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Post pandemic The challenges ahead

While the COVID-19 pandemic has brought global financial crisis in all fields, the changing paradigm on the other hand forced the healthcare sector and laboratory medicine to diversify their menu and services like never before.
The challenge caught us off guard, we had to devise means to withstand the unprecedented time, cope up with it, and at the same time be ready for more such events in future. It was survival of the fittest in terms of health and business, but the big question is how to remain fit to survive in future.
The forbearance calls for many measures. Clinical laboratories work from designated offices with huge infrastructure, the patients reach out to us to avail our services, but COVID demanded social distancing, quarantine, and limited mobility.
Looking back at six months, we still shudder at the initial chaos and ambiguity we had of even proper selection of mask for the type of work we do. As the experiences were shared between experts and guidance poured in from WHO, CDC, and government, new SOPs were framed and regulated, now reviewed regularly and modified as required.
The first measure we took and will strive to do was reaching out to the fear ridden consumers at their site. One patient pulled in ten more samples from his contacts, leveraging the limited resources was need of the hour; the suitable staff was mobilized to the fields while strictly following the guidelines.
Pandemic demanded new tests and more inventories. The demand for D-Dimer increased manifold and it became necessary to procure new instruments exclusively for its testing. While PCR had COVID monopolised, the non-COVID molecular tests were put on back burner.
What have we learnt? Fortitude alone is not the answer; we need smart solutions, prudent landscaping of the technology, and more maneuvered strategy to step into future.
I am for propagating on-site testing, use of POCT, telepathology, and telemedicine. This is not a preparation for another pandemic but makes sense even otherwise to connect with remotely located in-need patients. There is a buzz about lab-on-chip and if it hits the right places then lab services can reach the consume’s doorstep.
India has lot of potential. If properly cultivated, the technology will reep benefits especially in rural and remote areas.
Ambulance service in our country is limited to patient transport. We can equip ambulances with small, compact instruments along with the currently available rapid card tests. Various tests like HB, HCt, urine chemistry, malarial antigen, dengue rapid cards, Trop T, COVID-19 Ag, and antibody along with oxygen saturation can easily be done at consumer level with ease and go a long way in diagnostics when patients are deprived of transport in a situation like the recent pandemic we experienced or during a natural calamity like floods when infectious diseases are rampant.
Of course we can discover means to notify the communicable diseases and form an action plan. Right now point of care tests has limited applications, I strongly believe these tests can grow beyond glucometer for testing blood glucose or cards test for diagnosing pregnancy.
Hematology has a lot to offer in such dynamics. Recently lots of companies have come up with nanotechnology, microfluidics, cartridge based analysis etc. Like in radiology, virtual image based diagnosis in pathology too can shorten the critical time and timely action taken can save many lives.
Telepathology or e-diagnosis should get a boost as its still in nascent stage. Virtual images can be peer-reviewed and be archived. We can make the system more robust to integrate apps on smart phones and interface it with the treating physicians. This way use of mobile phones and PCs can grow beyond Netflix and for a best cause save lives.
Pandemic has challenged us in many more ways, health of the HCW was badly affected, the laboratory staff even though not in frontline suffered mainly being the contact points, soon the strength was lean and the staff preferred to work as small teams in rotation.
Some were quarantined and a few returned to their villages. What did we learn? Save the man and spoil the machine, not literally though!! I would recommend automation in maximum possible areas, from pre-analytical to post analytical phases with robust quality assessment and adequate stand-by instruments. This becomes meaningless without a reliable, unfailing LIS and 24×7 availability of biomedical support. Have frequent stock audits to replenish them in time.
It would be prudent to keep the purchase department happy. A foresight on the load, pile stock for minimum three months, keeping other options open like new methodology, new kits, work distribution on machines considering various factors, and importantly consuming from more than one company are a few tips.
Pandemic also taught us to unlearn quite a few etiquettes at work. From dealing with patients to handling of samples, from processing to reporting, all were marked with unsafe practices. Now it is succinct, safety can never be compromised. COVID has strongly enforced good laboratory practices which were partially followed even in best reputed labs and hospitals. We have put SOP in place for each stage in the cycle of the sample, and is being followed without reminders. These SOPs will be reviewed time to time as needed and by trial and error.
We have already set up a follow-up clinic for survivors, and the ability to deal with panorama of presentation is in itself a huge challenge. Question need to have answer do we have means to discover attributes of COVID vs other aetiology? What more is coming our way? It’s time we roll-up the sleeves and face the brunt positively.
After this awakening call the pandemic may wean off at some point but the sequelae will not change for generations to come.
The landscape of the healthcare sector should be accommodative with an inclination to honor the needs and bridge the gaps, only then our services can be rendered timely, meaningful, and unaffected in crisis.
We at Apollo have made a beginning and the change is coming.

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