A general change has been that the number of ‘routine’ hospital emergency room visits has gone down drastically
It is now more than four weeks since I have been here in the land of the free and home of the brave, otherwise known as the United States of America or just the US. Covid-19 is still around but it seems that people are starting to learn to live with it.
Yesterday my grandchildren, aged five and eight, attended school for the first time since the beginning of the pandemic. But their schools near Washington, DC, are not going to be without restrictions, including masks and social distancing. And at the first hint of Covid-19 among the school children, schools will close down.
After my self-decreed two week imprisonment, my children came by to spend an afternoon with me, masks and social distancing being enforced. And so did my cousin who also dropped by. And yes, my wife and I did venture out on a couple of shopping expeditions. Other than that all other contacts with friends and former colleagues have been by phone.
When I said above that people in the US are learning how to live with the virus, I did not mean to imply that most people are now following medical recommendations about how to prevent spread of the virus. It is an election year in the US and the supporters of President Trump are trying to convert medical recommendations into a political issue.
The so-called conservative politicians who support the re-election of President Trump to a second term as president are trying to present forced wearing of masks and social distancing as attacks by liberal medical establishment on personal liberty. Even President Trump opposes wearing of masks for obvious political reasons.
Unfortunately in the US the development of a vaccine against the virus causing Covid-19 has become the subject of political expediency. President Trump wants to announce that an effective vaccine is available just before the election to be held in the first week of November this year.
Whether development of an effective vaccine will be possible before the election is doubtful but political pressure might force the use of a vaccine that has not been properly tested. However unlikely this might seem, that is a fear that has to be confronted.
Even though the public health measures to control the spread of the virus are becoming a political issue, in general two major parts of life in the US are presently being severely restricted. These are professional and college sports and the restaurant and the bar scene. While educational institutions are still wrestling with full opening at this time.
The positive change in the US is that the intense pressure on the healthcare system during the height of the pandemic has decreased considerably. There is a slow decrease in new cases and doctors have also learned how to treat Covid-19 a lot better than before.
Fortunately, so far most of the effective treatment of Covid-19 is based on available methods and medicines. Here it is important to emphasise that so far there is no cure for this disease but supportive treatment has cut down the chance of dying from it. And the statement that ‘prevention is the best cure’ still applies.
Perhaps one of the most important developments in how medicine is practised in the times of Covid-19 is the rapid dissemination of the scientific information about the latest treatments of this disease. Because all the information is so easily available, doctors in Pakistan are able to use the latest treatments as they become available.
The positive change in the US is that the intense pressure on the healthcare system during the height of the pandemic has decreased considerably. There is a slow decrease in new cases.
Even though inaccurate information is also being spread but most physicians the world over are able to separate the false from the factual. Fortunately, some of the ineffective treatments like the use of anti-malarial drugs have been so fully discredited that no qualified physicians are offering them as a treatment.
During conversations with friends and former colleagues in the US certain changes in how medicine is being practised at this time became evident. The first change is the emergence of what is known as ‘tele-medicine’. This has been around for a while but it came into widespread use during the last few months.
A lot of technology that was floating around suddenly became useful. The wrist watch that can also take an ECG and body temperature and transmit them to a physician along with the smart phone that can take a picture of your sore throat or the funny bump on your skin and then send it to the doctor on his phone.
And a large number of problems can be taken care of through a doctor-patient conversation on a phone with the help of electronic transmission of much of the relevant information. Such ‘virtual’ medical consultations might be a major part of the future of medical care but with a computer rather than a human physician on the other end.
Another change is that patients now don’t wait in a doctor’s office but in the parking area and come in after a phone call. A doctor friend was even thinking about installing capability in his office to be able to do rapid tests for Covid-19 on the patient’s arrival in the office.
A general change has been that the number of ‘routine’ hospital emergency room visits has gone down drastically as has the incidence of ‘elective’ or non-emergency operations or hospital admissions. This change is due primarily to the fear on the part of the general public in visiting hospitals during a pandemic.
The downside of this reluctance on the part of people to visit hospitals or doctor’s offices for fear of coming in contact with ‘infected’ patients is that non emergent medical problems are allowed to fester until they become serious.
The big question for doctors as well as their patients is whether these changes will last or things will go back to ‘business as usual’ once the pandemic is behind us. I believe that besides telemedicine, other changes are temporary.
There is, however, one change that is going to become a part of all future political and economic calculations even in less developed countries like Pakistan. And that is a greater emphasis on health care, for people like me that have been writing about the importance of adequate health care as a right rather than a privilege have been proven right by this pandemic.
If infected, your driver, cook or cleaning lady is going to infect you. We are all in this together and so the health of every individual is important. Once infected access to a fancy private hospital is not going to make too much of a difference whether you make it.
Obviously this pandemic has also resulted in major economic dislocation. Economic recovery will eventually happen but until it does, the poor, both individuals and countries, are going to have a hard time. However much it might seem to be too expensive, it is an opportunity for us in Pakistan to fix our health care system.
Finally to the question of why Covid-19 seems to be giving Pakistan a pass. I have spoken to many well informed physicians and nobody really knows why.
The writer has served as professor and chairman at the Department of Cardiac Surgery at King Edward Medical University