Delay in Resuming Regular Hospital Services in India May Cause Future Spike in Deaths, Experts Warn

It's been nearly two years since 48-year-old Santo Kumar was diagnosed with ovarian cancer. Last November, she visited India's premier hospital All India Institute of Medical Sciences (AIIMS), Delhi, where a doctor suggested oophorectomy surgery or the removal of ovaries. In view of the contagious coronavirus, they couldn't get it done as many health services were shut at the hospital. 

Now, after waiting for months, Santo visited AIIMS on 7 June along with her daughter Pooja. They wished to have a confirmed date of surgery. But hospital authorities revealed that the surgery section is yet to resume functioning.  

Talking to Sputnik, Santo's daughter shared that her mother is in a lot of pain. “Now she can't do anything to help herself. She remains lying in the bed the entire day at home".

Pooja said that "since then [when her was diagnosed with cancer] we have visited more than six hospitals. All of them avoided us by referring my mother to a bigger hospital. Now, AIIMS hospital [due to being the biggest hospital] at least cannot ask us to go to any other 'bigger' hospital".

Seeking an appointment for a surgery at AIIMS also involved great hardships. 

To stand in the queue, she had to leave her mother alone. Santo, who usually requires a helping hand for anything, waited for her.

Sputnik spoke to some other people awaiting their turn for an appointment in the queue just to learn that almost every patient had his or her own difficulty to share due to health services disrupted by COVID.

Some patients have been visiting hospitals since 2019 or 2020. They said that due to COVID-related problems and lockdowns, hospitals shut down their OPDs. And, this in turn, caused a recurring problem for them to get an appointment for surgeries or be admitted.  

The AIIMS hospital closed its OPD services on 22 April, according to a hospital spokesperson, and was set resume them on 18 June. Until then, only emergency services had been operational.  

Delayed Treatment

Studies and health experts have expressed concern over a decline in screening activities during COVID-19-induced lockdowns as missed diagnoses may lead to an increase in cancer-related and other deaths over the next few years in the country. 

According to The Lancet, between 1 March and 31 May 2020, cancer screening was either fully stopped or was functioning at less than one-fourth of its usual capacity at more than 70 percent of the nation's centres during these months, when comparing it with data from 2019. During the same period, new registration patients fell by 54 percent, outpatient clinic visits decreased 46 percent, the number of surgeries reduced by 52 percent, patients accessing radiotherapy reduced by 23 percent, pathological diagnostic tests by 38 percent, radiological diagnostic tests by 43 percent, and palliative care referrals by 29 percent. 

Pandemic Affecting Hospital Services, Experts Say

Speaking with Sputnik, oncologist Dr Harish Kancharla of the Hyderabad-located Yashoda Hospitals, shared that services at his hospital too were impacted due to the COVID-19 pandemic.

Underlining the long-term impact of cessation of cancer screening and delayed hospital visits, Dr Kancharla said that it "will result in the progression of ailments, decreasing the chance of operability and worsening of performance status with delay in diagnosis. There is potential harm to patients from an interruption of services".

"Old-age group, patients with haematological malignancies, stem cell transplant patients who are on immunosuppressive medication, and advanced solid malignancies are more likely to be affected and pose a greater risk for life-threatening complications", he added.

Demand for Empowering Primary Healthcare 

As per K. H. Reddy, president of the Public Health Foundation of India: "We have some data suggesting that during the lockdown, early post-lockdown when relaxation was restricted many people could not get the required attention in hospitals, both public and private".

When there was no lockdown but cases were surging, hospitals reserved beds for COVID patients, and that even without lockdowns non-COVID cases didn't receive attention, he said.

Stating that India needs to strengthen its primary healthcare system, Reddy said: "Our health system cannot meet multiple demands. Except for a few states like Kerala and Tamil Nadu. Most of the COVID cases in these two states [were] reported to primary [civic hospitals] and secondary level, and very few reported in tertiary care [state level or big hospitals], which were serious".

​Hence, when the pandemic hit these states, other healthcare services weren't dealt such a significant blow, he added.

Focusing on strengthening healthcare facilities, Reddy said: "We should try to improve primary and homecare systems. For home care, we should set up 24x7 telephonic consultancy so that the burden doesn't shift to big hospitals all the time".

He also stated that now when general consultations and OPDs are opening, all hospitals need to prepare themselves, understanding the urgency of the requirement to screen problems as soon as possible.