With COVID-19 cases rising, what can those with comorbidities do to stay safe?

Senior citizens wait for their turn to get vaccinated with COVID-19 vaccine, at BMC hospital in Mumbai. (PTI Photo)

As the COVID caseload continues to rise in the country – currently at over 3 lakh new cases a day for over a week now – the importance of physical distancing rules and following safety protocols can hardly be ignored. To check the virus from circulating unchecked some cities have resorted to lockdowns. But then, in an atmosphere of heightened risks of exposure to the virus, what do patients who have comorbidities need to do to stay safe? Especially those with more than one underlying health condition and hard to ignore ones like diabetes, heart conditions, and cancer. While vaccination is the only defence available it does not guarantee immunity from the virus and one needs to still stay cautious. The comorbidity conditions that most seem concerned about fall in the category of NCDs (non-communicable diseases). These are a very important segment of healthcare as in the Indian context, healthcare providers estimate that typically 60 percent of all deaths are due to NCDs, and therefore this segment of the population needs to take care and should not ignore their conditions.

Financial Express Online spoke to leaders in each of the disease segments. One element that was common to all was a plea not to ignore any worsening of the symptoms and the availability now of the specialists through a teleconsultation.

Why sugar levels matter even more now

Diabetes is a chronic ailment and has to be managed lifelong and if properly monitored then apparently there is nothing to worry about, but then connect with the doctor and regular checkups are critical.

“Starting April, the footfalls of diabetic patients has come down significantly and tends to range between 20 and 30 percent of what used to be the case normally,” says Dr V Mohan, founder chairman and consultant diabetologist, Dr Mohan’s Diabetes Specialities Centre, a chain of diabetes care centres across the country.

He says it is with good reason as people, quite rightly need to ensure they are not exposed to viruses when moving out of their homes. But then, he says, “while the focus today has to be on COVID and checking its transmission but at the same time, people should not neglect chronic ailments like diabetes, hypertension, heart disease or cancer.” Those who are diabetic, he says, should check their sugar levels either on their own or get the service delivered at home and subsequently tele-consult with the specialist. This is because these are the very people who need to take extreme care as they could be at a greater risk than others with COVID and should also be vaccinated at the earliest.

The key message, he says, is diabetic patients need to increase their testing at home and increase the frequency of glucose monitoring apart from taking care to ensure they do not stop taking medicines. “Even if they have COVID, if the symptoms are mild and the diabetes is well controlled then I have seen hundreds of my patients stay at home and recover completely,” says Dr Mohan. However, he also cautions: “If the oxygen saturation drops and if you are diabetic then you need to rush to the hospital as some may need ICU support. In any case, in a hospital setting mostly for diabetic patients insulin is administered as some may have to be on steroid therapy and these typically are known to boost the sugar levels significantly.”

Virus effect on heart

Dr Naresh Trehan, chairman and managing director, Medanta and a leading cardiothoracic surgeon, says, “The main thing is the virus can affect the heart also and if people feel any change in the symptoms then they should contact their cardiologist right away and what may be needed to be done is a cardiogram to see if there are any changes.” He says, what is also helping now is that “we have now the means to record these remotely.” He says, his hospital gives its cardiac patients a device with sensors built into it that they can take home for remote monitoring of the heart. This, he says, was started about two months ago. While some may have taken to it, there is no denying that footfalls even in cardiac care have declined. Dr. Trehan says it is today down to around 30 – 35 per cent of what used to be regular inflow at his hospital in Delhi.

Remote monitoring of cardiac patients is an option many seem to be inclined to. Several leading cardiologists at least have been using devices that help monitor patients more regularly and remotely. For instance, in some cases doctors ask for real-time continuous monitoring of the cardiac rhythm using ambulatory ECG monitoring devices referred to as either Holter monitors or loop recorders.

Why cancer needs urgent care

In cancer treatment, patients need to get themselves treated in the hospital and should not ignore it, as it is a condition that if not checked, may escalate. Dr B S Ajai Kumar, executive chairman, HealthCare Global Enterprises, a leading chain of 25 cancer care hospitals in the country, says, “we are alerting people on the need to attend to their ailments through messages on social media apart from offering them follow ups through teleconsultations. However, for surgeries, chemotherapy, and radiation they need to be in the hospital, where we have taken care to ensure all healthcare workers have been vaccinated.”

He says, the patients seem to be realizing this and many are attending to it though he does see around 10 per cent decline in the overall footfalls.

Taking Child Immunization Seriously

One segment of the population that just cannot be ignored is that of newborns and infants. With a fear of hospitals and physical distancing, there is always a risk of child immunization taking a backseat. Dr. Ramesh Kancharla, chairman and managing director of Rainbow Hospitals, a chain of 15 children’s hospitals in the country and headquartered out of Hyderabad, says, “Across all our facilities (including cities like Bengaluru, Chennai, Hyderabad and Delhi) we are today doing vaccination for infants all the time. We have been sending out messages to all people not to miss the most crucial basic vaccinations that newborns need. We were doing vaccinations also at home which in the past two weeks we have stopped as a matter of abundant precaution but since a children’s hospital is not a COVID hospital, we encourage people to get the vaccinations done at the hospital.”

For this, he says, “we have opened special vaccination clinics in each of our facilities and segregated it from other operations and these are kept open early in the morning before other people come to the hospitals.”

Describing a typical schedule, he says, “BCG – Bacille Calmette-Guerin – (vaccine to build the immune system against tuberculosis) is given at childbirth and therefore everybody gets it. Thereafter, it is the turn of polio drops, hepatitis B and DPT (Diphtheria, Pertussis or whooping cough and Tetanus) and MMR (Measles, Mumps and Rubella). The primary immunization (polio, BCG and DPT and HiB) has to happen within the first three months of the newborn and the complete immunization (including MMR) has to be administered within one year.” This, he cautions, “cannot be ignored, at any cost as you then run the risk of seeing a surge in communicable diseases and serious threat to life, he says.”

The apparent underlying message across all is that while the onslaught of COVID may be hurting and there is a need for extreme care to check its transmission, there are some areas of healthcare that also need attention and cannot wait.