View: Coronavirus is feeding off other treatments

By Bachi Karkaria

Being Covid-positive is terrifying. But the ‘medical distancing’ the contagion has given rise to has made it even scarier to suffer from any other serious ailment or illness. The worst-hit are those whose quality of life, or life itself, hangs on regular interventions, such as dialysis, blood transfusions, pre- and ante-natal checkups, tuberculosis (TB), cancer and infertility cycles.

They are caught in a cruel Catch-22. Lockdown makes it difficult for these non-Covid sufferers to be treated. Fear of the virus keeps them away from hospitals — their particular disease having lowered their immunity, the risk of being infected by Covid-19 is heightened. A Mumbai cancer patient’s radiotherapy session was reported to have been postponed as he did not carry a Covid-19 test result with him.

On the same day in the same city, a dialysis patient had to reportedly wait for seven hours for treatment because of the same reason. In the middle of these rising concerns, GoI on Tuesday asked state chief secretaries to ensure that hospitals and clinics do not insist on Covid-19 tests for every patient needing medical care.

Experts have red-flagged serious setbacks to the fight against cancer and TB, both already grappling with dropouts due to traumatic side-effects and crippling expenses. The danger is immediate for India’s 175,000 renal failure patients.

All India Institute of Medical Sciences nephrologist Sundeep Guleria warns, ‘Skipping even one dialysis session triggers a life-threatening build-up of toxins.’ With mass immunisation halted, lakhs of infants will also remain unshielded from death and disability.

At 27%, India has the world’s largest TB load. ‘Lack of adherence to the drug regimen was 15-17%. Covid has spiked it to 40% in Mumbai,’ says Medical Research Foundation director Nerges Mistry.

‘There’s also been a precipitous drop in TB notifications [to the national portal, Nikshay] from 15,000 a day to just 2,000, indicating that access to a centre has been affected and diagnosis is compromised,’ she adds.

Cancer patients are hit by a double whammy. They are usually 60-plus and the disease has compromised their immune systems. Damned if they go for treatment and damned if they don’t. Covid-19 has also halted in mid-flight the magic arrow of Intensified Mission Indradhanush 2.0.

It aimed at immunising, by 2020, 90% of under-2s as well as pregnant women against eight diseases that kill or can seriously disable. International Paediatric Association executive director Naveen Thacker estimates that ‘15-20 million children are missing out, because doctors, ASHA (accredited social health activist) workers and auxiliary nurse midwives have been subpoenaed.

Serious outbreaks of measles, pertussis and diphtheria could result. And even after lockdown ends, parents will be wary of taking babies for their shots.’ The good news is that we need not face the global shortage of these vaccines — the Serum Institute of India is the world’s largest supplier. Past gains are majorly neutralised when immunisation or cancer/TB treatments are interrupted.

The health ministry, the World Health Organisation (WHO) and the United Nations Children’s Fund (Unicef) have been issuing guidelines to save long-term diseases from Covid’s gluttonous maw. But these seem to succumb to on-ground pressures. Chronic has had to bow to the acute. Much of India’s success against TB rested on DOTS — Directly Observed Treatment, Short-course.

Now, with access to clinics impaired, tablets are perforce given out for a month at a time, and it’s difficult to check if they’re being taken in the prescribed manner, or at all. The mountain coming to Mohammad is as fraught.

The intrepid health delivery corps is now reluctant to go into the slums where TB patients and children needing immunisation live because of ‘coronaphobia’. It’s not very different in antiseptic halls.

The medical team’s first duty was to protect the patient. But the patient not taking the same precautions that the doctor does will adversely affect both. Delhi oncologist Nitesh Rohatgi concedes, ‘The fear which keeps patients away from desperately needed treatment is also what’s making doctors do the right thing’ — just as HIV (human immunodeficiency virus) ushered in much-needed good hospital practices.

There is a yet-underplayed danger. Today’s spectre of mass migration will haunt public health long after the pandemic has spent its force, with all immunisation, surveillance and follow-up regimens scrambled.

A TB patient can infect 10-15 others, and the ‘Covid effect’ is bound to impact latent TB, which flares up when immunity goes down. TB’s co-morbidity with cancer, HIV and other immune-compromised conditions is already a drain on resources.

Considering how Covid-19 has snarled access to vital, cyclical interventions, its future impact is ominous, could last a lifetime, and inflict a heavier physical, psychological and financial burden on the individual — and the nation.

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