New Delhi: Nearly three months since the lockdown restrictions began to be eased under Unlock, elective surgeries remain affected across Delhi-NCR hospitals, say doctors.
Elective surgeries are the ones that can be scheduled in advance but cannot be avoided for a prolonged period. They include cardiac surgeries such as angioplasty and stenting, gall bladder stone and appendix removal, hip or knee replacements, and even early cancer interventions.
In March 2020, the Ministry of Health and Family Welfare issued an advisory directing hospitals to “postpone” non-essential elective surgeries until 31 March “since the medical infrastructure of the country need(ed) to be prepared for any possible influx of patients on account of Covid-19”.
Doctors at multiple Covid and non-Covid hospitals in Delhi and the larger National Capital Region (NCR) told ThePrint that elective surgeries, halted completely in light of the government advisory, are yet to return to earlier levels.
While at least two government hospitals tackling Covid patients said elective surgeries remain completely suspended, other facilities stated that they are holding just about 40 per cent of the operations they pulled off in pre-Covid times.
Patients, they say, have paid a heavy price for this lull, with some cancer patients who were diagnosed in the initial stages of the disease now staring at a dismal prognosis because they couldn’t seek treatment in time.
ThePrint sent multiple emails to health ministry spokesperson Manisha Verma for a comment on the current government advisory regarding elective surgeries — whether the March advisory has been updated or reiterated — but was yet to receive a response at the time of publishing.
However, doctors say the government directive is not the only reason the surgeries haven’t returned to pre-Covid levels. The fear of Covid infection has been a factor in keeping patients away, they claim, adding that many are only returning now because their symptoms worsened.
Doctors say some elective surgeries, although not urgent, can’t be completely avoided. In fact, a prolonged delay can result in the disease taking a more severe turn, they add.
Dr Nandakumar Jairam, CEO, chairman and group medical director at the multinational Columbia Asia Hospitals, said surgeries “can be classified into three different buckets”.
“One is emergency surgeries, which have to be done on an urgent basis. If not, then there could be serious effects on patients,” he said.
“Other forms of surgeries are those wherein the procedure needs to be done on an early basis, for instance, removal of gall bladder stones. These surgeries have resumed to some extent. Then, there are really cold surgeries, which are not absolutely essential. This includes surgeries like cosmetic surgeries, which can wait,” he added.
It’s patients awaiting the second kind of surgeries that have been hit the hardest by the pandemic.
“I have seen patients whose conditions have worsened. One patient was diagnosed with cancer at an early stage five months back. But he couldn’t come for a biopsy. He came after many months due to the lockdown, the cancer has grown and is now at a very advanced stage,” said Dr Ajay Swaroop, chairman for the ENT department at Sri Ganga Ram Hospital in Delhi.
Dr Subhash Jangid, director and unit head, Fortis bone and joint institute, Fortis Memorial Research Institute, Gurugram, had a similar experience. “I have two patients who had bone cancer. Earlier, the cancer was just limited to the bones. Four months later, the cancer has spread to the lungs and liver and has now become inoperable.”
He said cancer patients were not alone in suffering thus. “People who need cardiac bypass surgery waited at home. Due to this, either they passed away, or they are getting strokes or paralysis at home. By the time they come to the hospital, the disease reaches a very advanced stage and the mortality becomes high.”
Dr Lavindra Tomar, director and unit head for orthopaedic and joint replacement surgery, at Max Super Speciality Hospital, Patparganj, said patients in need of hip or knee replacements had seen their pain become unbearable in the absence of timely surgery.
“Initially patients in need of hip or knee replacement surgeries were scared of the virus and weren’t willing to seek treatment. However, now they have started coming because the pain was too much to bear for them.”
According to a report published in the British Journal of Surgery on 12 May, more than 5.8 lakh elective surgeries had either been delayed or cancelled due to the Covid-19 lockdown in India. Among those delayed were 5,05,800 non-emergency surgeries, 51,000 cancer surgeries and 27,700 obstetric procedures. The number of operations cancelled in India was estimated at 48,728 per week.
Two designated Covid-19 government hospitals in Delhi have confirmed that they still haven’t resumed elective surgeries owing to the Covid-19 case load.
Dr Ritu Saxena, medical superintendent at the Delhi government’s LNJP Hospital, the biggest Covid facility in the capital, told ThePrint that they had not resumed elective surgeries.
Dr A.K. Singh Rana, head of surgery and medical superintendent at RML hospital, a central government facility in Delhi, said, “No elective surgeries have been resumed so far owing to the Covid case load. But we plan on resuming them very soon.” However, he didn’t elaborate exactly when.
Change in surgery protocols since Covid
Doctors said surgeries are being delayed not just because of the government’s advisory but because patients are themselves afraid to get these treatments.
Dr Tomar of Max Super Speciality Hospital, Patparganj, said, “Gradually, these surgeries are resuming again. Earlier, patients were scared to undergo such procedures due to fear of the virus.
“Around 35 per cent to 40 per cent surgeries have resumed so far. How long can the patients really wait? I have started operating on knee and hip replacement surgeries, which can cause considerable pain if delayed,” he added.
Dr Swaroop of Sri Ganga Ram Hospital in Delhi said, “Even the medical community was a little afraid of doing routine surgery. In comparison to pre-Covid times, we have resumed 40 per cent to 45 per cent of surgeries.”
Doctors said the post-Covid era has also brought delays in process of admitting patients, and increases in cost of surgeries.
“We get a Covid test before admitting a patient for elective surgery. Patients who arrive in the hospitals and we don’t know their Covid status are sent to the grey zone,” Dr Jangid of Fortis added.
“Once they are tested for Covid, if they are negative, they are sent into the clear zone for surgery, else they are asked to quarantine for 14 days,” he said.
Previously, he added, patients who came from far-off areas for treatment wanted to get treated on the same day. However, Covid has caused a significant delay in the admission procedure, he said.
“The cost of the surgery has also increased slightly, with everyone having to wear protective equipment and the extra precautions that need to be taken for the same,” he added.
Dr Swaroop said there has been a massive change in surgery protocols since the pandemic began. “As far as the surgeon and auxiliary staff is concerned, they wear protective gear. Also, no cross-movement is allowed in the (operation) theatre… All the people operating remain in the theatre and only go to the doffing area once the patient is revived from anaesthesia,” he said.