Heart failure is a serious public health concern, therefore it becomes important to know what it is, how to prevent, diagnose, and manage it. Heart failure is a condition which is caused either by ineffective pumping or inadequate relaxation of the heart. It is the culmination of various other diseases, says Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal. “Heart failure does not mean that the heart has completely stopped working, but that its capabilities have reduced. Left unaddressed, it can lead to decreased quality of life and complications like irregular heart rhythm (arrhythmias), recurrent hospitalisations, and sudden cardiac death. There are different stages of heart failure and treatment is focussed on slowing its progression into advanced heart failure,” mentions Dr Divya Marina Fernandes, Interventional Cardiologist, Aster RV Hospital, Bengaluru.
“Heart Failure has a 50% mortality rate in five years. 30% of deaths in the US and 33% of deaths in India are due to heart failure alone. Majorly, there are two types of heart failure, preserved ejection fraction and reduced ejection fraction. In India growing cases of heart failure is of preserved ejection fraction. The reason for rising heart failure in India is due to increased hypertension. Earlier there was a myth, weak heart leads to heart failure which isn’t correct,” says Dr Sai Ravi Shankar, Consultant Cardiologist, Apollo TeleHealth.
Dr Kumar points out, “There are various reasons for heart failure but the most common cause is heart becoming weak due to a previous heart attack. Other causes are the development of blocks inside the heart which causes weakness of the heart without causing any heart attack, viral infections which affect the heart muscles, nutritional problems like thiamin and selenium deficiency, uncontrolled diabetes, thyroid problems, excessive alcohol intake, persisting cardiac rhythm disturbance, and uncontrolled hypertension for a long time. Rarely heart failure can also occur due to stress, which is called stress cardiomyopathy.”
“Heart failure is often connected to lifestyle factors, therefore it is important to follow a healthy diet and lifestyle from a young age. Management of diabetes, obesity, and hypertension is of utmost importance. A healthy diet with lots of vegetables, grains, pulses, lean meat, sufficient hydration, supported by cardio exercises such as walking, jogging, swimming, playing sports, etc, basically any activity that gets the heart rate up is good to maintain a healthy heart. Fluid and salt restriction is usually advised for these patients. Unhealthy fats, salty and oily foods, excessive consumption of sugar, alcohol and smoking among others can all damage the heart over the long run, so it’s best to quit these as soon as possible, adds Dr Fernandes.
TREATMENT OPTIONS FOR HEART FAILURE
Dr Shankar says, “The treatment for heart failure has stages. First is identifying and treating the cause. The major cause for health failure is heart blockage which is treated by CABC, angioplasty with stent and valve replacement. The new drugs that are proven helpful for heart failure are ARNI, SGLT2 and Beta-Blockers that have been available in India as well. The non-surgical treatments that are available in India are New Assist Device i.e ICD, CRT, LVAD, TAH (total artificial heart). These are called the bridge to transplant. If the heart patient has reduced ejection fraction we take help of non-surgical treatments before going for the surgical options. But the cost is Rs 25 lacs approximately so lots of people can’t afford it.”
Dr Ashish Agarwal, Head & Senior Consultant, Department of Cardiology, Aakash Healthcare suggests some non-transplant surgical options in heart failure:
Coronary revascularisation: This treats ischemic cardiomyopathy, the most common cause of heart failure across the world, and events it may cause, such as myocardial hibernation, myocardial stunning, and myocardial cell death. For patients with ischemic cardiomyopathy, coronary revascularization should be the first treatment modality.
Mitral reconstruction: This treats mitral regurgitation (MR), a common event in heart failure patients. Along with another surgical intervention termed percutaneous mitral valve repair system, MR can better restore left ventricular remodeling, and gives patients a better quality of life.
Stem-cell regeneration of myocardium: The process replaces myocytes lost from the injured cardiac region and is a viable nontransplant treatment for heart failure. The myocardium could be regenerated by injecting stem cells such as peripheral blood stem cells, skeletal myoblasts, and bone marrow stem cells, into the damaged heart.
Geometric ventricular reconstruction: This is another nontransplant surgical means to treat heart failure.
PRE-EXISTING CVD, COVID-19 AND RISK OF HEART FAILURE
Are patients with pre-existing cardiovascular disease infected with Covid-19 at higher risk of heart failure? Dr Shankar replies, “Patients with Covid-19 and pre-existing heart disease can lead to more heart muscle damage which eventually weakens the heart, the virus can lead to more blockage in the heart, heart rate irregularity, and sudden cardiac deaths. The people with heart disease should take utmost care, that is wearing a mask, sanitising, and social distancing followed by regular medications and immediate consultations with the doctor in the case of an emergency. Also, Covid-19 vaccine is proven to be safe for heart disease patients.”
Dr Agarwal opines, “People with pre-existing cardiovascular disease (CVD) are more likely to have a more severe form of the infection. It may lead to heart failure as their hearts are weaker than normal. However, not all CVD patients who contracted Covid-19 have died, many have recovered as well.” He suggests one should take precautions to not get infected by Covid-19 such as wearing a mask, maintaining the medicine schedule, avoiding outside exposure unless mandatory, washing hands, and maintaining social distancing.
Ways to lower the risk of heart failure
Heart failure risk can be reduced if we address and treat the risk factors effectively. Since the most common cause of heart failure is heart attack, reducing the risk of heart attack will help in reducing the risk of heart failure. Some of the measures to do so: · Having a healthy diet (low calorie and low-fat diet) · Regular exercise · Effective management and treatment of the risk factors such as diabetes, hypertension, and high cholesterol levels · Taking medications and regular check-ups · Nutritional deficiency can be treated with a healthy diet. If there is any cardiac rhythm disturbance, consulting the cardiologist and treating them would reduce the risk of heart failure.—By Dr Sunil Kumar, consultant, Interventional Cardiology, Columbia Asia Hospital Hebbal
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MUSIC AND MEDITATION: THE MANTRA FOR MODERATION
She sat in a room by herself, the door had been locked for days, months perhaps but she was unaware. Her Ektaar sat in her lap, her eyes half-closed with a soft smile laced upon her face. Her name was MeeraBai — the Princess who found enlightenment through music.
Music has always been a way to communicate with the higher power and evokes feelings of emotion and healing with one another. The reason why I decided to be a bhajan singer is that music has the power to influence your mood and unleash your emotions. Devotional music of any kind, in any faith, allows you to silently surrender through sound. It also provides you with a vessel to carry the emotions that are burdensome on your shoulder, and through the musical notes and various intonations, you find yourself emptying that vessel of your mind into the ocean. That grace and surrender music naturally gives you without the need for conscious prayer is what can alleviate the pain and stress we feel. Anyone can think of a time of difficulty they have gone through and recall the album that gave them some solace.
Hindu monks have always been very particular about the way mantras are chanted because of the power they contain. There are rules as to how you chant, where your tongue hits when you say a certain word, when you should take a breath and ensuring you maintain a certain rhythm and timing. Although you might find this rather onerous, it had a scientific purpose. Controlling these factors enables a certain kind of physical and mental change within you and could also be used to govern the circumstances around you. Although, we may not chant mantras in the same way anymore or with such detailed precision, just listening to them is very beneficial. The mantra is like a key that is used to unlock your chakras, break negative thought patterns, clear karma and raise not only your vibration but the vibrations of the room you dwell in. Hence why certain rooms feel so peaceful whereas others might leave you feeling tired or restless.
Music is also playful and soothing because a melody is similar to the natural flow of a stream. It doesn’t require any conscious study, thought, or energy. It simply allows you to trace and follow it and that creative movement frees you from the things that have us stuck and troubled. Music lives loftily above an ego infused world. You’ll find someone in East Asia feeling the same way about a song as someone else on the other side of the world. Or you can go to a classical concert, and regardless of an individual’s background, they find themselves identifying with the music. This brings you closer to spirituality because it is breaking boundaries and barriers that we have formed within ourselves. And if the point of spirituality is to feel oneness then music enables that.
We associate music with love; first wedding dances, lullabies for our children, singing at the top of our lungs with friends at a concert, or even crying over a heartbreak to a song on the radio in the car. Music; to me, has always been about love, and meditation is about creating space to love and understand your real self. When you marry the two together, the emotional intensity of music allows you to dive deeper within yourself.
There is no ‘right’ or ‘wrong’ type of music, it is a personal connection between you and sound. Sound is energy and that energy is transferred to you, therefore you decide how you wish to receive it. Whenever your mind is running in a hundred directions and you feel distracted, take a moment and listen to something that is produced specifically for you to tap into the higher (listening to a song about being jealous for example won’t be very conducive!). Breath slowly, close your eyes and allow yourself to let everything go. For all the things you don’t dare to say or release, the music will do it for you. Remember a song is temporary, so is this moment and our problems, let it seep out of you through the sound. And like MeeraBai, you will find yourself moving upwards, beyond the material and superficial ropes that have you pegged down. Your heart, as it heals, as all hearts require, will be flooded with love. Those around you will trace the sweetness of the melody by the curve of your smile and the light in your eyes. Music, coupled with your devotion and discipline, will have set you free.
The writer is a Spiritual Urban Yogi and Indie Devotional Singer.
PANDEMIC GRIEF: WAYS TO HELP COPE WITH THE LOSS
There is no perfect way to cope with grief and loss but there are healthy ways to release these emotions from your mind and body. When we experience any form of loss, grief is the first emotion that sinks into our heart. Grief can be overwhelming as it encourages other emotions such as anger, disbelief, guilt, shock, pain, or sadness to take control.
Spiralled in these negative emotions, not only our mental health goes for a toss but also our physical health. Some may experience insomnia, increased level of anxiety, fatigue, nausea, eating disorders or over-thinking.Also, coping with the news surrounding the pandemic is challenging.
Here are fe tips on how to cope with grief:
Face the fear: While most people suggest time will heal the pain unless you face the fear and resolve it from the root, it will surface again and again. Ignoring the pain now can be harmful in the longer run.
Release your emotions: It is vital to release the negative emotions from your body. To release these emotions, some may cry, yell, write it down in a diary or spend time alone. Expressing your emotions does not make you weak. Rather, it makes you an emotionally mature individual.
Move on: There is a difference between moving on and forgetting about it. Every incident will remain in your memory forever and form a major part of who you will become in the future. However, when you decide to move on, you still retain those memories in your heart but do not allow them to restrict your growth. In simple words, you take charge of your life.
Seek help: Asking for help is also a sign of strength. Never hesitate in reaching out to people to seek help. Talking to someone who truly cares about you, helps you healthily release your emotions.
Recurring emotions: The pandemic has been a tough time for all of us. Some have lost dear ones, relatives, friends or colleagues. It can be hard to deal with grief in these times. Don’t be afraid if these emotions keep recurring. Instead, reach out to coaches who can help you get rid of them.
Support your mental well-being: The best way to support yourself mentally is to take care of your physical health. From maintaining a healthy diet to maintaining a healthy routine, it will work out in your favour. A healthy body helps heal the heart.
Fill your emotional cup: Your grief is personal to you. Acknowledge and accept that it is okay to feel sad or cry. Involve yourself in activities that help you feel lighter. Write a letter, listen to music or repeat positive affirmations – the aim is to feel happier.
Be empathetic with yourself: Blaming yourself or being too hard on yourself will only make the pain seep deeper into your heart. Instead, acknowledge your efforts and learn from your mistakes. Give yourself time and space to heal from the grief.
Trust and faith: No matter what happens, the first and foremost thing is to retain your trust in yourself and faith in the universe. When you trust yourself, your brain starts to release signals to your heart – ‘Everything will be okay’. This mindset shift will bring a major shift in your life.
If you know someone who has recently suffered a loss, support them. A genuine & compassionate conversation can help people cope with difficult times faster. Being in physical isolation does not have to mean emotional isolation as well. Stay connected to your loved ones through video calls, texts and prayers.
The writer is a renowned life coach, consultant, speaker, and author.
HOW TO TAKE CARE OF COVID-POSITIVE CHILDREN
Doctors simplify the clinical guidelines around Covid management in children by the Union Health Ministry and tell us how certain therapies help in the treatment of kids with severe corona illness.
The Union Health Ministry recently issued certain guidelines to manage Covid-19 in children. This comes amid speculations that children can be a possible target of the third wave of Covid. The Ministry, in the guidelines, has said that Remdesivir is not recommended for children, and steroids should be used to treat only moderately severe and critically ill Covid positive children.In the recommendations, the government has stressed the use of a six-minute walk test on children above 12 and oxygen therapy as well as the Corticosteroids therapy in cases of children with severe Covid-19. Let’s understand what the terms in the guidelines mean and how they are going to be beneficial in treating Covid positive children.
Talking about Covid-19 in children, Dr Sarthak Chakravarty, General Physician, Dr Sarthak’s Clinic, New Delhi says, “Usually, children from 2 yrs to 12 yrs of age do not show many symptoms with regards to Covid-19 infection. Children with Covid may be an asymptomatic, mildly symptomatic, moderately sick or severe illness. Asymptomatic children are usually identified while screening if family members are identified. Such children do not require any treatment except monitoring for the development of symptoms and subsequent treatment according to assessed severity.”
“Children with mild Covid may present with sore throat, rhinorrhea, and cough with no breathing difficulty. Few children may have gastrointestinal symptoms also. Such children do not need any investigations. In such mild and moderate cases where children may display a slight fever or cough that may not last for more than two to three days, only symptomatic treatment and home remedies are required. For fever, give paracetamol syrup as required (can be given every five to six hours), for cold and cough give cough syrups two to three times a day,” adds Dr Sarthak.
Guidelines stipulated by the Government of India on the management of Covid-19 in children for the third wave are synonymous with the guidelines formulated by local bodies (Karnataka IAP chapter) and national bodies (central IAP) since the pandemic started which encompasses the role of radiology in the diagnosis of RT PCR negative Covid, says Dr Srikanta J T, Consultant, Paediatric Pulmonology, Aster RV Hospital, Bengaluru.
“Fortunately, till now, less than 1 % of the children affected have had severe covid disease. Typically, children with the severe covid disease have background medical conditions and develop breathing difficulty with low oxygen levels. Treatment will warrant hospital admission with HDU/ICU facility. The mainstay of treatment is supportive care with oxygen, ventilation, fluid management, and timely judicious use of steroids,” shares Dr Sanjeeva Reddy, Consultant Paediatrics, PICU, and Neonatology, Manipal Hospitals Whitefield, Bengaluru when asked about his advice on treating children with severe Covid-19.
Why is Remdesivir not being recommended for children with severe Covid-19? Dr Sarthak replies, “Remdesivir Injection is a broad-spectrum antiviral medicine. It is used for the treatment of suspected or laboratory-confirmed Covid-19 in adults hospitalised with severe disease. The medicine decreases the viral load in the body and speeds up the recovery process. It works by inhibiting an RNA-dependent enzyme called RNA polymerase that helps the SARS-CoV-2 virus make more copies of itself. It is given as an injection into veins under the supervision of a doctor. You should take this medicine only at the prescription of your doctor. Take it only as per the dose and duration suggested by your doctor. You should not self-medicate this medicine.”
Talking about the side effects of this medicine, he says, “Anaemia, fever, acute kidney injury, increased blood glucose, and increased transaminases are some of the most common side effects of Remdesivir. If you experience any allergic reactions after taking the medicine or if any of the side effects bother you, you should let your doctor know. Since the side-effects are life-threatening and medicine is very strong it is not at present being recommended in children.”
Dr Sarthak warns that at the age of development, such side effects can cause a lot of damage to the body. There is no FDA/ICMR/WHO recommended safer alternatives at present for children. But viral diseases usually last for a few days in children and tend to disappear after completing their course. Symptomatic treatment helps in any viral disease — whether Dengue, Chickenpox, or Covid-19.
Why the government has advised doctors to be selective in prescribing high-resolution CT scan to children? What can be its adverse effects? Dr Srikanta explains, “As compared to adults in whom CT thorax is used to both diagnose and triage patients in Covid management, it cannot be applied to children as appropriately 95% of them have either asymptomatic or mild symptoms that do not require even a simple chest Xray. Even in those who present with moderate to severe Covid, unless we are looking at disease progression or complication, doing a CT doesn’t value add to already existing evidence for treatment. So, all the guidelines in both resource-rich settings like in Delhi, Bengaluru, where all investigations are at our disposal, we still don’t do even a CXR for 95% of children. In resource-poor settings like villages where RT PCR isn’t available or likely to get delayed, there we can ask for CXR followed by CT thorax for triaging purposes only depending on symptoms.”
He informs that the other concern is radiation. However, with the current technology of ALARA (As low as reasonably achievable) the dose to take an HRCT is very small. But again, with clear guidelines about when and where to use one makes the use of these modalities that much more ethical.
At what point is the oxygen therapy initiated and why the fluid and electrolyte balance should be maintained? Dr Sanjeeva replies, “Normal children maintain oxygen levels of over 94% while breathing atmospheric air. Supplemental oxygen becomes necessary when the levels drop to less than 92% consistently. Adequate fluid intake is necessary to distribute oxygen and other nutrients to body tissues and maintain energy levels. However, too much fluid especially through the intravenous route can lead to accumulation in the lungs due to their sponge-like nature and make the already difficult breathing worse. Proper balance is essential.”
During the Covid-19 pandemic, there have been discussions around diagnosis, investigations, treatment, and complications. Dr Abdul Bashir Khan, Senior Consultant, Pediatrician, Masina Hospital, Mumbai highlights two bedside ways to monitor lung functions that can be done at home, “Checking the oxygen levels of blood and heart rate with a pulse oximeter. Even more important is to see this same level after a six-minute walk. The walk should be at a normal pace inside the house and any drop in saturation recorded at this time is the first sign of lung function compromise. This is the time when the CT scan can be advised. It is a simple test to be done two to three times a day. Normal oxygen saturation on pulse-oximeter in a human being is always above 95% at rest and should be above 95% even after a walk for six minutes at a normal pace.”
Talking further about the six-minute walk test, Dr Abdul adds, “It is a very early predictor of detecting any changes in pulmonary parenchyma (Pneumonia). All adults and children above 12 yrs suffering from Covid can be told to perform this test.”
DOS & DON’TS
1. Isolate children when the elders in the family turn Covid positive.
2. If children show any symptoms do not give any medicine without consulting a paediatrician. In case there is no symptom present then only give multivitamin/zinc syrup and vitamin C chewable tablets once daily.
3. Keep children hydrated and give plenty of water and protein-rich food.
4. Do not give steroids unless prescribed by a paediatrician
—By Dr Sarthak Chakravarty, General Physician, New Delhi
COVID CONTROL VIA BETTER PUBLIC AWARENESS AND BOLD INSTITUTIONAL RESPONSE
From the unusual anatomical challenges of Covid-19 swiftly exhausting the common man’s savings, followed by acute depression, and anxiety-ridden days in two spells, people have had enough in the last 15 months. The existing gap in the number of deaths vis a vis rapid reduction in confirmed cases after 55 days, makes it apparent that the role of science appears subdued. Instead, the psychological dimensions are assuming a greater role. After the first anniversary of the Janta Curfew on 22 March 2020, we have a choice of at least eight vaccines (four in India) as compared to none earlier.
These are the fresh developments:
(a) Alpha (B.1.1.7) to Delta (B.1.617.2) variant switch leading to most devastating spike from 99,181 cases on 10 September (fell to 88,198 on 2 April) to a rise to 93,249 on 4 April and again to 4,14,188 cases on 7 May
(b) Findings of Indian scientists of NCDC and IGIB, that prior infections and one dose vaccination are insufficient against the virus, need to be flagged first. Thus, light on the necessity to have upgraded public awareness, conduct, and behaviour may have to be thrown. It will have to be supported by a robust public health response.
‘FOREIGN’ MUTATIONS AND VARIANTS
From a period of disturbing developments between the first week of 13 April to 14 May, showing creeping up 24-hour cases, positivity, CFR, and active case rates, there was a downward trend but a slow reduction in the number of casualties disturbs. One of the English dailies hinted at 771 Covid variants, whereas another daily had presented a very grim picture of Maharastra and Kerala on one hand and Punjab and Chattisgarh on the other. These were all having cases of Alfa, now renamed to Delta by the WHO, these are cases of Californian, the U.K. type, South African, and the Brazilian variant. In a vast, congested, and casual India, fresh Covid awareness and appropriate conduct are very much necessary.
Interestingly, one study of AIIMS had indicated that the common cold virus may have saved many Indians. Further, cross-reactive T cells from coronavirus that cause common cold may not protect from Covid but by responding to SARS-CoV-2 protein, they may restrict the severity of the disease. Also, immunity from Indian food habits may have been a contributing factor.
Whatever it may be, longer resistance or distance of about seven feet cannot always be enforced or guaranteed by the executive, each time an announcement is made regarding lockdown or Covid curfew.
BETTER CARE AND CONDUCT A MUST
As opposed to blanket 68 days of lockdown of the first wave, the liberal measures of the second wave lockdown (54 days) and slowly emerging concessions, have not boomeranged exactly but the government can always be ‘taken for granted’.
While the desire for a change or ‘breathing out’ after a long spell may be imagined, if not appreciated, a close look at people’s habits and reactions in the last few weeks even while rushing for vaccinations are not at all encouraging.
FAITH OR FEAR
Unconvincing and inconclusive debate on this issue has been on since the beginning of Maha Kumbh. Despite meticulous planning, mobilisation of large manpower and sizeable expenditure, not only hundreds of pilgrims died but very aged heads of eight Akharas also expired. Hence, taking a chance itself proved to be a ‘sin’. Further, threats emerged from apparently essential festivities, weddings, death ceremonies, unwanted urge for window shopping, recreating networking, away from home offices and whatnot.
The mega spreaders were three day Holi celebrations and five weeks of the election process in four states and one Union Territory that made a mockery of all Covid protocols. Not only the election-bound states together with the Election Commission of India avoided adopting strict measures, Covid data collection, its analysis and final report to the Centre too suffered. And as yet, a very modest number of cases and casualty figures are being reported from otherwise tension causing and volatile states of Bihar, West Bengal, and Assam.
Though Northeast states of Sikkim, Manipur, Mizoram, and Meghalaya did not undergo elections, they are reporting case-fatality ratio (CFR) and positivity rates higher than the national average for a month, mainly on account of the public non-cooperation.
Incidentally, the above-indicated parameters were within limits during the first wave and the first quarter of 2021. This speaks of a clear compromise on Covid awareness and prescribed protocols.
According to a study of Cellular and Molecular Biology (CCMB), Hyderabad while there is an immediate need to avoid crowded places and hygiene will have to be ensured and the earlier practice of carrying sanitiser may have to be insisted upon. Taxi and TSR drivers must refix plastic sheets. One should carry minimum cash and valuables while leaving home.
We are taking pride in being the world leader in vaccinations(almost 23.11 crore doses so far) but one forgets the loss factor, at a time when some of the countries are yet to begin even the first round. The average 10% loss of vaccines in Andhra Pradesh, Telengana, and Uttar Pradesh is something unpalatable.
60 PLUS DESERVE CARE
Also, slow coverage of 60 plus category is a matter of extreme concern. Not more than 50 % achievement has been recorded. Thus one can imagine the time to be taken for vaccinating over 20.2 crore people in this group. Not always official callousness may cause misery. Experience of many states has shown that people are in double mind even after registration and taking the first dose. Another threat comes from the listeners/viewers picking up a few shortfalls quickly and circulating the same without realising the consequences. But genuine success stories are mostly ignored.
NEGLECT OF VILLAGERS
Another disturbing development is very little focus on rural areas. Not only precious time is lost but rural folks are also manoeuvred easily by the negative news. Further, carelessness can be fatal in future, irrespective of ongoing summer and freak weather conditions.
Measures like night curfew, 33 % office attendance, restarting metro with 50% occupancy, and partial building activity etc. may not help at the moment. The behaviour pattern of relatively well-off citizens looks incorrigible while the poor continue to suffer. The desire to have fresh air gets multiplied day after day. While a thorough review of institutional mechanism should be on cards, the Central government will also have to extend the present lockdown and reconsider the decision to delay the second dose of the vaccine.
In the public domain, it is not always an ideal-typical scenario. Life is full of compromises, especially in a happening place like India. For right-thinking individuals, the dictum of self-help being the help may also work. More and more casual behaviour will prove counterproductive. Also expecting everything from the government may not be fair.
The writer is the ex-Chief Secretary, the Government of Sikkim. The views expressed are personal.
HEALTHCARE BEYOND CORONAVIRUS
Covid-19 has dominated the health discourse for over a year now but it doesn’t feel like a ‘Happy Anniversary’. Newspaper headlines aren’t going to change much in the next few months; public attention is focused on more possible lockdowns, rising Covid-19 numbers and higher mortality.
Meanwhile, another crisis may be brewing just below our national radar.
Covid-19 has had significant effects on healthcare workers, the healthcare infrastructure and healthcare systems. Most of all, the pandemic has had a serious impact on patients that fall into two categories:
• First, interruptions in treatment, testing and monitoring on patients – particularly those with non-communicable diseases (NCDs) like diabetes, cancer and heart disease – are expected to raise long-term risks
• Second, many medical experts also believe Covid-19 will have even more serious effects on patients with NCDs
Both impacts need deeper analysis.
The Ministry of Health & Family Welfare’s (MoHFW) Health Management Information System data reported that inpatient admissions declined by 45% in the first quarter of FY 2020-21 (April to June), compared to the same period in the previous year. Anecdotal reports suggest that things haven’t improved since then, though we will have to wait for more updated information.
Outpatient visits declined by 43%, including treatment of cancer and acute heart disease. Doctors fear that the delays in treatment can have longer-term effects; patients’ conditions could have become much more dangerous. A large number — 28% — of patients with kidney disease have missed at least one dialysis session.
Before the pandemic, NCDs were already the biggest cause of deaths globally; they killed 41 million people each year, or 71% of deaths (in India that number is 61.8%. According to the World Health Organisation’s (WHO) Global Burden of Disease study, more than 182 million people in India suffer from NCDs. In a rapid assessment of service delivery for NCDs reported in June 2020, the WHO found that health facilities in rural India received 30% fewer patients with acute cardiac emergency patients in March 2020, compared to the previous year.
Mortality rate analysis could provide other clues on the pandemic’s impact on NCD patients. The Consumer Pyramids Household Survey (CPHS) covers the same 232,000 households three times a year and captures data on mortality (but not cause of death). An analysis by Renuka Sane and Ajay Shah of the National Institute of Public Finance and Policy (NIPFP) showed that it almost doubled in 2020 over 2019. Covid-19 couldn’t fully account for the increase, but death from one or more NCDs could at least partially explain the significant jump in mortality.
From the currently available information, how long the pandemic will persist, is not clear, but it is not expected to be permanent. NCDs, however, are going to be around for a long time. The Covid-19 pandemic shows us the urgency of addressing gaps in our healthcare system that could significantly reduce national health risks over the long term.
WHAT CAN WE DO?
The first challenge is to improve access to healthcare services; this is partly addressed by telehealth/telemedicine, but more is needed. Providing access to medicines, vaccines, and services even to the most remote locations is necessary. The healthcare system should be able to respond to situations like Covid-19, quickly and effectively. How? Private-public partnerships: and solutions should increase both the scope and scale of access.
Second, the spirit of Atmanirbharata or self-reliance will have to be real. Nowhere is this more critical than in the domestic manufacturing capacity of APIs, or active pharmaceutical ingredients, a key input in drug-making. Almost all our entire API needs are met by imports; this is unsustainable. Government can create self-reliance with the right policy incentives.
Third, as the world’s pharmacy, we have to get bigger and better. In short, Indian pharma companies need to innovate, invent, and discover new drugs and therapies. This is a long-haul affair, but even the longest journey begins with the first step. Investing in research and development needs both initiative, and a supportive and stable policy environment. Drug companies say they have the inclination and can make up for the lost time.
US President John F Kennedy once pointed out that the Chinese word for crisis is made up of two characters: one represents danger and the other opportunity. We are living through the danger; let’s also take on the opportunity and press down on the accelerator pedal.
The writer is Healthcare Practice Lead at SPAG.
HOW TO MANAGE STRESS IN HYPERTENSION PATIENTS
Psychological issues in Covid-19 times may take a toll on health in already-at-risk hypertensive patients. Read and find out the reasons and ways to cope with it.
The Covid-19 pandemic poses a significant effect on physical and psychological stress. The whole world is witnessing a high rate of morbidity and mortality. It is common to have mental issues, including fear, anxiety, and depression during such a scenario. However, it is necessary to manage these conditions, especially in people with cardiovascular diseases such as hypertension. Psychological issues may take a toll on health in already-at-risk hypertensive patients.
IMPACT OF THE PANDEMIC ON CARDIOVASCULAR HEALTH
The pandemic has affected the life at every quarter including the physical and mental health of an individual. Several studies have revealed an increase in psychological stress in the people who have recovered from Covid-19. People who are living in an environment filled with fear and uncertainty also experience stress.
Hypertensive patients with advanced age and other conditions such as previous heart problems, diabetes, obesity, and chronic kidney disease have a poor outcome from Covid-19 infection. Such patients must take care of their physical and mental health.
Psychological stress due to the pandemic may occur at any age. However, the symptoms of poor psychological health vary with age. Stress in adults includes lack of interest, lethargy, increased irritation and shouting, emotional outbursts, alteration in the sleep cycles, and depression.
Various reasons contribute to poor mental health due to the pandemic in patients with hypertension. Some of them are:
Fear: There is an unparalleled fear in the environment. The fear of losing oneself and the loved ones’ lives
Reduced Physical Activity: Studies revealed a significant reduction in sleep quality, mental health, and physical activity in people with hypertension due to the pandemic. Low physical activity results in poor control of blood pressure
There is evidence of poor mental health in the people categorised into high-risk groups. Patients with chronic conditions such as hypertension and heart problems experience a high level of anxiety, stress and depression. Mental health further takes a toll when such people contract Covid-19.
Lack of Social Interaction: Hypertension occurs more commonly in adults and the elderly. However, the increased risk of serious illness due to Covid-19 have confined them within the home boundaries. It has affected blood pressure control and cardiac health
Negativity in the Environment: Social media, newspapers and news channels are continuously delivering information about Covid-19. Further, people are also receiving information about the severe illness or death of their relatives. It creates a negative environment around patients with cardiovascular disease, thereby impacting their cardiac health.
Admissions in the Hospitals: The healthcare system is working at full stretch, and people are searching for beds, oxygen, and ventilators. Patients admitted to the hospital witnesses death and panic resulting in mental stress.
Increase in Domestic Issues: The incidences of domestic violence and family fights have increased during a pandemic. It may be due to spending more time among family members in close contact. Irritation due to job losses and financial constraints further compounds stress, anxiety, and depression.
Functional Limitations: Functional limitations in hypertensive patients due to lockdown had increased mental stress. Cardiac patients may have severe illness due to Covid-19, which results in extended recovery time. Confined to bed also causes psychological stress.
COPING STRATEGIES FOR MANAGING PSYCHOLOGICAL STRESS
There are various ways to manage stress in hypertensive patients during Covid-19. Some of them are:
Physical Activity: Indulging yourself in physical activity may reduce stress and anxiety. Make exercise part of your daily routine. Various online exercise classes will help to maintain physical activity.
People with chronic diseases require a regular follow-up that reduces the probability of deterioration. All people should strictly follow the universal Covid-19 protocols. Minimising media exposure, practising relaxation technique, and monitoring blood pressure helps in reducing stress.
Minimise Exposure to Media Coverage: Limit your media exposure. Overburdening yourself with Covid-19 information throughout the day may result in poor mental health outcomes. Do not believe in fake information and educate yourself from the trusted sources.
Maintain Good Sleep: Pandemic had caused a disturbance in the sleep cycle. You may experience difficulty sleeping or problem waking up. Keeping a healthy sleep routine improves immunity and helps in managing blood pressure control and maintaining a good cardiac condition
Practice Relaxation Techniques: There are various relaxation methods available that may help you in managing psychological issues. You may practice yoga or meditation.
Monitor Your Blood Pressure: You must have your blood pressure under control. Take medicines strictly as prescribed by your doctor. Do not skip scheduled appointment and seek video consultation if possible. Monitor your blood pressure.
Seek Support: Do not hesitate to share your feelings with your family and friends. It is a powerful stress buster. If you have a persistent fear of getting infected, share your feelings.
Follow Passion: Indulge yourself in the activities you love. It may be gardening, cooking, painting, music or dancing. It will divert your mind from all the negativities and improve your cardiac health.
Instil Positive Attitude: Fear and a negative attitude may worsen your cardiac health. Many patients suffering from Covid-19 had deteriorated their condition due to sadness, depression, and hopelessness.
Taking care of physical and mental health during the pandemic is critical, especially in people suffering from cardiovascular disease. It will help in coping with psychological issues and taking care of cardiac health
The writer is a Consultant – Cardiology & Electrophysiology, Manipal Hospitals Whitefield, Bengaluru.
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