Corona Virus / Covid-19 Quick Facts.

Since WHO has declared it a pandemic, it only makes sense that the media sensationalizes it up to the heavens to make us feel like we've all gone to hell.

There have been many questions, even more answers, more videos, posts, tweets and public awareness messages in the last week than the entire year's health budget expenditure by our precious government.

Allow me to bring some common sense back into the equation and to allay some of the fears you may have. These are not myth busters but simple facts that would put you in a better position to deal with the pandemic should it ever reach your doorstep, heaven forbid!

What is it?

The corona virus or the new strain causing COVID-19 is not a new virus. It is something that was there in the past, only this strain is a new strain that seems to have come from animals. In the past, in humans, several varieties of the virus caused diseases ranging from simple common colds to Severe Acute Respiratory Syndrome (SARS). 

Symptoms?

The same as any flu. Cough, cold, fever, congestion, aches, pains and sometimes diarrhoea. Most people may not even feel the severity of these symptoms. 80% will recover with their own immunity without any treatment. Elderly people, those with lowered immunity and those with chronic diseases are the ones that may progress to severe disease and have breathing problems.

How does it spread?

Like any viral flu, this virus also spread through droplets from the nose and mouth expelled either while coughing or sneezing. Any surface that these droplets rest on can remain infective to other people who touch said surface and then in turn touch their face, specifically their respiratory organs that allows the virus to be inhaled. Eyes too can absorb the virus if touched with an infected hand.

Can it spread through someone with no symptoms?

Yes, but only because the person who may be infected may not be exhibiting symptoms yet. There is an incubation period wherein the person may be infected but exhibit no symptoms during this period. This ranges from 24 hours to 14 days.

How can I prevent getting infected?

BASIC HYGIENE. There is no way to emphasize this enough. Simple measures like 20 sec hand washing has shown to be the most effective way in preventing the transmission of this virus. How do you know how long to wash? Sing the entire song of happy birthday to you. That is the perfect time frame to scrub your hands. Also, this is important before putting anything in your mouth as well.

Be careful of what you touch. Everyday items like your coffee cup, your mouse, keyboard and other computer peripherals, your staircase railing, your lift buttons....any of these could contain droplets of someone infected in the neighbourhood. Sanitize your hands often and wash regularly when in contact with a public surface.

Keep your distance from anyone with symptoms  of the flu. The recommended distance is 1 meter or 3 feet. A simple way to do this without having to measure is to keep your handspan distance from the other person. 

Avoid touching your face. Just in case the virus gets onto your hand and you haven't had the chance to wash or sanitize, just keep the hand away from your face, specifically from the points of entry viz, eyes, nose and mouth. Get to a tap or sanitizer first, then scratch away at the itch

Do not indulge in the international pass time of picking your nose! 

Follow respiratory hygiene. If you have to cough or sneeze, cover your mouth and nose, keep a handkerchief or napkin handy, use tissues if available and dispose them immediately after use. Do not wait for the second sneeze to throw that tissue away

If you are sick, stay home. Be responsible and avoid spreading it to others!

Avoid travel unless absolutely necessary. Break out of the cocoon that nothing can happen to you. That's what everyone who is currently infected thought, including the doctors!

What is the risk of catching it?

If you follow the basic rules above, very very low! If not, remember the virus does spread fast and not only do you risk catching it, but also spreading it forward very quickly. The only risk is close contact with an infected person or his belongings which may contain droplets

How long does the virus stay on surfaces?

There is no clear cut answer to this as it will differ with temperature, the type of surface and the humidity but in general the virus could remain from a few hours to a couple of days. In very hot climates, it would tend to be lower! 

Do I need to worry?

Not really. Be aware but don't be paranoid. Most infections are mild and self limiting. If you can prevent it, that is the best case scenario. If you have people around you that are in the high risk category, it would be wise to take extra precautions. If not, basic hygiene should see you through

Antibiotics?

There is NO ROLE of any antibiotics in the treatment of COVID-19. There are some trials with regards to anti HIV medication but those are reserved for the severe cases. No self treatment or IDIOT (Internet derived information obstructing treatment) behaviour (credit for this to a video I saw with an infectious diseases specialist doctor) and definitely no Doctor Google's self medication please!

Vaccine?

Not yet, but the powers that be are working on it 24/7

What is the deal with masks?

The most common mistake that people are making is to think that wearing a mask will protect you from infection. It doesn't. If you are sick, you need to wear it to prevent spreading the infection. If you are not sick, you are wasting a mask from people that may need it. Also, disposable surgical masks can be used only once! There is no point if you wear it after 24 hours as it probably has become a hotbed for the virus particles itself.

The N95 mask is to be used only by those who are in direct contact with infected persons. Medical personnel, nurses, medics, paramedics are at higher risk to inhale droplets from patients. They need to wear the mask at all times.

Should I give up Non vegetarian food?

There is no evidence that well cooked non vegetarian would increase the chance of spreading the virus. Avoid exotic meats at this point of time though.

Should we stop meeting people and isolate ourselves?

Not at all, unless there is an infected person among the group. Meet up with friends, have a relaxing time, stay positive and be aware.

Do not spread panic, do not spread forwards of doom and despair. Instead share this post to educate more people and help stop the spread of the virus.

Dr. Dheeraj V. Mulchandani

  

Doctor Shaming at It's Best!

This past week I read a post on facebook by a woman who had lost her mother and she vented out on social media against the hospital and Doctors that were in charge of her mother's care. It took all of my restraint to not post on her wall as a reply, because I knew it would do no good and it wasn't the right time to justify things to someone hurting. Also, I didn't really think it was worth it as I thought people would be more intelligent than to accept everything written on face value. Unfortunately, the link came up on my high school group with some questions being asked and instead of just replying to them, I thought I'd write about it.

Before you read any further, I would suggest you to visit this page and read the article or even better, keep it open side by side and read through.

The article which linked to the facebook post

The headline itself is inflammatory and sets the bias for the article which I think is grossly unfair. 

Girl's FB Post Tells How Doctors Cheated Her Family & Charged Rs 1 Crore But Couldn't Save Her Mom

This implies that she was cheated for sure and the Doctors charged her the amount and there was some guarantee of saving. Now, I'm not going to nit pick and argue fine details and take sides here but read the article and the title starts to stink right from the third paragraph.

"Doctors are considered as God on Earth as they have the capability of not only curing a person but also saving his/her life. However in the present times, as many doctors have been found guilty of illegal activities such as organ trafficking, gender determination, etc., the faith on doctors has decreased to some extent."

We aren't considered as God and never asked to be. We have the capability of treating someone but that treatment will not always result in a cure or life being saved and we're only too well aware of this. Unfortunately, it seems that the general public is not. It has become some kind of inane expectation that if you pay a certain amount of money, the life that was handed to us must be saved irrespective of the disease or condition.

"it won’t be wrong to say that the big hospitals are no less than 5-star hotels and they charge exorbitantly from the patients and doctors play an important part in milking the patients for cash."

Big hospitals are like five starts because the people demand a certain level of service and they have to be satisfied for the hospitals to run. Last I checked, most of the so called 5 star hospitals were not charitable, neither were they forcing people to come in and get admitted, nor were they set up using public funds. They have a right to charge an arm and a leg for them to survive because of the level of expectation set up. This may sound horrifying to all of you but let's put it into perspective. I know of hundreds of people who won't watch a movie in any other theatre than an Inox because of the quality or whatever. I know people who wouldn't touch tea cup from a road side tea stall for fear of leprosy or some other disease being contracted. I know people who refuse to travel in buses for all the above reasons. When these people require healthcare, most of them have accepted the fact that quality healthcare is expensive and sterility costs a bomb. They understand the reasons for the high costs of healthcare, which by the way, compared to the rest of the world, is still dirt cheap here in India. The problem is with the other end of the spectrum where you have people who save their life savings going to these big hospitals. There is a clear reason for this. THERE ARE NO GOOD ALTERNATIVES THAT ARE ACCEPTABLE.

I don't even need to ask you, I will tell you that it is the role of the government to provide quality healthcare at affordable costs, not the role of Doctors or Private Establishments. At the same time, I will also tell you this, there are enough and more Doctors who will go to no ends to push the limits of how much money they can squeeze out of you. This is sad, but very true. The choice, however, still lies with you. Pick the correct one who you can trust. Find one out there, because there are more than enough of us around/

"Parul’s mother fell sick due to ammonia attack and it was later found that she was suffering from Liver Cirrhosis which is the last stage of liver disease"

Factually incorrect and inept journalism. There is no such thing as an Ammonia attack that I have encountered, in my medical training, as far as I remember.

"they tried out to churn out money from them without providing proper treatment and how they harassed them for paying the bills and purchasing medicines from their dispensary at high prices rather than buying it from outside at low cost."

I wonder how she decided it was not proper treatment and when she would think was the right time to harrass someone to pay a bill. It is standard practice in a corporate hospital to send out daily bills to patients in the ICU with a three day period to clear those dues because even hospitals realise that costs add up and if they don't do this, there will come a time towards the end of a long hospitalisation that the bill suddenly sky rockets and causes severe mental trauma to the relatives. This was actually an order passed by the government towards the same. It allows the relatives to think of alternatives when the costs seem to be going above their heads.

Again, unfortunately, I agree about the point of overcharging by the hospitals for medicines that are available cheaper at regular chemists outside the premises. This is something we really need to look into. It is the same as going to a movie and being forced to pay more than double for pop corn and water bottles.

"have spent nearly Rs 1.2 crores on her mother’s treatment who took her last breath on May 7, 2018, due to multiple organ failure despite successful liver transplant. Parul also told that her mother was kept in ICU for nearly 100 days by these hospitals and they charged them Rs. 1 lakh per day for this purpose"

Well, if you want to stay admitted in a 5 star hospital for over 100 days with Intensive Care support which is required after liver transplants, just what would you expect the bill to be? ICU is extremely expensive and I would invite any of you to take up a job running an ICU to try and bring down the costs and offer that model to any hospital. We would gladly pay you for your service! Also, I wonder what Parul's idea of a successful liver transplant was?

At this point I have reached out to several news channels like Aaj Tak, Zee News, News 24 and the honorable CM and Health Minister of Delhi and the Indian PM, but I have not received any help or support in the matter. I have no other option now but to go public with this information so that appropriate action can be taken against these so called hospitals, established to help the ailing members of our society

Maybe there is a reason none of them are ready to help. Possibly, there is nothing to help about. I would love to know what is the appropriate action she would like to be taken against these hospitals? Also, just to make it perfectly clear, no corporate privately owned hospital exists to help ailing members of society. That is an illusion that defeated people hold on to. They are a business here to make a profit and provide a living to thousands who are employed there. To help ailing members of society, we are supposed to have a robust health budget from the central and state governments who are supposed to provide world class care in their state and municipal run hospitals. The BMC is supposed to be the richest civic body ever, how about asking them to spend more on their hospitals and provide basic care, forget world class facilities.

"January 04, 2018: Doctors at BL Kapoor Hospital advised her to undergo a liver transplant. Total cost mentioned: Rs 18-19 lakh."

Sounds like a reasonable budget to me for a liver transplant with private hospital care and post operative medications and ICU care.

"January 12-13, 2018: a lady named Jyotsna Verma (link to her website: http://www.indialivertransplant.com/…/jyotsna-verma-liver-t…), claimed to make a liver available to us in a very short time. Total cost estimated: Rs 23 lakh.

January 16, 2018: Ms. Jyotsna called us to inform about a liver from deceased patient being available at Yashoda hospital, Secunderabad. She charged us Rs. 1 lakh for the information shared."

These two lines perhaps are the only reason I am reacting to this. What remarkably poor judgement to trust a lady who claims to make a liver available rather than Doctor's at the hospital in Delhi. As far as I can see, her costs are also higher, this again leads us to the point of a choice being made. Parul chose to trust someone who wasn't a doctor over the doctors at Delhi. Moreover, she had no problems paying 1 lac for information about a liver but has a problem paying one lac for intensive care for failing organs. Something to ponder over, I think!

"January 16, 2018: My parents flew to Hyderabad and were given a cost estimate of Rs. 27 lakh. The doctors at Yashoda Hospital would quote a fee from Rs. 24-29 lakh to the different patients for a liver transplant."

Looks like she chose to go with the 27 lac quote rather than the 18-19 at Delhi. Furthermore, different patients have different conditions to be dealt with and will accordingly be quoted different costs for the transplant depending on how much pre and after care would be required. This is, however, something I don't expect her to understand but perhaps she could appreciate it after some research.

"February 05, 2018: My mother underwent a successful liver transplant.

February 08, 2018: She was put on ventilator because of a lung infection."

Lung infections are extremely common in hospitals and are one of the reasons for maintaining the 5 star cleanliness and sterility that make up much of the costs of the admission process. Unfortunately, with the number of germs in the hospital and the immunosuppression involved in liver transplants so that the transplant doesn't get rejected (thereby a successful transplant) the patient is always at a high risk to contract infection.

This is followed by how her mother was in the ICU on the ventilator and how the costs escalated. I've already touched on those points and again reiterate that healthcare is bloody expensive.

"My mother developed Jaundice on a Friday evening and doctors from Yashoda Hospital in Hyderabad recommended the doctors in Delhi to immediately install a stent in her liver to prevent the spread of jaundice in her body as she had a similar problem while she was in Hyderabad"

The story is far from simple as there are multiple episodes of health issues and infections coming and going. No one is going to assume that this was easy for the family but mostly all would agree that this doesn't sound like a routine patient with a successful liver transplant. The costs were to be expected and there is nothing the hospitals or the Doctors could do about it. Yes, they could have been more polite, yes there could have been more empathy but who is to say there wasn't. It's just one word against the other. I will not defend the Doctor here though because I've seen some really rude ones in my life and I agree that most have a superiority complex and an ego the size of a football field.

"for the doctors in Delhi, their weekend was more important and they delayed the installation of the stent to Monday afternoon (April 23)"

I don't know the circumstances as to why the stent was delayed but perhaps, just maybe, the patient wasn't fit for the procedure yet or there were some complications due to which the stent could not be placed. I've never known a Doctor to enjoy a weekend when they have a serious patient in their care. It just doesn't happen. Ask my wife!

"They kept on performing kidney dialysis almost every day on a person who was practically dead, in an attempt to make more money."

Would you believe that perhaps it was to try and keep her alive? Perhaps, it is the only thing they could do to stop her from dying there itself? Or would you have preferred that, because that then is an argument for euthanasia which is anyway a topic I can discuss with you for days! Besides, no one makes money with dialysis, it's more lucrative to not offer dialysis and give more medication and treatment. Dialysis is now so cheap that it would cost less than the room rent for a 5 star hospital!

The bottom line is that the poor woman died. Parul is clearly going through the 5 stages of acceptance and needed to vent. It was unfortunate, but certainly not negligence nor was it a money game or an incidence of cheating.

There are a lot of you that will be on her side of the fence. Reach out to me, come live a doctors life for a month and see how much we care for our patients. See how we lose sleep just so that patients get theirs. Watch how we crumble under the pressure in the privacy of our own lives just so that we can put on a strong face in front of you. Feel the pain we feel when we miss important events in our families lives just so we can put in a stent on time.

Anyone who would like to take this further can reach out to me at any time. Leave your comments if nothing else. Share this so more people are aware of the lack of affordable healthcare which our government should have provided us years ago. 

Doctors and their charges, should the Government intervene?

The State Government of Karnataka is considering tabling a bill in the Winter Session of the Legislative Assembly which would make the private medical practitioners in the state come under the Karnataka Private Medical Establishment Act (KPMEA), 2017 (Amendment).

The act in question aims to bring down costs of healthcare in the state of Karnataka by enforcing certain caps on the treatment costs incurred at the said private medical establishments. The act also seeks to form a district grievance committee which will perform the role of a civil court. The role of this body would be to respond to complaints at the district level. The complaints received will be reviewed and a recommendation sent to the manager of the establishment with a copy to the Karnataka Medical Council or the Ayush Medical Council. It will also inform the registration authority, comprised of the deputy commissioner, the district health officer, the district AYUSH officer and two members from recognised associations, which can also register a private medical establishment. Any complaints regarding the services offered by a medical professional belonging to a private medical institution can be made to this district grievance committee, which will decide the process further.

The entire state of Karnataka is at this point in time in a state of us vs them. The lines have been drawn and the game is afoot.

The major issue here seems to be the fixing or capping of costs for medical services which the government states, they are trying to do, in order to compile uniform rates for procedures across the state. They claim to have set up a committee to decide fair and just prices for standard services like an OPD consultation, basic surgeries like appendectomy, hernia repair, delivery, cesarian sections etc.

Let's look at this objectively for a moment. On the surface, to the general public, this will sound great ,at first! I get to meet a consultant who used to charge Rs. 5000 for 15 minutes of his time and all I have to pay him now is Rs. 200 (Super specialist Fees). Awesome!! 

Let's get back to reality now. Do you think he charges Rs. 5000 only because he wants the money? The more probable answer is that he is a senior citizen who is now working for a few hours a day, using all his years of experience, giving opinions and second opinions to patients who haven't found answers elsewhere, all while trying to keep the lines down to a minimum because everyone in the city wants to be treated only by the 'best doctor' in the field! The price point is probably a technique to fend off those who may not really need his advice and to make it more manageable for the Doctor to see genuine cases who he might be able to help.

Another Doctor charges a sum of about Rs. 500 to Rs. 1000 depending on his qualifications and specialty as a routine consultation fee. A lot of the general public might find this expensive, a lot of them find it fair. The point is they have a choice. As should he, to decide what his time is worth! This has nothing to do with how much he spent on his education and how much time and money and how many years he's invested in becoming the Doctor he is today. It has to do with his freedom of choice as to how he wants to position himself. If he isn't good at what he does, even if he charges the stipulated Rs. 50 that the Karnataka government wants him to charge, he won't have any patients. Even then, and especially then, the choice is still his, because the last I checked we don't live in North Korea (with 5 haircuts allowed and a dictator with the worst one).

A lot of people in the past few days have tried to defend this saying it's not targeting doctors but private medical establishments. How ridiculous is that? There is a reason private medical establishments are expensive. They have spent money obtaining the land, building that structure you marvel at, keeping the place spic and span so that you are satisfied about the cleanliness of the hospital, not to mention, it ensures that you don't get infections once you're admitted in there, hiring the best staff so that your experience in the hospital is a pleasant one, hiring the best nurses and Doctors so that your care is epitomised. Even then, if you think they charge more than required, remember that open MRI machine you wished they had because you are claustrophobic and can't get into a closed one, that costs some more money now doesn't it. The wonderfully reclining bed so that you can watch your TV post surgery, that non-squeaking cushioned wheelchair, that doesn't hurt your backside when they wheel you to get an x-ray, that non greasy x-ray machine that takes the perfect x-ray so that your tiny kidney stone isn't missed...the list goes on. Unfortunately, these cost money. Money that the government isn't giving to the hospital, neither is it spending on its own public hospitals so that you don't need to go private at all.

That really is the crux of the matter isn't it. Do we really need a cap on the private medical practices or do we need better sustainable public healthcare? As an example of Mumbai, would you mind going to a public hospital if it was made as Kokilaben or HN or Saifee hospital? I would gladly go there if they weren't so badly maintained, ill equipped, badly staffed, unclean, and terribly stocked.

Why only medicine? Could we cap a lawyers fee just because he isn't a public prosecutor? How about a cap on those who build our roads (rather potholes)? A cap on the MLA's allowance....I mean he isn't really providing a service is he? He could do it for free? A cap on architects and interior so they can't charge you to make you house look beautiful? 

As a last point of contention, I've worked in both public and private hospitals. I am a surgeon. Once the patient is admitted under our care, we no longer look at where you've come from or what you own or how much you make in a year. All we are concerned about is how to get you well again and how to send you home in better health than you came in with.

This article appeared in the first post website and I think it's worth a read.

Is it time for Subscription Based Healthcare?

I'm going to start with stating the obvious. This is the digital age, where pretty soon, everything is going to be controlled by either your cell phone or more recently your smartwatch.

The services industry is going gaga over providing the best service to you right where you are, mostly through the use of these digital devices.

All you have to do is subscribe to a service.

You can get food delivered to you at any point of the day / night. You can get updates on news, views, rants, campaigns, cricket matches, football scores or even the colour of the month! You could get a phone company servicing you either online, virtually, or even in person at your home on demand. Banks lure you into internet banking and send people over when you want to open an account. Basically, everything is at hand, where and when you need it. Almost everything. 

Healthcare is being left behind, and I intend to correct this. Why can't we have a subscription based healthcare delivery system. Sections of the industry are heading this way already. You can get your blood tests done at the comfort of your own home at any time. You can order in prescriptions if you know your chemist well enough. You can now even get emergency care at home with services like Topsline and others like healthspring.

What you can't get is an appointment when you want with your preferred doctor.

I propose a subscription based Doctor Patient relationship wherein you basically subscribe to a particular Doctor for his consultation services annually. You agree on a particular fee, and pay the Doctor in question, for which, he provides you free consultations and priority appointments for the said period.

This works at an advantage for both the patient and the doctor. 

The patient knows he has someone he can go to almost anytime for an opinion or just to clarify doubts, without waiting endlessly in a queue. He also has the comfort of emailing, whatsapping, messaging, videoconferencing etc etc with the Doctor without the Doctor feeling shortchanged for offering his opinion for free.

 

The Doctor, knows, he has a reliable patient who wouldn't go elsewhere (it's a fear all doctors have, trust me), the number of no-shows would decrease, and even if you are a no-show it causes no harm as nothing is lost in terms of time, patient space etc. The doctor is also assured of a continuous stream of information towards your health and can be in a better position to diagnose you!

The possibilities are limitless. The economics brilliantly simple and cost effective to both. The only factor going against this would be time and commitment. I really think this can work. I have a lot more thoughts about this, but I don't want someone stealing my idea just yet. What would you look for if you were to opt for such a service and how much do you think would be a fair annual subscription amount? Please do leave a comment and let me know your views.