'Hospitals should only be for the acutely ill, rest should be managed at home'

There will be a move away from inpatient care to home care, outpatient care, Dr Ballal noted

Post-Covid, healthcare should take a different turn based on the old wisdom that prevention is better than cure, Manipal Hospitals Chairman Dr H Sudarshan Ballal tells DH’s S Raghotham, arguing that today, technology allows for monitoring of health parameters at home and telemedicine allows for remote consultation and treatment, so hospitals must be for only for those who are really sick or need surgical intervention.

Are you expecting a third wave of Covid this month? How do you think it will turn out?

The third wave is predicted to hit in October. It could be a third wave or it might just be the tail of the second wave continuing for a longer period. Unlike the first wave, the second wave is tapering down slowly. But I do believe that even if a third wave does hit, the numbers will be small, the disease will be less severe and, overall, easier to manage.

Fortunately for us, many things have happened which, I believe, are going to protect us from a severe third wave. The serosurvey after the second wave showed that 70% of the population has already been exposed to the virus, which means a large number of us have some kind of antibodies and immunity. Secondly, most of the vulnerable population — those aged above 60, people with comorbidities, frontline workers, etc — has been vaccinated. Now, the only people left behind are the younger population — children. By and large, the disease is milder in them.

Thirdly, we are still predominantly with the Delta variant of the virus, which made the second wave so severe (though there are new mutants like the Mu), to which most of us have been exposed. Unless that changes, we will be on the safer ground during the expected third wave.

And, of course, we have come a long way in our understanding of Covid. Supportive care, good facilities for oxygen delivery, ICU care and steroids at the appropriate time and in the right dose, are the only things that are useful. Now, we also have a cocktail of monoclonal antibodies. Given early in the disease, it prevents it from becoming serious. That’s one more tool available in dealing with Covid now.

So, for all these reasons, even if the third wave comes, it will not be as serious as the second wave. However, we really shouldn’t let our guard down at any cost.

What became of people with other diseases during the pandemic?

There has been a significant delay in, or absence of, treatment for other diseases, especially lifestyle or non-communicable diseases (NCDs) like heart disease; many cancers have progressed, from an operable stage to inoperable stage; kidney and liver transplants had to be put on hold for fear of infection and due to the restrictions that were there; it has significantly affected diabetics as they couldn’t go to hospitals and seek medical attention; hypertension and heart patients did not seek medical attention. Many of them might have died of heart attacks at home. For people with kidney disease, dialysis is a lifeline, but many could not go, and it may have been fatal in many cases.

Things are coming back to normal slowly. As Covid has tapered down, hospitals are doing more transplants, many more house procedures, surgeries. So, some of the backlogs will get cleared, but whoever has suffered during that time has suffered. If their cancer was stage two, now it may be stage four, which we cannot reverse. But at least from now on, I think there’ll be a steady state of treatment for non-Covid patients.

You are making a pitch for preventive healthcare. It seems counterintuitive, coming from a corporate hospital chain boss…

A lot of people ask me that question. But I honestly believe that prevention is better than cure. We need, so to speak, preventive maintenance. Your heart — which has to continuously pump 70-80 times a minute for your entire lifetime — needs maintenance. So also, the other organs that function tirelessly. Unless there is some preventive maintenance, they will get damaged, but go unnoticed.

Indeed, many lifestyle diseases are silent diseases. Unless you look for signs of them, you may not find them until the damage is done. A typical example is diabetes. So also, kidney or heart disease. Most people have no symptoms of these early on. But they can be detected early and easily with a simple blood test and urine test for sugar, creatinine, protein and lipid levels. You must keep track of four important numbers — sugar, BP, cholesterol, creatinine. If these four numbers are under control, you may not need to see a doctor.

I also talk of 7Ss to take care of — sugar, salt, smoking, spirits, sedentary lifestyle, stress and sleep. All of these factors come under preventive care. If you take care of these seven things, many of the NCDs can be controlled.

How do you see hospital care evolving post-Covid, given what we experienced during the pandemic?

There will be a move away from inpatient care to home care, outpatient care. Most things should be managed as outpatient care or by home care or, at most, daycare. Hospital admissions should only be for the really sick or those who require intervention.

There is technology today that is enabling this in a big way. Medical devices or wearable technology help you keep track of BP, sugar, oxygen levels, even record your EKG to detect heart rhythm disturbances. All these tools are available to constantly monitor conditions related to lifestyle diseases. They aid preventive healthcare. We have done some work with old-age homes, where people are very prone to develop many such conditions. By keeping a wearable device on them, which is monitored by a doctor or nurse at the old-age home, we have observed a significant reduction in serious illnesses and visits to the hospital, just by constantly monitoring patients in their own settings.

Yes, and telemedicine seems to have taken off. Is this all sort of learning forced on us by Covid?

Digital health or telemedicine got a huge boost because of Covid. We had been fighting a battle for telemedicine, on both legal and regulatory issues. We just couldn’t get telemedicine approved until Covid struck. But within a few days, in March 2020, the rules were changed and telemedicine was allowed.

We were fortunate that we participated in a PPP with the Government of Karnataka, along with many other hospitals. We appointed a team of specialists in intensive care, emergency room medicine, anaesthesia, etc., who would have daily meetings with doctors in the district hospitals to guide them on Covid care. We saw over 10,000 cases in a few months. Without any other change (in district hospitals), just through these telemedicine discussions, we were able to reduce the mortality of those patients by 50%. All that happened was that the district hospital doctors were able to discuss the cases with the team of experts in Bengaluru. That made a significant difference at very little cost. So, I hope this will continue even after Covid.

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