The coronavirus disease outbreak started on December 31, 2019 when the Wuhan Municipal Health Commission reported 27 cases of atypical pneumonia caused by virus “SARS-CoV-2” . On February 11, 2020, the World Health Organization named this disease as COVID-19 . India announced its first case on 30th January 2020 and since then, Indian health system is continually trying to tackle this unique yet arduous crisis. The Indian Government has worked extraordinarily to contain this infection and to spread awareness among the people. Policies about the functioning of hospital were designed in consultation with Indian Council of Medical Research (ICMR) and various SOPs were formulated to maximise the use of available resources.
India is one of the most densely populated countries in the world and this directly poses its health system with many challenges. The vulnerable patient population with surgical diseases can be broadly grouped into three categories, COVID positive patients, COVID negative emergency patients and COVID negative general patients. Where all the arrangements were focused to deal with COVID positive patients and COVID negative emergency patients, COVID negative general patients were mainly provided with alternative options to continue the treatment like telemedicine. In this group, patients who were planned for their elective surgeries were most affected because of the postponement of elective surgeries. On March 20, the Central Government directed hospitals and medical institutions to postpone non-essential elective surgeries up to March 31 and this was to be reviewed “as per evolving situation” . According to a report published in the British Journal of Surgery on May 12th, 28.4 million elective surgeries were cancelled or postponed during the “12 weeks of peak disruption” . In India, this number was expected to be 48,728 per week and about 585,000 over 12 weeks period . Where all agencies were planning to provide the maximum benefit to the patients, knowing the perspective of these stakeholders (patients) is important to design appropriate strategies.
In this study, our main focus was to understand the suffering of this group of patients and to understand the cause of their concern. We found out that 6.5% patients developed complication. This fact is alarming that more and more such patients will develop complication or progressive disease and this will increase their morbidity and mortality.
Most of the study population was aware of COVID 19 disease and its mode of transmission. A cross-sectional study among general public also showed similar results . Another study done by Roy D also showed sufficient awareness among the general population . They were also aware that the purpose of lockdown was to limit social interaction and to prevent virus infection. They were also aware about the postponement of elective surgeries. This showed that the government’s strategies towards the spread of awareness through social media, newspaper and television shows were effective . Also maximum patients were found to be aware of the progression of their disease and related complications which speaks about the importance of detailed counselling at the time of consultation.
Patient’s attitude towards the choice of treatment was mostly dependent on the progression of their disease where patients with progressive disease were keen for treatment during current period. More than 50% patients wanted to continue their treatment on wait and watch policy. Patients were avoiding hospital visit and many of them were afraid of it because of the risk of infection. This information provides an insight about the impact of COVID 19 pandemic on patient’s psyche and suggests the need for detailed discussion in view of COVID 19 to make a more patient-centric treatment decision regarding their surgical condition.
Maximum patients wanted to wait for at least 2 months or more. This was suggestive of the perception that this disease will be controlled within this time frame. Similarly, in another study, majority (93.02) of the respondents believed that COVID – 19 will be controlled successfully and have the confidence that our country can fully eradicate the virus as early as possible. This information lacks scientific evidence but shows the positive attitude of general public which is important in these troubled times . Keeping a high morale is one thing and facing the reality is another, especially at the time of making a crucial decision about one’s treatment.
Therefore, General surgeons, because of the wide variety of procedures they perform, are uniquely affected and have to take extraordinary leadership roles which can balance these factors and maximise output. Following points can be considered.
- Interpreting the patient’s need of treatment as “elective" or “non-essential”  unless the risks of the disease impose a potential risk, morbidity or organ failure .
- Rethinking how we care for our patients in a time of social distancing during the COVID‐19 pandemic and recognizing the role of technology in certain aspects like teleconsultation. The fact remains that, in surgical practice, there is nothing more intimate than the customary patient–physician interaction .
- If a patient is being called for surgery, ensure proper measures to protect patient and healthcare workers form contracting the infection. Guidelines regarding this can be formed at the individual institutional level, in coordination with the local circumstances, local and national governing bodies .
- Patients on wait and watch list will form a backlog of those seeking surgeries as the outbreak abates 5 and these patients will become the part of the ‘second and third waves’ .
- Follow up these patients as regularly as possible in a timely fashion so that disease progression and complications can be addressed as early as possible.
- About 50 per cent of revenues for hospitals in normal business conditions is generated by elective surgeries. Industry body Medical Technology Association of India (MTaI) requested the government's intervention to ensure that elective surgical procedures were resumed at the earliest. This is vital for the Indian health sector as a large number of patients are served by private hospitals but this should not be the only factor behind the delicate decision of surgery .