Let me share a practical problem that clinical establishments including standalone clinic, nursing home & big corporate hospitals are struggling with these days & the consequences of this problem.

P.s. - Solutions & discussions are welcome. But vilification & activism is not.

Asymptomatic patients & spread of #Covid_19 is a fact. This creates multifold concerns for clinicians & clinical establishment like -

1. How do we protect healthcare workforce from exposeure to undiagnosed asymptomatic Infection because this can be practically any patient?

2. How do we protect other patients who may be admitted in same ICU's , come in OPD'S during the same timeframe from these undiagnosed asymptomatic patient encounters??

There are some examples of suggestions/solutions to prevent these but all of them have consequences attached for clinical establishments, patients as well as healthcare workforce.
I am going to share a few of these examples

Eg.A - since anyone can be asymptomatic carrier, we assume everyone is covid suspect & ask everone to wear masks, gloves, provide handwashing areas or sanitizers, restrict OPD slot to 2 (max 3) patients every hr, social distancing in OPD areas,alternate day OPD, layered screening

The problems associated with Eg. A are -
1. A huge Increase in wait time for consultations (I on an average see atleast 50-60 patients in OPD ina day, even if I work 10 hrs a day I will only see 20 patients per day, in govt hospitals units see 200-300 patients per day)

2. This decrease in daily patient number will also impact revenue generation through OPD (though you may say healthcare cannot be guided by financial concerns these losses can be significant & make it financially unviable for many clinical establishments to keep running)

3. Elaborating 2nd point- to keep OPD'S functional any clinical establishment will need to provide PPE's for all staff involved & sanitizers for staff & patients & cleaning (Handwashing is not option always cuz I'll chap my hands if I wash then with soap everytime I see patients)

4. Quality Sanitization & PPE cost (& these days exorbitantly) even if I assume wholesale costs at which may acquire them (all can't) that is a significant daily cost & then is the cost of workforce (there salaries need to maintained with low revenues & increased expenditures)

We may solve the problems in Eg. A by - Increasing cost of consultation (then patients & media will outrage) or by laying off workforce (workforce will obviously outrage) or we may try telemedicine (this one is clinically not applicable to most situations requiring evaluation)

Eg. B is a scenario where we have to do a procedure either on OPD basis or by admitting patients in hospital & it may require 2-3 days of stay.
These patients can be asymptomatic covids or covid presentations in form of stroke or heart attacks etc.

In Eg. B- There is risk of transmission to healthcare staff involved, other patients in ICU or ward & even attendants (because quite possibly the attendant of patients may be asymptomatic spreaders too!!) So how do we ensure safety of procedure, staff, patients & hospital areas?

Again we presume any walk in as suspect, provide layered screening, reduce admission, seek covid testing as per criterion,delay or avoid procedure wherever clinically possible,ensure PPE to all care givers involved & to patient & attendant also,increase frequency of sanitization

The solutions of Eg B again has issues - 1. Eg. In cardiology even if I perform one Angiogram I will require PPE kits for atleast 3-5 people - 2 operatoes, 1 technician, 1 nurse & 1 sanitation worker. A minimum of 3 for stay in ICU. These kits cost. Who will bear their cost?

2. We will need to sanitize the lab after every procedure, have a minimum time after which only we can start the 2nd procedure. This will limit the number of procedures we do in a day (again leading to long wait times for patients & revenue loss for establishments)

The solution in Eg B have consequences & costs attached for eg. Low procedure revenue will again mean lack of operational viability which will either lead to increased cost of treatment or salary cuts or workforce lay offs.

The 2 examples above are not exhaustive, the scenarios will vary differently in different scenarios like Dialysis, ER, chemo therapy, cancer diagnostics, obstetrics, geriatric, gastro, ENT, radiology, emergency procedures & so will the logistics & consequences

This will invariably lead to (whether anyone likes it or not) certain changes will #covid19 vaccine or treatment remains elusive-
1. Cost of providing healthcare will change
2. Healthcare job vulnerability
3. Changes in Healthcare modalities & delivery policies

Scenarios in health care industry are same as that of airline industry - extremely high running cost, high maintenance cost, low revenue & uncertain projections - but when airlines will increase ticket costs it will be acceptable but rise in treatment costs won't be acceptable

Throughout the length & breadth of country in healthcare set ups be it pvt or govt I am seeing a denial of these real time practical issues & their consequences. In govt this denial is manifesting as inadequate testing, PPE'S, gagging healthcare expression

In pvt it has manifested as knee jerk salary cuts, laying off of healthcare workers, increase of treatment costs or reduction in operations significantly

In my understanding healthcare problems that I have mentioned above for the interest of institutions, patients & workers are only the following - 1. Indigenous production of PPE & sanitizers leading to rapid availability & reduced costs & ensuring cost caps

2. We need a massive upscale of tests both rapid & antibody to the tune of 5-6 lakhs per day (at the minimum) by involvement of all lab resources available, testing prices should be priced as per incurred cost analysis.

It is urgent for govt to communicate transparently & clearly regarding its testing strategy, PPE procurement & availability strategy & has a discussion with all stakeholders of healthcare industry like healthcare workers, patient groups & management.

Resource pooling & public pvt partnership between govt & pvt hospitals & labs is another suggestion that needs detailed discussion

This thread is only a bird's eye view of general day to day problems we are experiencing in healthcare delivery due to covid19.
The problems difference as per speciality, operation levels, patient inflow etc

And, I have not even factored in the losses due to loss of international patients & medical tourism to not just hospitals but many associated industry partners. Also, the delays that hospitals will have in receiving govt money for all panel patients who get treated in pvt setup.

Another suggestion can be - partnerships between corporates, Industries & private health establishments for healthcare needs of their employees with employer & employees contributing equally & hospitals offering discount vouchers.

Real impact of these problems which so far remain unaddressed by any measures from govt will be apparent once the lockdown is over & people begin to access health services - then you will notice the price hike in treatment & procedure cost, that your doctor has been laid off

At that time instead of being angry with front desk or admission staff or doctors at the clinical establishment please factor in everything that I have written above & also factor in the policy paralysis at the end of govt & place the blame where the fault lies.

Another problem is who will incur cost of PPE in patients who are paying individually for procedure vs those being paid by health insurance vs those who are empaneled through CGHS, DGHS, ESI etc which donot provide the cost of the extra PPE charges.