As Covid-19 cases surge, telemedicine may address doctor shortage

Topics Coronavirus | healthcare | doctors

Prior to the Covid-19 pandemic, India would get around 500,000 intensive care unit (ICU) admissions every year, with roughly 70,000 ICU beds in the country
Even as the country’s health care infrastructure of beds, ventilators, and personal protective gear is ramped up and new therapies prescribed to treat Covid-19 patients, the shortage of critical care specialists has become acute as the number of cases rises. 

Health care professionals and state governments are addressing the problem in a two-pronged strategy of training doctors to become intensivists and adopt the telemedicine route. 

According to a Ficci-NatHealth report on telemedicine, 1.7 million Covid-positive cases are expected to seek tele-support in the next 100 days, and with other primary care needs will need around 33 million hours of doctors’ consultations. 

The study adds that if 15-20 per cent doctors come on telemedicine platforms in the next 100 days, 25 million hours of consultation can be delivered.

Prior to the Covid pandemic, India would get around 500,000 intensive care unit (ICU) admissions every year, with roughly 70,000 ICU beds in the country.
But the number of critical care specialists or intensivists to treat these patients is around 11,000. Even in normal times, this ratio is unfavourable and appears worse during a pandemic, say medical professionals. 

 

 
About 15-20 per cent Covid-19 patients need hospitalisation and do fairly well with oxygen support. However, at least 4-5 per cent patients slip into severe conditions and need ICU care. India is adding close to 12,000 cases daily right now and in July and August, the cases are expected to see a spike. After having just recovered from a coronavirus infection, Dhruva Chaudhry, who heads the Department of Pulmonary and Critical Care Medicine in University of Health Sciences in Rohtak, is now spearheading the effort to connect district hospitals in Haryana through telemedicine to his medical college, which will act as the command centre. 

Chaudhry, who is also the president of the Indian Society of Critical Care Medicine, adds that the society has around 11,000 members — roughly the number of intensivists in India. 
To address the shortage of critical care experts, other specialists such as anaesthetists and doctors of internal medicine are being trained to treat critically ill patients in almost every state in the country.

Apollo Hospitals is conducting free online courses in ICU and ventilator management since March, said Sai Praveen Haranath, medical director, Apollo eACCESS tele-ICU Services and senior consultant pulmonologist and critical care specialist at Apollo Hospitals, Hyderabad. 

Telemedicine in India, too, is getting a makeover — it is not only confined to video consultations between doctors and patients, but it is increasingly becoming the tool to handle critically ill patients from remote locations. 

Sandeep Dewan, director and head of the department-critical care medicine at Fortis, said tele-ICUs are relevant not only in the hinterland but also for metros as they protect super-specialists from contracting the infection and also enhances productivity. 

One intensivist can handle 60 ICU beds when he is monitoring remotely, while he can monitor only a few beds in a physical ICU. The data is displayed on a doctor’s computer and he gets an alert when any patient’s vitals need attention. “The moment the cardiovascular parameters of a patient change, the doctor gets an automated alert before the nurse on-site can react,” says Dewan. 
The industry claims that infection rate for health care workers is 8-14 per cent. In tele-ICUs this is almost negligible. Dewan, who also teaches a diploma course in critical care, informs that not more than a few hundred doctors take up critical care every year. 

Chaudhry adds that a minimum of three-four years of training is required to prepare a doctor to become an intensivist. “For every critically-ill intubated patient we need four nurses each day in shifts and for every five patients one doctor. In the public sector, the number of critical care beds is abysmally low,” he says. 

The industry says that there is a definite shift towards tele-ICUs though. Alok Roy, chair of Ficci’s health services committee, and chairman of Medica Group of Hospitals, says that almost 90 per cent of the ICU consultations are now on telemedicine, especially the specialists. He adds: “It’s not only cheaper for the patient, but also safer for the doctor.” 
State governments, too, have shown interest recently. Vikram Thaploo, chief executive officer, TeleHealth, Apollo Hospitals, says some state governments have tried to understand the kind of protocols being used for remote monitoring of patients. “Ramp-up of telemedicine has happened in private health care. Smaller hospitals in Tier II cities have reached out and have upgraded their ICUs to tele-ICUs,” he says. 

Apollo TeleHealth provides infrastructure support and the back-end doctor support from its ICU command centre to these smaller hospitals which have a few ICU beds but not enough intensivists.

Converting a general (non-ICU) ward into a remotely monitored ward is even cheaper and requires temperature monitoring and oxygen saturation monitoring mostly for Covid patients, and is being done at government-run facilities housing Covid patients. 



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