With no signs of vaccine for mass use, and the daily caseload continuing to grow at an exponential rate, there seems to be no respite to the COVID spread in India. Even though the recovery rate continues to improve, it is far less than the daily increase in cases. A community transmission, especially in the rural areas, would only worsen the situation given its already-strained healthcare system.
Preparedness of India's healthcare sector to handle this unprecedented crisis is questionable. Over the past ten years, public spending on healthcare has been around a meagre 1% of GDP, way lower than that of other developed countries (average for OECD countries was 8.8% in 2018). India has a dismal ratio of healthcare professionals, with one doctor for every 1,404 people and one nurse for every 675 people. This is far lower than WHO's prescribed norm of one doctor and three nurses per 1,000 people.
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In the current crisis, with a healthcare system overwhelmed by catastrophic events, how to enact the crisis care standards (balancing healthcare requirements between COVID and non-COVID patients) is a question of paramount importance.
Non-COVID patients left helpless
Since a vast majority of the healthcare resources are directed towards fighting COVID, it is the non-COVID patients who are paying the price. A substantial number of doctors have been re-assigned to treat COVID patients with a rotational quarantine policy in place as a preventive measure. In an existing under-staffed healthcare system, the unutilized pool of medics further leads to a dearth of available doctors for non-COVID patients.
Additionally, instances of entire hospitals turning into dedicated COVID care centres, and cases of private practitioners and nursing homes temporarily closing down, is leading to a substantial delay in treatment of non-COVID patients. Patients with chronic conditions like asthma, diabetes, hypertension, cardiac diseases, etc., need ongoing treatment and regular medical consultations. Cancellation of planned visits or any delay in receiving medical attention could further deteriorate their health and may increase the chances of death.
Leveraging technology to address the healthcare demands
With regular healthcare delivery unable to provide the pre-pandemic level of services to the general population, there's never been a more urgent need as today to mobilize digital innovations in providing healthcare services remotely through smart devices and AI-powered apps.
Remote patient monitoring through devices, where data is tracked by sensors such as blood glucose monitors, ECGs, heart-rate monitors, pulse oximeter, etc., combined with telemedicine could prove to be a lifesaver for patients with comorbidities. Many innovative AI-augmented products in the Indian market today enable remote monitoring of patients at home. Bangalore-based 'ten3T' has come up with a wearable patch for remote patient monitoring, which collects vital signs like ECG, pulse, oxygen saturation, respiration and blood pressure. Its AI-based algorithms analyses data for signs of early deterioration and sends alerts to caregivers. BeatO's smartphone-compatible glucometer with an automatic
alert system, can effortlessly take sugar readings and maintain a log of all previous readings to understand the pattern of sugar levels.
AI-augmented technology can help reduce manual tasks for an overstretched staff by taking over some of the diagnostic duties. For example, app-based AI imaging tools can help patients with suspected pneumonia, tuberculosis, etc., in detecting the disease by screening chest x-rays. Hospitals in India have started using Google and Microsoft's algorithms and machine learning platform for detecting diabetic retinopathy.
Similarly, images taken from smartphones can be an important supplement to clinical quality imaging. The number of smartphone users in the country has increased drastically over the past years. With the quality of mobile cameras improving rapidly, smartphones can produce images that are viable for analysis by AI algorithms. For instance, Cureskin app analyses pictures of skin to diagnose skin conditions and recommends treatment through a mobile app.
At a time when non-emergency departments have been suspended by many hospitals, telemedicine practice can provide access to medics without the unnecessary risk of infection to both sides. This pandemic is the first time that has led to telemedecines being adopted extensively to address a public health crisis. Leading telehealth service provider Apollo TeleHealth's Foundation has seen a 300% growth in demand for telemedicine after the government issued guidelines for telemedicine practices at the start of the lockdown.
Telemedicine enabled virtual visits by medical practitioners, could be used by patients for diagnosis and treatment of their conditions, or follow-up consultations on ongoing treatments. Mobile apps such as Practo, mfine and DocsApp, have also been making significant headway in the telemedicine sector. Telemedicine is one of the best possible ways to ease off the workload from the frontline care staff during this crisis and address patients' needs simultaneously. It is also helpful for populations that do not have physical access to qualified practitioners, especially the rural areas.
Mental health issues on the rise during this pandemic
A crisis at the scale of the COVID pandemic has affected not just the physical well-being, but has also left a lasting impact on mental health. India has been labelled as the most depressed country in the world as per a WHO report, with an estimated one in seven Indians suffering from poor mental health. With a heightened fear of losing jobs, health scares, series of lockdowns and the overall volatile environment, serious mental health consequences are emerging out of this pandemic. A 24x7 helpline set-up by NIMHANS, Bengaluru has received over 3.5 lakh calls since the beginning of lockdown, mostly from people with no history of clinical mental illness.
In India, AI is being employed to address mental health issues through chatbots like Wysa. Its smartphone sensors collect data from mobile phones, and its AI-enabled system uses it to warn about potential health problems through changes in patterns of communication, activity, and sleep. Woebot and BioBase offer similar services that track changes in user mood, find patterns and helps them think through situations with step-by-step guidance. With the stigma associated with mental ill-health and people's reluctance to seek a therapist, these could encourage people to talk freely without hesitation. These applications can act as an outlet for the many workers to vent their anxieties and fears about job losses in the turmoil facing the industry currently. During such moments of crisis or at odd hours, a helpline or chatbot is one of the first resources people can turn to.
Increased financial burden on Non-COVID patients
The costs for the non-COVID patients have not just been limited to their health. Healthcare costs have shot through the roof in these times due to the added costs of logistic and other sanitation measures. The expenses across procedures in private hospitals have risen by 10-25%, with non-COVID patients being charged for personal protective equipment (PPE) and other standard operating steps.
A cut in the visit to doctors, hospital stays and re-admissions, and home treatment significantly reduce healthcare costs. In the current circumstances, telehealth and telemedicine may turn out to be the cheapest and the fastest way to not only reduce the rural-urban health divide but also in tackling the COVID-19 crisis.
Government needs to step-up technological investments in healthcare
The pandemic has exposed the drawbacks in the healthcare system of the country. While the government races against time to fix these gaps, the healthcare industry needs to look at the glass as half full. COVID has raised an array of opportunities for Indian healthcare startups to embrace. AI-augmented data generation units in the form of wearables, apps can help not only in real-time diagnostics, but also in creating vaccines and drugs using the richness of the
data from millions of people.
Adopting AI-augmented technology in healthcare is not a 'thing for the future'. Instead, it can address the immediate healthcare demands in our pandemic-hit country. Technology isn't going to solve all the problems facing the healthcare sector. However, the stress on its greater usage should be imperative, keeping in mind similar situations in the future. It is crucial to leverage technology-based healthcare solutions and turn them from interim arrangements to mainstream interventions. Healthcare services would have far-reaching benefits in terms of accessibility only if the provision and use of technology is not restricted to the private hospitals. The government needs to fully exploit the power of technology during the current crisis so as to make the AI-augmented products available for mass use.
Investment in hospitals and human resources will always remain the best way to achieve quality 'Healthcare for All'. However, the enormity of such pandemic demands to move beyond the linear growth in healthcare, such as building hospitals and adding professionals, and complement the system by leveraging technology. Technology has all the potential to be a real gamechanger.
(Nilanjana Bhattachaya is a Doctoral Scholar, Department of Economic Sciences at IIT Kanpur
Ancy Thomas is a Consultant at Deloitte US)
