Covid Has Enabled Us To Do Things Remotely: Dr Naresh Trehan
How can we deliver easy access to healthcare?
You have to categorise the patients into different segments. If somebody is ambulatory, do they require ancillary services along with ambulatory care? Suppose you have an elder person who needs physiotherapy with minimal equipment, it certainly can be done at home and is much more economical.
The National Health Service in the UK or the Medicare in the US already have in-built programmes for senior care and are able to provide certain services at home, which they too find efficient. This is not very well developed in India and must be seriously looked at. Covid-19 has enabled us to do things remotely and think of progressive systems.
At Medanta, before Covid-19 we were doing 100 consults on the telephone or video, which have now gone up to 500-600. We are also recognising that there are newer tools that have come up. As many as 50 per cent of the patients need not travel to the hospital and we can at least do their preliminary diagnosis at home.
Tell us about the increased evidence of cardiac symptoms among Covid-19 patients
At the very beginning of the pandemic, the understanding of the virus was less than what it is today. So, we were under the misconception that the virus affects the airway tract, multiplies there and then starts affecting the lungs and then people cannot breathe and their oxygen exchange becomes difficult. In Italy, 50 autopsies were done, which found that the lungs were affected but that was not the prime cause. Rather the virus stimulates the body and the body starts to fight the virus which is known as cytokine response.
This in turn produces a lot of inflammation that causes clot formation in the arteries, limiting oxygen exchange. The inflammation is not limited to the lungs but also affects the heart, kidney, liver and brain. In people who had pre-existing cardiac diseases, inflammation was even more serious than in those whose hearts were normal.
Has the incidence of cardiac diseases gone down in India?
No, cardiac disease is not going down, but getting worse. Younger people are getting it. In India, the affliction is about ten years ahead of that among the western population. Now I have seen the scenario getting worse. But the understanding of the disease and communication to the public is better. People need to be aware of a family history of heart diseases, or of whether they have certain pre-existing problems like diabetes, high blood pressure or a highly stressful job. However, if one is able to control these factors, one will be able to control the incidence of heart diseases.
What are some of the lessons learned from Covid-19?
A new normal has come about for everybody and for every field. The first learning is that there is no predicting about this virus. We have learned that there is no point in taking liberty with it and we need to be self-protective. It teaches you that you are not powerful enough to rule your own future and there are forces that can create havoc on human beings.
