COVID EFFECT: Towards Safer Care?

The often ignored and undervalued importance of community medicine would need to be overhauled. This branch of medicine needs to take centre stage as the health of the community will have a bearing on all aspects of care.

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Each adversity comes wrapped in opportunities. Some more distinct than others. The Covid-19 pandemic seems no different. The staggering toll that the pandemic has extracted in human lives and lost livelihoods cannot be offset with any gains that we make as a society or health system.

Nonetheless, resultant measures as a direct outcome of the outbreak that improves public health metrics and helps in preventive health strategies are failtes.

Previous disease outbreaks have led to safer and better care for patients and health workers alike. If one were to look back at the outbreak of Hepatitis B over three decades ago, it led to a better understanding of the spread and nature of viral diseases and helped hardwire techniques to prevent them.

The use of personal protective equipment like masks, gloves etc. became sacrosanct in clinical practice, especially those that involved higher risks of exposure. Preventive vaccination strategies that developed post the rise in infections, have helped the world overcome this particular outbreak , which at the time was taken as insurmountable.

If one were to look back further to the rise of HIV/AIDS in the 1980’s, once again the surge in numbers extracted a major impost in lives lost across the world. However, with better
preventive strategies, awareness, spectacular breakthroughs in the creation of anti-
retrovirals etc. ensured that today the earlier torment of the past, has somewhat receded as a major public health challenge.

Covid-19 is also providing such opportunities for improvement and safety. Hospitals and
healthcare workers, hospitality and the travel industry, neighbours and neighbourhoods all
are taking enhanced precautions to best handle the outbreak.

While bizarre overkills continue to populate our timelines and television screens, there is reasonable confidence that the residual benefits for better sanitation and hygiene can be hoped for in the future.

From the fundamental importance of hand hygiene to the novel (!) concept of queueing, the benefits of Covid-19 for our culture at large, looks promising.

The need to move from looking at one’s own health as paramount to larger health concerns
of the community and our impact on them will be welcome. The act of wearing a mask or
maintaining social distancing is not just self preservatory, it is also to ensure the safety of the larger community.

And such awareness is not restricted to the current times. The need for social responsibility towards sanitation, healthier living and community based steps to improve health will all need to become part of who we are.

The Covid-19 crisis has also helped in creating a conducive environment for reiterating the
need for safety within hospitals themselves. The need to greatly expand our health
infrastructure and resources has been acutely felt in the present outbreak.

It is time that we as a country accept this inherent lacunae and begin to address it in earnest. This need for expansion is a key cornerstone for ensuring patient safety, by reducing crowding, enhancing quality of care and increasing the time and quality of the healthcare workers-patient interface.

Second, healthcare and prevention now needs to become central to public policy discourse.
A move from quantitative-only healthcare, driven by metrics of bed numbers and doctor
counts, to a wider qualitative one which encompasses hygiene, sanitation and prevention
along with the more traditional metrics is the way forward.

Third, accelerating safer care through more identifiable metrics and quantifiable measures
would need to become inviolable for Governments and providers. Currently, the assessment
of quality of an institution is too narrowly defined and often not adequately measured and
reported.

The move towards more measurable standards of safety for patients, visitors and
staff would need to become central to the caregiving process. This would mean creating
safer infrastructure, benchmarking safe use of medications and technologies and
protocolosing processes that ensures risk reduction in the delivery of care.

Fourth, the often ignored and undervalued importance of community medicine would need to be overhauled. This branch of medicine needs to take centre stage as the health of the
community will have a bearing on all aspects of care. This has been amply clear in states
with strong public health, surveillance and disease management systems in place during the Covid-19 outbreak.

Lastly, a new social health pact would need to be evolved between an individual and the
community. Given the rise of non-communicable diseases, healthcare has become
individualised to the health condition of the patient. Patient-centricity, personalised care and predictive medicine for an individual are the new paradigms of care.

These are important no doubt, but would now need to amalgamate with the larger health of the community as each has a bearing on the other. The right of an individual to equitably access affordable quality care needs to be as important as the individual’s responsibility towards the health of the community.

The firewalling between the two approaches – between the health of the
individual (largely the domain of hospitals) and the community (the domain of public health) would need to be removed over time. This pact would ensure the mutual exclusivity between the two approaches becoming a unified measure as we chart into a new global health order.

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