Compromised Health and Constrained Human Life in COVID-19 Pandemic, and Concurrent Healthcare Transformation

Citation: Vinod Nikhra. Compromised Health and Constrained Human Life in COVID-19 Pandemic, and Concurrent Healthcare Transformation. Biomed J Sci & Tech Res 39(3)-2021. BJSTR. MS.ID.006310.


The SARS-CoV-2 Infection and COVID-19 Pandemic
The current ongoing pandemic of COVID-19 caused by SARS-CoV-2, is associated with high morbidity and mortality in several countries across the globe. A prompt and effective detection of the disease is crucial to identify those infected, to monitor the infection from epidemiological perspective, and to take measures for its containment. On the other hand, the early diagnosis and efficient treatment of COVID-19 including newer therapeutic modalities such as monoclonal antibodies against SARS-CoV-2, may contribute to the individual clinical improvement and limit the morbidity and mortality in the society at large. The likely course of COVID-19 pandemic not certain, and the pandemic being considered a major health hazard, may continue in the foreseeable future or may with low or moderate level of transmission become endemic. The COVID-19 vaccines bear hope to bring COVID-19 pandemic under control, paving a way for its endemicity [1]. In this respect, the WHO in a recent communique indicated that COVID-19 in various countries including India may be entering some kind of stage of endemicity with low or moderate level of transmission [2].
The effects and fallouts of COVID-19 pandemic are striking as it has impacted the social, economic, political, and healthcare aspects of human life. The pandemic is being considered a major health hazard that may continue to afflict human life in the foreseeable future. The transformation of life, thus, at the individual level as well as at the community and collective levels, seems inevitable.
Another aspect of the COVID-19 pandemic is the unprecedented levels of misinformation, rumours, and conspiracy theories related to COVID-19 relayed and reproduced by lay and social media, dubbed 'infodemic' by the WHO, which are counterproductive to the fight against the pandemic in the short and long term. There are concerns about low to middle income countries (LMICs) related to the COVID-19 preparedness, knowledge sharing, intellectual property rights, and environmental health together with the serious constraints regarding readiness of health care systems to respond to the pandemic. In fact, the spread of COVID-19 presents an extraordinary ethical dilemma for resource constrained nations with poorly developed health and research systems.
In the current crisis, sharing of scientific knowledge and technology has an important role to play. In addition, emergency preparedness is a shared responsibility of all countries with a moral obligation to support each other [3]. The ongoing pandemic has led to a situation in which the scale of emergency is similar to WW-II, requiring decisiveness and commitment. In LMICs, the greatest challenge is to design strategy for early response to COVID-19 outbreaks. South Asia holds a quarter of the world's population with currently COVID-19 affected countries including Afghanistan, severe constraints in management of the pandemic. In fact, the current low number of reported cases from these areas is likely to be due to less testing with limited resources in these countries.
The resource allocation should be rational, transparent, and based on scientific evidence as the current COVID-19 crisis presents challenges that are beyond and above the earlier outbreaks.
Efforts for developing and supplying medical devices, diagnostic tools, vaccines, therapeutics, and other medical technologies for COVID-19 pandemic should be tackled judiciously.

Restricted Human Life and Compromised Health
The SARS-CoV-2 Infection control measures are recommended to prevent exposure as well as reduce transmission of the infection include the personal preventive measures at individual level such as mask-wearing, diligent hand washing, particularly after touching surfaces in public, respiratory hygiene (covering the cough or sneeze), avoiding touching the face (in particular eyes, nose, and mouth), cleaning and disinfecting objects and surfaces, and ensure adequate ventilation of indoor spaces. Apart from the mask-wearing decreasing exposure to the infection, has also been hypothesized to reduce the viral load when exposed, and hence to reduce the risk of severe illness [4]. There are other public health measures apart from personal preventive measures for infection transmission reduction focused for source control and containment of infection and include social/physical distancing, stay-at-home orders, school, venue, and nonessential business closure, bans on public gatherings, and travel restrictions with exit and/or entry screening.
The preventive measures are supplemented with aggressive case identification and isolation and contact tracing and quarantine.
In the containment areas, the residents are encouraged to stay alert for symptoms and practice appropriate measures to reduce further transmission. The widespread testing and quarantine strategies are imposed to quickly identify secondary infections in an exposed individual and reduce the risk of exposure to others. There are strategies involving self-quarantine at home, with maintenance of at least six feet (two meters) distance from others at all times.
There are variations about preventive and quarantine measures for   [6]. It has also served as a reminder for proactive planning and preparedness. In addition, it has highlighted the necessity for technologically oriented solutions for healthcare provision and the need for significant healthcare transformation.
On the other hand, it has opened the pathways to evolution and expansion of the concept of HaH incorporating communication technology-based approach as a major step to deliver healthcare at home or closer to home with all necessary steps to safeguard the safety and privacy of the participants.
In fact, the healthcare at home (HaH) can be modelled on lines of the hospice care as a multidisciplinary team approach, generally home-based and sometimes providing services through freestanding facilities, in nursing homes, or within hospitals for handling potentially treatable conditions such as pneumonia, heart failure, and alike, with brief hospital stays if necessary (Figure 2). The HaH describes a delivery paradigm where the entirety of the hospital-based inpatient care modality is substituted with intensive at-home treatment approach enabled by digital technologies, multidisciplinary teams, and ancillary services [7].
The potential spectrum of HaH can incorporate the hospice care. But as compared to the latter, apart from providing healthcare services for the terminally ill and elderly in form of hospice care, the HaH can be also useful for all those patients who need intense medical care and treatment but can be managed with help of technological monitoring and remote supervision by healthcare professionals at their homes with possible access to a nearby medical facility or hospital. HaH can make possible for people to receive a variety of medical services in their homes and can satisfactorily deal with various health conditions, as it incorporates therapeutic and nursing care, and medical assistance. In fact, the HaH is being envisaged as an alternate attractive model for accommodating increased demand for inpatient health care and as we prepare for the post-COVID-19 pandemic era, there are evolving salient features of HaH potentially promising to maximize the benefits of transformed health care [8].

The Management and Delivery of Healthcare at Home
During the COVID-19 pandemic, there has been a decline in emergency department visits and hospital admission rates in various countries [9]. It seems that in addition to a shift to virtual healthcare, COVID-19 also influenced emergency department visits and hospital admissions unrelated to COVID-19 itself. The studies from both Spain and Italy have shown a reduction in admissions and procedures related to conditions like myocardial infarction and acute coronary syndrome [10,11]. A recent study from Thailand demonstrated that during a national lockdown for COVID-19, there was a significant reduction in daily emergency department visits [12]. Similarly, a study from Melbourne, Australia documented that during times of COVID-19 restrictions there was a significant reduction in ED visits [13]. can be remotely managed aided by current regulatory flexibilities (15). In fact, the HaH is being envisaged as an attractive model for accommodating unprecedented demand for inpatient capacity created by Covid-19. As we prepare for the health care for the postpandemic era, there are salient issues to be solved to maximize the benefits of HaH -1. The HaH models must encompass the provision of healthcare of analogous intensity to hospital inpatient standards, and have a specified geographic catchment area, with properly defined correlates.

2.
As the HaH is supposed to create the acute hospital care at home and to enable health systems to provide intensive care at home for patients with various acute and chronic conditions, this may lead to a remarkable expansion of HaH.

3.
There is a unique opportunity to extend and expand HaH in current times, which can become a new vehicle for integrating non-medical services into healthcare as the patients may require further support due to complexity of their illness.

4.
With the advances in digital technologies and their increased utilization by patients and healthcare providers, there is taking place transformation of the home environment into a preferred healthcare delivery site.

5.
As the health awareness and rising cost of healthcare services may lead to increase in demand of HaH, managing and delivering HaH with technological backup should be affordable and providing quality service.
6. Further, a regulatory and policy implementation roadmap is required for provision of HaH, which should be accompanied by monitoring tools, such as, public reporting, patient registries, and maintenance of reliable database.