Cancer, dialysis patients struggle for treatment as hospitals are stretched by Covid-19

Most government hospitals have stopped routine services & are running only emergency departments and conducting emergency surgeries.

A nurse uses thermal screening device on a patient at a Railway hospital in the wake of the coronavirus pandemic, in Patna (representational image) | ANI

New Delhi: The coronavirus pandemic and the nationwide lockdown announced by Prime Minister Narendra Modi on 24 March to contain its spread seem to be taking a toll on dialysis and cancer patients.

Dialysis centres are facing a staff crunch due to the lockdown, while cancer patients have been asked to wait as hospitals are now busy dealing with Covid-19 cases.

Dr Vish Bhilla, Mumbai-based nephrologist and director of Apex Kidney Care, said every time a dialysis patient coughs, he wonders what if he has the coronavirus. 

Even if one patient shows symptoms of Covid-19, it can pose a lot of problems for a dialysis centre as the premises need to be disinfected and the medical staff needs to be quarantined along with other patients.

Most government hospitals have stopped routine services and are running only the emergency department and conducting emergency surgeries, including AIIMS.

In order to free up hospital beds and medical staff to prioritise Covid-19 patients, most private and public hospitals have been asked by the government to postpone non-essential medical procedures, meaning surgeries have been postponed and outpatient departments (OPD) closed.

Some dialysis centres have shut down

According to some estimates, 1,30,000 patients are on dialysis in India and most of them depend on private dialysis centres.

Dialysis is a process that purifies blood using a machine in case of a kidney failure.

Dialysis patients already have a compromised immunity, which makes them susceptible to catching Covid-19 infection. So for such patients, visiting dialysis centres in the middle of the outbreak is fraught with challenges.

“Patients, especially those without private vehicles, are finding it difficult to reach the dialysis centres. Dialysis centres that are run by charities are also finding it difficult to function due to financial crunch and many have shut down,” said Purnanand Sanket, member of Kidney Patients Welfare Association, Bengaluru.

Another issue is the short supply of medical supplies, including dialyser, IV needles and anticoagulant or drug thinner like heparin, which are required for dialysis. 

This problem is felt more in tier-1 and tier-2 cities, which have a limited number of dialysis centres.

While bigger hospitals and centres had procured the dialysis-related supplies in bulk before the lockdown, smaller centres and those run by charities do not have the financial resources to do that, Sanket said.

These centres are also facing a staff crunch as workers are finding it difficult to reach the centres in the wake of the lockdown.

“We are giving them facilities to stay and eat here so that they don’t face transportation problems,” said Bhilla. 

On 1 April, the Union health ministry released guidelines for treatment of both dialysis patients with coronavirus-like symptoms and also regular Covid-19 patients.

Since Covid-19 infection in some cases could lead to kidney failure, patients in the intensive care units would require dialysis facilities.

But in case the number of such Covid-19 patients rise, there will be a need to create separate set-ups for dialysis, which has to be done at the earliest by the government, said Bhilla.

Worried cancer patients

Everyday, since the lockdown, Rajvinder Kaur, a social worker with NGO CanSupport in Delhi, has been answering phone calls from worried cancer patients.

A 50-year-old with oral cancer had a surgery date at Lok Nayak Jai Prakash Narayan Hospital but after it was declared as one of the five hospitals that will treat Covid-19 patients in Delhi, the medical staff asked him to get the surgery done in any of the private hospitals under Ayushman Bharat, which is the Modi government’s flagship health insurance scheme.

“The patient is scared and asks me, ‘where should I go’?” said Rajvinder Kaur, adding that with minimum staff able to make it to work, even private hospitals are turning patients away.

“Postponing cancer treatment can lead to progression of the disease and once a patient has started chemotherapy at a hospital, he cannot just start treatment afresh in another hospital,” she said.

Doctors are also worried about the delay in cancer treatment.

“Since the outpatient department is almost closed, patients are not being diagnosed on time, which will affect their outcomes,” said Anil Heroor, oncosurgeon working at Fortis hospital in Mumbai, who has seen his surgeries reduce by half in the last ten days.

Fetching drugs has also become an issue during the lockdown. 

“I drove to the distributor to fetch drugs for my patients as he had no one to deliver,” Heroor said.

Consultations over phone with doctors

Tata Memorial Hospital, which is India’s largest cancer hospital that treats 65,000 patients every year, is working at a third of its strength.

“Since 85 per cent of our patients are from outside, they are not able to visit the hospital since the last ten days,” said C.S. Pramesh, director of the hospital.

The hospital has asked the follow-up patients to stay at home and they have been consulting with doctors over video conference and phone, Pramesh said. 

Non-urgent chemotherapies are also postponed because chemotherapy suppresses immunity making them vulnerable to coronavirus. 

Parmesh said balancing the risk of delaying the procedure versus the risk of conducting the procedure amid the outbreak is proving to be difficult.

But this delay of three weeks, coupled with the average three to six months waiting period for procedures in government hospitals, may mean a longer wait for treatment.

“Many of these patients may not be able to afford private care. Will we see more deaths due to these delays than due to Covid-19 infection? asked Heroor.