Challenges of medical fraternity in post COVID-19

COVID-19 as an illness has brought in challenges, both at the individual level and society at large. Statistically, India currently ranks third to the number of people affected by COVID-19 worldwide. According to a recent epidemiological survey and a report by the World Health Organisation, the surge is yet to arrive in India.

Given the implications of the COVID-19 outbreak, challenges in the healthcare sector are likely to multiply. Especially to seniors as they are the most vulnerable demography to the disease. There is a dire need to define and follow strict protocols to face the challenges posed by COVID-19.

Looking ahead, one cannot help but wonder – is the pandemic going to pass? And what will the world look like post COVID-19? In my opinion, we’re going to have to co-exist with the virus (SARS-CoV-2) in the foreseeable future. With the passage of time, a vaccine against COIVD-19 will be developed, tested and made freely available for mass inoculation. While the vaccine will be able to help us build immunity against the disease, it cannot, however, eliminate the virus.

Once we carry out mass inoculation of the vaccine successfully, it is only a matter of time before we develop herd immunity (resistance to the spread of COVID-19 because a significant percentage of the population has acquired immunity to it).

On a positive note, there have been innumerable cases of super senior citizens or people aged 80 and above, recovering from COVID-19. However, we cannot be complacent about the much-needed precautions to be taken in the interest of the senior population. Let us begin with categorising and strategising to tackle the envisaged challenges.

Categorisation of senior citizens
It would be prudent to broadly categorise senior citizens based on their living conditions and health status. Based on their living conditions – individual seniors living independently in their houses; Seniors living in mixed families (dependent on their families); Seniors living in gated communities; and Seniors living in retirement homes.

Based on their health status – seniors with comorbidities such as diabetes, hypertension, cancer, immunocompromised illnesses; Senior citizens without any comorbidities that access to the support system as well as their reaction time matter when it comes to fighting against COVID-19, irrespective of their living conditions and health status.

Emerging challenges
The reluctance to report with early symptoms of COVID-19, fearing isolation and hospitalisation, can result in seniors seeking treatment only when their condition gets acute and the reaction time is minimal.

Self-medication to avoid visits to hospitals can result in complications and possibly reduce the chances of a smooth recovery.

Fear and anxiety around COVID-19 can aggravate the existing comorbid conditions, thereby putting them at a higher risk of getting infected and complicating the treatment in positive cases.

Social distancing has become the norm and has worsened the fear of isolation among seniors. Consequently, seniors are likely to either experience new mental health issues or aggravate their existing conditions.

A sedentary lifestyle combined with seniors spending most of their time indoors can cumulatively lead to vitamin D deficiency, which, in turn, negatively impacts their immunity.

Going back in history, poverty and unavailability of food during the many wars, famine and epidemics slowed down human metabolism over time. This has resulted in seniors having a predisposition to Metabolic Syndrome and the associated disorders such as morbid obesity and diabetes, thus making them more vulnerable to infection.

Seniors who have had pneumonia or a chronic obstructive pulmonary disease (COPD), and have recovered from COVID-19, may need respiratory rehabilitation.

Strategies for overcoming, coping with challenges
A comprehensive geriatric care system, addressing the physical, emotional and mental well being of senior citizens is a primary requirement.

This can be achieved by involving primary care physicians to address health holistically by doing the following:

The next generation of doctors should be trained to serve the increasing population of seniors with professionalism and compassion. Geriatric care should be made a mandatory part of the medical students’ residential internship. This can be easily achieved by liaising with clinics and hospitals that treat and care for the elderly.

Family clinics should be staffed with general practitioners who are trained in caring for the elderly and should be available on call for home visits. Avoiding visits to healthcare centres helps limit unnecessary exposure to contagious infections and diseases.

A care system comprising of nutritionists, physiotherapists, psychologists and general practitioners trained in geriatric care could be teamed up for early intervention and timely services.

Role of primary care physician
An integrated approach through respiratory rehabilitation services, yoga and movement therapy should be prescribed to the elderly recovering from illnesses.

Respiratory rehabilitation should be made a part of the follow-up treatment of seniors who have recovered from COPDs, COVID-19, and pneumonia. To avoid daily visits to the rehab centre, seniors should be assessed and prescribed customised programmes at the time of discharge.

Exercises and movements that improve flexibility, strength, stamina, balance and coordination should always be prescribed and demonstrated to seniors in a detailed manner. Online physiotherapy sessions are practical, given the present circumstances and restrictions.

We need to adopt an integrated approach to tackle the COVID-19 crisis. This can be done by integrating preventive, promotive, curative, rehabilitative and palliative healthcare by integration with the existing public healthcare system. The Ayush HWC initiative is a brilliant example of a holistic healthcare system successfully implemented at a national level. Looking ahead, this integrated approach applied at a primary care level seems to be the way forward.

National Accreditation Board for Hospitals & Healthcare Providers certified mobile lab services should be scheduled at gated communities and senior living communities on a regular basis to provide easy access to necessary health check-ups and tests.

Consultations with specialists
Getting an appointment with a specialist is a cumbersome process. In order to encourage seniors to get regular health check-ups, telephonic and online consultation sessions should be popularised.

Strategic digital initiatives
There will be a greater need to develop new healthcare systems by leveraging digital advancements while retaining the human aspect of it. A forward thinking digital healthcare system built for compliance with evolving government regulations will have a lot to offer.

Mental health consultations are most needed in times of this situation. Counselling sessions with therapists should be made more accessible to seniors.

Healthcare workers are not the frontliners any longer. They are the last line of defence. Individuals have to step up as the frontliners in the battle against COVID-19. The war has shifted to the communities wherein it is the individual’s responsibility to protect themselves and pull their community to a safe shore.

Author Name : Dr. Karthiyayini Mahadevan

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