28 Tuesday
April 2020
Are you ready for a virtual clinic visit?

In the world post Covid19, we will have to get used to many new things. Wear masks when out of home, keep a safe distance from anyone else, not touch surfaces like doors, lifts and staircase railings. We will have to wash our hands every few hours, reach home and change clothes before we sit down or hug our kids. This is the new normal, set to last at least 6months- 2 years, depending on how soon the world develops herd immunity or effective vaccination.

There will be no more eating out every weekend, no power lunches, no catch up coffee meets or lavish dinners. Or unending wedding functions. There will be many more video conferences,webinars, group meets and WhatsApp chats. I wonder when kids will finally go to school. Or attend their birthday parties! Will we have cricket matches any more? Will our sports facilities cease to exist?

In this new normal, I would ask patients and doctors alike to prepare for virtual clinics. Be mentally prepared to speak to your doctor on the phone instead of in person, and do video calls instead of reaching the clinic. Other than the times when a broken bone needs fixing ,a foreign body or wax needs to be removed, or a wound needs to be stitched up, it’s possible a lot of treatment will happen while you are at home.A lot of diagnostic tools will come up to be attached to the smart phone. ECG, blood pressure, ultrasound, audiometry, spirometry will soon be available on an app in your phone.These can be shared with your doctor and a prescription will be messaged to you.

I know many things will still need a hospital visit. Endoscopies. Angiographies. Deliveries and MTPs. Acute abdomen. Mostly it will be things that need procedural intervention.Routine outpatient services will be replaced to a large extent by video calls and telephonic consults. Online payments. The cost of in clinic visits will go up because of the extra expenditure on sanitation needs and the cost of personal protective equipment.

The new way to see patients!

The world as we knew it has changed. We will need to embrace the new way of life.Throughout history, change has been the only constant. The sooner one adapts, the easier it will be to remain afloat in the post Covid19 world.

Good luck.
Dr.Sarika Verma
ENT surgeon Gurgaon

26 Sunday
April 2020
Social distancing :Yes Social stigma :No

When I first heard of the term social distancing I thought that’s new. Covid 19 has changed the world in a way unimaginable even a few months back. Who would have thought billions of people would become home bound for indefinite periods of time?Who could ever imagine global prices of fuel become zero dollars. Who could have possibly imagined staying healthy would become a bigger priority than making money!! Well, the new normal is here. Welcome to the world post Covid19.

The term we needed to use is actually physical distancing, not social. Socially we’re attempting to become closer than ever before.We are on innumerable WhatsApp chats, connecting on Twitter,Instagram and Facebook. We are video conferencing with family, friends, relatives, cousins and colleagues; playing games on multiple apps. Man is a social animal. We need human interaction to feel normal. We need to talk, read, reach out and connect in some way or the other.

Physical distancing is imperative, we need not shake hands or hug, but when our smiles are hidden behind the masks let us try to make eye contact, let us wave out to each other, let us wish good evening from balconies. Reach out to people around you to let them know you still want to remain connected. I find people have become afraid of each other, we are frightened that someone might be carrying the virus and infect us.

The attacks on Mongolian race people in India, Australia, USA are very saddening. No one knows for sure why the infection started in Wuhan, but to attack anyone who looks like that is simply a display of your own ignorance and depravity. The attacks on healthcare workers, police personnel, and those in public service are only going to harm society. We can stay indoors and keep out of harm’s way. We just need to be 3-6 feet away and wear a mask to remain safe. Why hurt anyone else?

The social stigma that has come along with the disease is disturbing and will hinder the authorities’ attempts to control it. Many patients have told me, we would rather stay at home, heal ourselves than go for voluntary testing. If we come positive, our home will be sealed,we will be taken to isolation wards, our landlord will ask us to vacate, our families will never talk to us…can you realise the fear that has become attached to this disease?? It’s a danger to all of us.

This fear of social ostracization is more than the fear of disease itself. The reason why doctors were being evicted from their homes until the administration intervened. The reason why people with fever and sore throat are not seeking treatment or getting tests done.

We all need to remove the stigma of Covid19. The only thing we need to feel is empathy. The fact is herd immunity will develop when 70-90% of us have been exposed to the infection. We are all going to get exposed, we will respond to it depending on the status of our immune response. Many of us will remain asymptomatic, some may develop mild infection, some with high viral load exposure or underlying disease will develop pneumonia and may need hospital admission. Some of these will need ventilatory support. Few may die.

Please remember if today someone else has come positive, tomorrow it might be you or someone in your family. What goes around, comes around. Treat anyone you know who is positive with love, empathy and compassion. Reach out with words of encouragement and prayers. Let them know you are their friend even in the worst of times.

Let’s remember to remain physically distant, but close to each other’s hearts. Remove the stigma of being Covid19 positive. We might be next, make no mistake.

Dr.Sarika Verma
ENT surgeon, Gurgaon.

07 Tuesday
April 2020
Dear Health Minister of Haryana

I write to you as a concerned citizen of Gurgaon, Haryana and as a medical practitioner hoping for more proactive measures to be introduced in my state.

There are a few states which are preparing very hard for the Covid19 challenge at hand, and I have been hoping to see that kind of preparation being done in Haryana. Covid19 has come as a massive challenge to countries across the world, even the ones with fabulous world class medical infrastructure have buckled under the pressure. There are thousands of people reaching hospitals for testing, isolation, needing admission for pneumonia and ventilatory support.We have seen Italy, Iran, Spain and the US hospitals overburdened and cracking under the pressure of excessive number of patients. The lack of protective equipment, shortage of medicines and ventilators and high levels of infection in healthcare providers have stumped all of them….

India is about a month behind them. The Prime Minister in all his wisdom ordered a complete shut down early on which has helped delay the spread and these three weeks of lockdown could be used for medical capacity building.There are some parts of government administration feeding the needy, the others enforcing lockdown and the rest identifying, tracking and isolating patients and their contacts. What the health ministry could be doing right now is massive capacity building for medical infrastructure.

Whenever the lockdown opens partially or completely(it obviously cannot last for ever) ….. life will come back to normal. When it does, we will face a surge in number of covid19 patients. Whether it’s on April 15th or May or September.Can we hope that the lockdown will make the disease disappear? I wonder….

May I suggest we use this this preparation time to

1) Start fever clinics

2) Arrange more test kits and test everyone with fever and cough

3) Increase the number of hospital beds available for Covid19 patients

4) Arrange isolation beds in hotels on pay-per-use basis

5) Arrange PPE in huge amounts as every health worker on duty will need at least one kit per shift that is 3 kits per day per post of health worker

6)Procure large number of ventilators

7)Train doctors and nurses to use the ventilators

Haryana has 13,842 beds in government set up, and about 5-7% of these are ICU beds. That means we have less than 1000 ICU beds for a population of 2.54 crore people.

Even if we depend on private hospitals, isn’t this the time to train more Doctors and nurses in the usage of ventilators? Only about 7% healthcare workers are trained in ICU and ventilatory support. I was thinking we must train staff on a war footing now. We cannot wait for the disease to spread and patients start reaching hospitals in droves before we do this. We will also have to be prepared that when the first batch of health workers are infected we have enough trained staff to take their place.

We could start fever clinics in all existing government hospitals, primary health centres and polyclinics and screen symptomatic patient as India moves into the third phase of the disease. The WHO has been asking us to test everyone, we could atleast test patients who are symptomatic and isolate their families early.

Kerala,Delhi and West Bengal have created isolation wards in various hotels, it would be great if we could make such tie ups in Haryana as well. That way, those who can afford to pay will be accomodated in these hotel rooms keeping government isolation wards for those who cannot pay out of pocket.

While we pray that the Covid19 pandemic will pass without causing too many mortalities in India, can we afford to be found lacking in our preparations? Once patients start arriving it would probably be too late.

Good governance is being prepared for the worst, while hoping for the best. The war on Covid19 will have to be fought by your medical team. I implore you Health Minister, please move mountains to prepare our state for all eventualities.

Warm regards
Dr.Sarika Verma ENT surgeon Gurgaon