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Crystal Gazing!

Corona pandemic has brought in its wake humongous suffering and travails with the prospect of more such events to follow. Scientific and medical community, as well as the industry, have responded with alacrity and have innovated and offered new technologies. Medical fraternity, which was reticent to take to these new technologies, seem now to have taken to them like a duck to the water and young and old are quite happy using virtual platform for patient care, knowledge transfer and acquisition (Continuing medical education) and governance.

Coming to specifics, besides the short-term human and economic tragedy of COVID, there are likely to be protracted after effects of ‘Long COVID’. Even direct cardiac and pulmonary manifestations of COVID, in terms of myocarditis and pneumonia, leading to long term heart failure and pulmonary fibrosis, will translate into increased need for advanced life support systems, including mechanical circulatory support devices and need for heart and lung transplantation.

Pari passu, with COVID, neglect of other communicable diseases like malaria, tuberculosis, measles, HIV/AIDS etc, and non-communicable diseases like atherosclerosis and malignancy, may increase the morbidity and mortality from these ubiquitous maladies going forward.

Though for some time now, India has been the pharma and vaccine hub of the world, we still do not have adequate indigenous production of the basic Active Pharmaceuticals Ingredients (APIs). India thus will probably need to internalize the entire supply chain under the Atmanirbhar Bharat, with decentralization of healthcare industry and more focus on development of local supply chain sources. Indigenization of medical equipment and devices is likely to get renewed focus and a systemic push from the government and the health industry should strengthen going forward, with more manufacturing of high-end products.

This pandemic exposed grossly inadequate governmental health infrastructure. A major part of COVID pandemic burden has been borne by the private sector – either at the primary physician clinics as first responders, or by the secondary and tertiary care hospitals all over country.

Human resources too need to be augmented and one would have to have a rethink on not just having highly qualified doctors, but even a basic intermediary work force, which can be flexible and versatile to serve as a paramedic-cum-medic. So a formal policy of healthcare human resource mobilization and utilization will have to be drawn.

The corporate world is likely to face headwinds, as the populist measures taken by various governments, be it at the centre or the state level, to endear and win over voters, not by their good work and efficient governance, but by ill-intended sops dished out as welfare measures in terms of unrealistic capping of prices of drugs, devices and infrastructure, will hurt the healthcare industry significantly. Government’s coffers are empty – not that they were ever full – and government’s power to spend on these welfare measures is going to be severely constrained. Therefore, no holds barred efforts will be made to extract their pound of flesh from the industry and the hospitals. We are not homogenous and united enough to either face the public, or the government, and therefore the coming future is not going to be as rosy as ordained by a lot of pundits.

Bringing up the rear, miscellaneous issues may need focused attention eg. psychological impact of the pandemic, both in the medical and paramedical professionals, as also in the general population. Remote sensing and utilization of drones and robotics in healthcare may be exciting prospects for the future, but in a developing country like India, with a large and relatively cheap work force, these will remain a distant dream, at least for the present.

Changing gears, on the flip side, I foresee positive things going forward. COVID-appropriate behaviour and sensitization of the population toward hygiene and sanitation may bring collateral benefits, in terms of behavioural changes, translating into less number of infective respiratory and gastrointestinal problems. There will be, in all probabilities, increased empowerment of patients, wider insurance coverage, sensitization of government towards creating a better healthcare infrastructure, more focus on preventive and health-appropriate behaviour, increased telephony based delivery of healthcare and integration of clinical decision support systems in day to day patient care.

All this may sound like music to the ears, but the last component, that is patient care, worries me a little. We hear stalwarts every day, extolling the virtues of virtual care and technology driven medicine. However, playing the devil’s advocate for the patients, I feel that the artificial intelligence driven, mechanistic medicine is going to take away, not even the charm of medicine, but also the empathy and human touch, so very integral to the healing processes of any mental or physical disruption of the human body. I shudder the day when they will replace or overwhelm clinical decision making and human touch.

God save the king should such a day see light!