolism (a clot formed because of the bone fragment getting lodged in a blood vessel),” Dr Pal Singh said.
Doctors advise patients that if they are wary of going to a hospital, then they must consult doctors online in a timely manner. Dr Pal Singh said, “A simple rule is that if you considered going to a hospital or a doctor for any discomfort or ailment and don’t want to, then at least get an online consultation. And please follow the advice of the doctor. If the doctor thinks you need to go to a hospital, please do so.”