The COVID-19 pandemic has wreaked havoc on the hospitals and healthcare systems all over the world. The situation is especially critical in low-income and developing countries. In addition, their health and social systems are already weak.
The COVID-19 pandemic has disrupted the routine at the hospitals globally. A study conducted by COVIDSurg which is a research network of surgeons and anaesthetists, has revealed that globally around 28.4 million procedures were postponed during the peak 12 weeks of the pandemic.
How are hospitals affected around the world?
The global health crisis will only worsen till COVID-19 is managed efficiently. With the sudden onset of COVID-19, healthcare should be provided to those in need at the lowest cost as economies around the world strive to remain proficient.
Australia has an estimated 682 private and 675 public hospitals but less than 20% of public hospitals have a specialised ICU. Population at the age of 60 is 21.4% of the total. The unexpected nature of the pandemic has resulted in a joint private-public partnership for the crisis with the government committing to pay for half the costs for private hospitals to provide services.
The UK has around 1257 hospitals which include the NHS trust-managed and private hospitals. The percentage of people aged 60 and over has increased to 23.8% in 2018. Around 92% of the recorded deaths due to COVID-19 in England have occurred in this age group and hence the UK is in a more vulnerable position. According to the NHS, one-quarter of the population, and two-thirds of people who are aged 65 or over have two or more long-term co-morbidities. The hospital sector is at severe risk of staff shortage. More than 65,000 retired doctors and nurses in Wales and England have been asked to return to the NHS. As well as anyone in Scotland who has left the medical profession within the last 3 years have been asked to come back. Allied Health Professionals have also been encouraged to return to work. The government has set up various field hospitals in different locations to meet the expected wave of patients.
Germany has 6 hospital beds per 1000 people and 33.9 intensive care beds per 100,000 people. Germany has 12 nurses and 4.3 doctors per 1000 inhabitants. Hospitals in Germany have been asked to postpone elective surgeries to keep beds free for COVID-19 patients. They have also passed the hospital relief act, where the hospitals will receive a compensation payment of 560 Euros per patient. This is done in order to protect the hospitals from financial losses.
The healthcare capacity in the USA is considered as adequate. There are about 3 hospital beds and 3 medical practitioners per 1000 individuals. People over the age of 60 years account for 17% of the total population. Healthcare capacity is burdened with the rising number of cases. The US currently has the highest number of COVID-19 cases in the world. They have passed 2.1 trillion dollars worth of coronavirus aid to provide significant relief to the US healthcare sector. The US has provided 100 billion dollars worth of grants to hospitals to cover health-care-related expenses and lost revenues.
About 24.2% are aged over 60 years in Canada. Canada has 2.6 medical practitioners and 2.5 hospital beds per 1000 people. This is lower than countries like Germany, the UK and the US. Hospitals are therefore overcrowded and there are limited resources to treat COVID-19 patients. However, the Canadian government acted quickly and committed more than a billion dollars to expand public health measures. Canada’s relatively low rate of infection currently does not possess a high risk of the healthcare system being overwhelmed but the ever-evolving situation with the virus puts the system at some risk.
In 2019-20 the New Zealand government spent 19.3 billion dollars on health-related items. New Zealand has 2.6 beds and 3.35 medical practitioners per 1000 people. The population that is aged over 60 years is about 21.3 %. The New Zealand government was swift in taking action against the virus by imposing early lockdowns. This placed New Zealand in a strong position both health-wise and economically. This had enabled them to return to business-as-usual quicker than other nations. Due to their stringent lockdown and robust healthcare system, the infection rate was low as compared to other countries and hence their healthcare system is at a low-risk of being overwhelmed.
How are hospitals affected in India?
Hospitals’ revenues have been affected since COVID-19 began picking up pace in India. During the lockdown, all non-emergency procedures and OPDs were shut based on the advisory from the government.
Difficulties related to healthcare delivery
Patients with chronic conditions like HIV, tuberculosis and those requiring dialysis struggled to access treatment as hospitals shut various departments. This was also due to the travel restrictions imposed during the lockdown. The risk of delayed treatment versus the chances of contracting the infection with compromised immunity is a difficult choice to make. COVID-19 related restrictions have left the patients to decide on the urgency of care that they need.
In India, there is also an issue with the allocation of scarce equipment. Healthcare providers like doctors have to make the ethical call for allocation of equipment. This is deeply distressing and emotionally draining. This not only affects the mental health of the doctors but also affects the mental health of patients and their relatives. Medical emergencies require immediate medical attention and delay could be life-threatening. During the lockdown, many incidences of delay in emergency care were highlighted by the media. Denial of care and consequences were reported as a fallout of stringent lockdowns. Patients faced issues while seeking care for chronic or acute conditions including the closure of public transport, non-availability of care providers (most of them engaged in COVID care), restrictions on movement, etc.
COVID-19 and the lockdown have changed the dynamics of the healthcare system. Many private medical practitioners across various cities have stopped opening the clinics even after the lockdown due to the fear of close contact with coronavirus-infected patients. Many patients were left with no choice but to rush to the hospital. This has led to overcrowding in hospitals and defeating the purpose of social distancing. This also puts unnecessary pressure on the already strained hospital staff.
The COVID-19 stigma
In India, app-based technologies are used to track hotspots and understand the spread of COVID-19. The lack of good data protection systems made the patients’ data vulnerable. The breaches in confidentiality of the patients’ health data can exacerbate the degree of stigma within the communities.
Healthcare workers often face discrimintaion for working in hospitals and COVID care centers. This was due to the collective fear and anxiety that lay in people regarding the spread of infection, often leading to even the patients facing discriminarion.
There were several reports of healthcare workers being harassed by their landlords or neighbours for working in hospitals. Keeping this in mind the Government of India noticed the challenge of fear and stigmatisation and began promoting positive messages and gratitude towards health and sanitation workers through caller tunes and social media.
Why do few countries perform better than others?
Many countries have flattened the COVID infection curve and a very few countries have almost eliminated COVID-19. This has allowed the precarious work of resuming economic activity. Different countries have used varying strategies to beat COVID-19.
The Swedish approach involved largely voluntary restrictions for the vulnerable population while keeping much of the economy open. They aim to build herd immunity among the young and healthy. This approach had attracted speculation from all over the world. The number of deaths was much higher as compared to other Nordic countries. However, the number of cases in Sweden has not completely overwhelmed their healthcare system as seen in Italy. Survey data suggests that most Swedes support the approach of the government.
The crush and contain strategy was successfully implemented by countries like South Korea, Taiwan, New Zealand etc. COVID-19 arrived in South Korea and the US in Jan 2020. Mid-March, the disease continued to surge in the US but South Korea had already flattened its curve owing to the crush and contain strategy. This strategy is built in response to past epidemics. Governments in Taiwan and South Korea rapidly imposed restrictions and deployed comprehensive virus-monitoring systems that included mass testing, contact tracing, etc. South Korea and Taiwan kept the number of cases below the limit by acting early. New Zealand initiated early countrywide lockdowns, along with rapid virus-monitoring systems. This type of strategy could be beneficial for small countries. It poses considerable challenges and harms international trade, tourism, etc. which are important economic drivers for many of these governments for eg: tourism accounts for 10% of New Zealand’s economy. Public health officials made innovative use of digital technology to aid contact tracing, which worked well in Hong Kong, Vietnam, China and Taiwan. The hard lessons learned from previous outbreaks readied Asian countries to act swiftly during COVID-19.
Once things begin to normalize, the situation won’t be as simple as before. The benefit, however, would be that as the restrictions are eased, non-emergency surgeries will pick up. These types of surgeries are more profitable to the hospitals. However, the footfalls are expected to stay low due to the fear of infection amongst the public.
The impact of COVID-19 on hospitals is visible. COVID-19 has disrupted the operations of almost all hospitals around the world. Reconfiguration of care in hospitals in response to COVID-19 has led to many patients suffering from the non-COVID-19 condition to delay their treatment. Governments should take steps to mitigate the major burden on such patients. As hospitals around the world try to cope, they need to be mindful about the ethical dilemmas that may occur during patient care. Hospitals should also come up with strategies and adopt technology such as Teleconsultation, Blockchain technologies, increased staff employment, re-organizing the facilities to host other specialties during Covid19. To combat the current situation and to be prepared for any futuristic epidemics or pandemics, hospitals should incorporate sustainable strategies and adopt technologies to ensure better processes.
- BCG: 3 Paths to the Future: Available at: https://www.bcg.com/en-in/publications/2020/three-paths-to-the-future-post-covid-19. Accessed on: 17 December 2020
- “COVID-19: Emerging gender data and why it matters | UN Women Data Hub”. data.unwomen.org
- COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans [published online ahead of print, 2020 May 12]. Br J Surg. 2020;10.1002/bjs.11746. doi:10.1002/bjs.11746
- Express Pharma: Long-term impact of COVID-19 pandemic on Healthcare Scenario in India. Available at: https://www.expresspharma.in/guest-blogs/long-term-impact-of-covid-19-pandemic-on-healthcare-scenario-in-india/. Accessed on: 17 December 2020
- Hebbar, Pragati & Sudha, Angel & Dsouza, Vivek & Chilgod, Lathadevi & Amin, Adhip. (2020). Healthcare Delivery in India amid the Covid-19 Pandemic: Challenges and Opportunities. Indian Journal of Medical Ethics. 01-04. 10.20529/IJME.2020.064.
- Horton R. Offline: COVID-19 and the NHS-“a national scandal”. Lancet 2020; 395(10229): 1022.
- IBIS World- Special Reports: Effects of COVID-19 on Global HealthCare System. Available at: https://www.ibisworld.com/industry-insider/coronavirus-insights/effects-of-covid-19-on-global-healthcare-systems/. Accessed on: 17 December 2020
- “U.S. Hospitals Hit By Financial ‘Triple Whammy’ During Coronavirus Pandemic”. NPR.org.