Covid-19’s second wave has put India’s healthcare ecosystem under extreme strain. The diagnostics sector is also not untouched. People are queuing up for tests and reports are taking days to come. The pandemic has exposed the weakness in our system and has also given it a chance to re-invent. In an exclusive conversation with Financial Express Online, Anand K., CEO, SRL Diagnostics talks about the challenges and solutions for the healthcare ecosystem in India. Excerpts:
What are the changes seen in the diagnostics sector triggered by the COVID-19 pandemic?
India has been accelerating towards digitalisation for a number of years now. As India fights back the impact of pandemic, there has been a massive shift towards digital technologies and applications for healthcare and essential purposes. While last year saw the transition happen, with the massive second wave, there has been an even stronger push to use virtual avenues to connect, communicate, and provide essential services. Indian healthcare sector is showing stronger resilience this year. Healthcare delivery efforts have been amplified with more thrust on drive-through testing sites, mobile vans for COVID sample collection, home collection, telemedicine, and tele-health services stepped up and gained momentum in preventing, diagnosing, treating, and controlling diseases. With three times rise in testing, diagnostics is again in the spotlight, highlighting the urgent need for more well-equipped facilities with qualitative testing capabilities.
In the pandemic, innovative ways and solutions are being implemented to penetrate interiors of India, such as the use of Mobile Units for COVID sample collection. This includes buses converted into mobile units enabling the safe collection of samples. The Indian healthcare ecosystem is staring at a crisis and yet a shift from a remote care model to a long-term care model focusing on measured assessment of healthcare needs and creating a survival strategy for hospitals and health systems.
Consumer mindset also has undergone significant change with the preference for home visits have amplified drastically, recording a 70% growth. It is partially the need of the hour and also an outcome of reliable home services being appreciated by the sector. The trust on molecular/genetic testing has strengthened, which resulted in augmented investments, largely by private labs. Leveraging technologies such as connected devices, IoT, and wearables, monitoring and care is shifting to home from diagnostic and healthcare facilities, especially with the advent of easy-to-use medical equipment for self-diagnosis like a Sugar, BP monitor, oximeter, etc., and AI technologies has widened and enhanced the role of diagnosis drastically. SRL continues to adapt and serve the shifting needs of consumers.
What are the immediate challenges that the healthcare industry needs to address to scale in the mid and long term?
With the demographic and geographical dynamics of India, the healthcare system of the country is currently at cross-roads. The Government’s strong commitment towards healthcare is visible with its investment into a number of comprehensive initiatives including Ayushman Bharat, Swachh Bharat, Fit India, and now National Digital Health Mission. However, the pandemic, especially with the second wave, has indeed exposed the fragility of healthcare infrastructure nationally and globally and have the Indian system under severe stress for almost a year now.
Universal health insurance which covers healthcare and diagnostic cost is essential for not only to bring people under the gambit of healthcare and reduce disease burden with early diagnosis but also to reduce the out-of-pocket expenses by making healthcare accessible even in the remote areas of the country. India’s diagnostic costs are valued at 1/5th of the cost of the United States. Yet, the reach is far from satisfactory. When diagnostics is combined with Government initiatives such as Ayushman Bharat it can become a successful model and a great means to make diagnostic and curative healthcare accessible to people.
The increasing Government spends on healthcare and the implementation of mega-healthcare initiatives are taking the country towards the right direction. However, there is an immediate need to address the existing manpower and skill gap in the industry and improve the doctor patient ratio in the country. While the crisis is strengthening, it is taking the healthcare services to the remote areas in the country. As India awaits rolling out of 5G very eagerly with its focus on strengthening the Digital India mission, the coming years will see opening of greater avenues in AI, machine learning and 3-D printing, which will make a huge difference specifically in the Healthcare sector.
The healthcare sector is re-inventing itself worldwide. Many efforts are going into various levels of innovations in the healthcare sector from those related to policy making and administration to that of technology and information security. The biggest leveraging factor is that technology is enabling integration of diverse models, encouraging standardisation of a kind which can help us achieve value-based care, which will shape the future of healthcare. Policy makers, healthcare providers, business leaders, technology providers and pharma companies need to make a collective effort to build an integrated nationwide healthcare system providing preventive, promotive and curative care available to masses at an affordable cost and rapid speed. And private participation in the healthcare space also needs to be elevated for an overall improvement in the healthcare delivery.
What are the challenges in terms of manpower being faced by the industry and what can be done to address the same?
The second wave of COVID has had an impact which goes beyond all imagination, and while people, systems, and institutions are fighting to overcome the challenge, it needs public support in adherence to COVID appropriate measures. Due to the limitations of vaccination and treatment therapies, diagnostics is considered to be key tools in containing the pandemic. However, with increasing caseload, there’s a tremendous burden on the healthcare sector in general and particularly on the diagnostics sector. At SRL, we are working towards improving the turn-around-time for reports and are undertaking measures for the same like adding more equipment and manpower to improve capacity.
Manning-up manpower is the key here. It has become an urgent need to have more frontline soldiers on the ground. More lab professionals and phlebotomists need to be hired and trained. The situation needs an organised sector to collaborate with stand-alone labs and work in areas such as skill development of the staff of these centres. This would prove to be beneficial as it would account for time implication and be more economical to train this semi-skilled workforce.
Where does India need to focus in the next coming days, as cases are rising up constantly?
The situation in the country is constantly developing and there is a growing need to first of all keep the population informed. It is vital that there is verified information reaching the masses from credible sources. The next coming weeks will be crucial for the country and it is imperative that extensive testing is followed and Covid appropriate behavior should continue that is adhering to safety measures, like masks, social distancing and sanitizing to ensure precautions. At this stage, we are unsure of being immune from the mutant strain even after the inoculation. Hence, in addition to the ongoing inoculation drive, it would be prudent to undertake aggressive testing at a mass scale, identify possible hotspots, and contain the spread to avoid serious nationwide measures as well as to safeguard the stressed healthcare system from duress. From monitoring the spread of mutant strains to the need for sequencing of the virus to identify variants of concern to increasing RT-PCR testing to monitoring levels of antibodies in the population, we need to implement a multi-pronged strategy to keep this new wave of the pandemic at bay. As our healthcare system is evolving at an unprecedented rate with digital technology, modern-day applications and innovative practices driving delivery of healthcare services.
The challenges being faced by the healthcare segment can be addressed adequately by advance use of technology like Telemedicine, AI, and digital Pathology and increased role of private players in the segment. Unlike in the past decade when distance of thousands of kilometres between a village and large city posed a challenge to quality care, distances have today become meaningless due to the emergence of these technologies. Digital pathology can significantly improve efficiency and reduce wastage and costs. At a time when there are severe resource constraints, with a low doctor to patient ratio, digital pathology is a promising alternative to deliver medicines remotely and create virtual access effectively. The technology becomes an aid for the doctor, amplifying their reach and capacity.
Please tell us about the anti-body test. Is it advisable to get this test done after vaccination?
The SARS-COV-2 spike protein antibody test is aimed at determining the development of neutralising antibodies post vaccination, giving vaccinated people a reasonable understanding of the antibody build-up against the COVID-19 virus. It identifies antibodies against the viral spike protein which binds to the human cells to gain access into the body. This is different from the regular Total and IgG antibody test, as the others are largely used for serological surveys to estimate virus spread in a population for epidemiological purposes.
The test helps understand the level of immunity achieved post-vaccination, something which the other antibody tests don’t tell us. The test, however, is not aimed to quantify protection or help determine the efficacy of vaccines. The antibodies broadly appear in two forms in the human body. One which binds to a pathogen but does not limit the spread of infection and the other kills the pathogen and protects the cell.
Currently there is limited awareness amongst people on how an Anti-body test can help them in understanding their immunity better post-vaccination. The test can play an important role at an individual and community level as we move forward in the inoculation drive; understanding of immunity level on a national level can help with building strategies to tackle the virus spread.
How much strain diagnostic centres are facing due to Covid-19 and what are they doing to ease it?
With the second wave of COVID 19 we are experiencing a sudden surge in the numbers and are conducting around 30,000 RT PCR tests per day, which is three times as compared to the numbers in February. To increase accessibility and improve turn-around time, we opened 15 RT-PCR labs across the length and breadth of the country and are planning to add 5 more such labs in Calicut, Jaipur, Surat, Lucknow, and Himachal Pradesh along with more drive through sample collection sites across the country. Furthermore, we are leveraging technology such as AI tools and ChatBot to improve the customer experience we started using to automation and are expanding our customer support team in order to respond to simple queries like rescheduling, order status, etc., thereby reducing patient anxiety.
Additionally, we have also started providing QR Coded test reports, which will aid authorities in scanning and verifying the reports online much quicker and increase the efficiency as well. By launching the COVID risk assessment tool, we are sharing with patients a series of solutions that’s designed to help people identify COVID19 symptoms quickly. We also have introduced WhatsApp for Business to share test reports, which has been useful in reducing patients’ waiting time and providing information on the go.
The pandemic has made employee safety central to the business operations, as every sector realised the need for protected human resources for business continuity and recovery. In the healthcare space, patient safety is vital. While employee safety has been a topmost priority for all of us, the pandemic has made us take a closer look and identify in case there’s a gap. In Gurgaon, Mumbai, and Bangalore we have instituted Digital Pathology labs in our reference laboratories. The lab has technicians to read images remotely, and supports real time virtual collaboration between their multidisciplinary care teams. By remotely assessing pathological cases, the idea is to prevent delay in diagnosis of critical cases, which is of most importance in times of crisis like this and our association with Microsoft will also pave the way to this transformation further.