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How to avoid a twin pandemic of flu and COVID-19

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Dr Gautam Sen, chairman and founder, Healthspring explains that diabetes and other NCDs acquire a special significance this season. With COVID-19 virus still on a rampage, getting the flu which is very common in the changing season of autumn,, is of high probability. And if that happens, one runs the risks of twin epidemics – one of high mortality rate (flu) and the other of highly infectious rate and much more dramatic in nature of its severity

The COVID-19 pandemic is a wake- up call for the world. For far too long we have been giving lip service to preventive health and completely fascinated with advances in technology in diagnostics and treatment for complex and end game complications of disease process, to the detriment of health outcomes and disparity and access to care, due to unaffordability of cost of care.1

Till the vaccines arrive at the scene, which may be a year away, all we need to do is follow inexpensive preventive care of lifestyle changes and bring the pandemic into containment where public health and robust primary care will play a major role.2

The focus has to shift from treating a disease-real, imagined and sometimes created, to keep a person healthy and being paid for it.3 It also means as and when complications do occur, timely referral to a tertiary care hospital of such an individual who has received preventive care can produce a far better outcome at a lesser cost. This is the essence of longitudinal care in an integrated care system

The horror stories of patient being refused admission for medical emergencies- be it heart attack, or impending stroke or cancer treatment- due to unavailability of beds being commandeered for COVID-19 cases, or due to insistence of hospitals to get clearance from COVID-19 RT-PCR test which takes 24 hours-abounds in our country.

The statistics in the advanced world is no better. At any given time in NHS hospitals in the UK, there is a 50 per cent reduction in emergency admission for non-COVID patients and as high as a 70 per cent reduction in planned admission for non-COVID patients.

US healthcare is in a collapsed state already with despite highest GDP expenditure 17-18  per cent and remains in the bottom quartile in terms of life expectancy, infant mortality and chronic disease management.4, 5, 6

Diabetes and along with it all other NCDs acquire a special significance this season. With COVID-19 virus still on a rampage, getting the flu which is very common in the changing season of autumn,, is of high probability.

And if that happens, one runs the risks of twin epidemics – one of high mortality rate (flu) and the other of highly infectious rate and much more dramatic in nature of its severity.

Evidence-based medicine shows an eight times increase in the risk of one getting an acute MI (heart attack) and six times increase in the risk of getting a stroke within a week of a diabetic getting flu infection.7

It assumes a greater significance when in the given circumstances of hospitals refusing admission till one gets a clear certificate from COVID-19 infection and in the process lose precious time during which life could have been saved, makes a strong case for everyone- leave aside only diabetics, should get a mandatory flu vaccination done.

The UK government has directed NHS to get flu vaccination done as a mandatory requirement and should cover a minimum of 75 per cent of population to avoid twin pandemic of flu and COVID-19 which could be a disastrous situation.8

As an organised primary care network, Healthspring remained open for routine and emergency non-COVID cases. Apart from taking proactive steps for meeting the challenge of COVID-19 pandemic, it embraced and adapted the changing circumstances in healthcare delivery of distant communication, developing point of care facilities of diagnosis and treatment and home care for quarantined patients and has undertaken a mass vaccination programme for children and adult and vulnerable groups.

References:

  1. World Health Report (2016) WHO
  2. “COVID-19 and Mandate For Preventive Care” Daniel M. Horn, M.D., and Jennifer S. Haas, M.D. New England Journal of Medicine, August 2020
  3. “Primary Care: Concept, Evaluation and Policy”, New York, Oxford Press 1992

Increasing number of Primary care Physicians after correction of socio- economic factors

Author Barbara Starfield, John Hopkins Bloomberg School of Public Health Baltimore

  1. America’s Health Rankings. Comparison with Other Nations. 2016 Annual Report. Accessed July 27, 2020. https://www.americashealthrankings.org/learn/reports/2016-annual-report/comparison-with-othernations.
  1. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V. “It’s the prices, stupid: why the United States is so different from other countries”. Health Aff (Millwood). 2003;22(6):89-105
  2. 5 Lessons from CEOs: Health Care Leaders Nationwide Respond to the Covid-19 Crisis NEJM Catalyst, No. | July 29, 2020 DOI: 10.1056/CAT.20.0150
  3. Factsheet. Available at: http://www.idf.org/sites/default/files/DA6_Regional_factsheets_0.pd. http://www.cdc.gov/diabetes/projects/pdfs/eng_brochure.pdf WHO. WER2005;80(33):277-88.
  1. NHS Directive for Flu Vaccination June 2020

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