As the world grapples with the COVID-19 pandemic, never has the link between public health and the economy been any more critical. As the global economy grinds to a halt, governments and the healthcare industry is faced with a monumental task of combatting the novel coronavirus while juggling the financial costs incurred in the battle.
Sangita Reddy, Joint MD, Apollo Hospitals and FICCI President believes that the immediate task at hand for governments and businesses is to allay fears of the public and ensure the economy is revived quickly.
Speaking exclusively to Boom's Govindraj Ethiraj, Reddy said, "We (need) to ensure that people have jobs, people have money in their pockets—first to buy essential products, and then to come back and stimulate demand. So that the demand and the supply engine of the economy, both of which have had a considerable shock, are both reactivated at the same time or as quickly as possible."
Below are the excerpts from the interview. The interview has been edited for clarity.
COVID 19 – Getting Back to Work: India's Healthcare Agenda
Govindraj Eithiraj: In a broad sense, as we are today, a week ahead of the lockdown lifting or likely to lift, what will going back to work mean or what should it mean?
Sangita Reddy: So, I think it is not a single line. The first aspect is everybody does not go back to work. Let us be very clear about that. But this is a calibrated well-planned lifting of the lockdown. First is, as everybody has heard, the traffic light strategy. If you are in a red zone, you are not going to go back to work. Everyone who can effectively work from home is going to be requested to continue to work from home. The amber (orange) and the green zones are opening; public transport is opening but with social distancing. Airlines will take a bit more time, but I expect in the next 10 days to two weeks, airlines will operate with limits. But once you are in a factory or in an office, I think, the precautions—one is FICCI has worked extensively with the industry and Apollo Hospitals has also worked to bring out what we are calling, 'Life after Lockdown'.
So, in our detailed guide on Life after Lockdown, we look at it from an individual's point of view, from an operator or an owner's point of view, the CEO's responsibility, as well as the HR's. So, this includes strategies like grouping people. For example, last week when a factory in Muzaffarnagar opened up, one person tested positive three days later and the Collector shut the whole thing down. That means 400 people are back without work again. So, now our recommendation is to make clusters of 20 people in a group. So, they sit together, they eat together so that your potential containment zone or tracking zone is only 20 people. That is number 1.
Number 2, before people come back to work, let them know if their desk space has changed. Do alternate days so that you are reducing the number of people. Extend the working hours and definitely schedule the lunchroom. Create core cleaning facility whether it is the tunnel or the handwash, definitely the temperature control. Have a sickbay in each office. I am not going to go through every parameter but there are detailed guidelines, and these have to be followed. Not just on day one, but consistently, rigorously, meticulously for the next many months to come.
Govindraj Eithiraj: I am sure people will download those guidelines. A slightly larger question: The link between the economy and public health has never been so strong, has never required to be so strong. How does that work and how are you viewing this? It is also perhaps in some way a philosophical question?
Sangita Reddy: So, leaving the philosophy that we will get to because all of us have had the time think so many things about life, but just in terms of pure numbers. I think the number of areas that are in the red zone and before it was district but now the zones are actually shrinking, in that the size of the zone is not related to the whole district but a three-kilometre square radius around the difficult spot. But there is still approximately 40-55% of economic activity in areas which are currently designated red zone. So, over the next two weeks, those areas coming out clean and careful is a very important aspect of the whole strategy we need to look at.
The second aspect is that the entire supply chain. Because if you look at things, we grow cotton in the West, we make the yarn in the South, and the stitching happens in clusters all over the country. So, there is an inter-dependency of commercial activity that goes actually around the whole country. So while transport was very effectively kind of opened up for essential goods, and food...and luckily most of our supermarkets were able to get all kinds of supplies and agricultural produce moved, and vegetables moved—there is a lot of proactive work from the government, the transport, the police as well as business and the farmer who reached out.
The big thing is why will a manufacturing person open up his store if he does not have a retail outlet to display his product. And the other aspect which is very important is, like Sulaja who is on our FICCI committee, she said, "Who wakes up in the morning and decide to buy a vehicle? How are we going to re-stimulate demand?" And from that comes the base question, of how much can we ensure that people have jobs, people have money in their pockets—first to buy essential products, and then to come back and stimulate demand. So that the demand and the supply engine of the economy, both of which have had a considerable shock, are both reactivated at the same time or as quickly as possible.
Govindraj Eithiraj: Let me ask you a couple of questions about the healthcare sector. The healthcare sector, I mean the sector here, has almost been affected as badly affected by COVID as have, let us says, patients or those who are on the frontlines of medicine because economically this has been a very tough period for you. So how are you seeing yourself coming out of that? Whether it is your chain or your peers in the industry?
Sangita Reddy: Clearly, the sector has been affected and we are calling it a triple whammy. Number 1 in the early days, patients could not come. Therefore, there was no revenue, and healthcare is a daily operation. The second aspect is like other sectors or industries did, we could not cut wages or salaries or tell people not to come to work because we need those people. Doctors, and nurses, etc—none of them were ever taken off the rolls. And the third thing is in preparation, some of us who were treating COVID, had to prepare and buy kits, buy PPEs, upgrade the number of ventilators and all this is very expensive.
Now, as we begin to open—actually at Apollo we are pretty much open, and a lot is happening —we have to do the new normal in a healthcare environment. It is not just everyone wearing masks but the whole cleaning protocols have grown by a factor of 10x. See every time you do a procedure or a protocol, everybody has to wear a PPE and that adds a cost to the whole thing.
You know for a Rs 500 consultation, the doctor is wearing a Rs 1000 PPE. This is the new dynamic and yet, we cannot refuse people. I got a message from someone saying, that their father has acute asthma and the hospital in Mumbai is telling him to have a test and prove that they are COVID negative and then bring his father to the hospital.
We cannot do this. What we said that is in all our emergency rooms any patient can come in and we will proactively treat as if they are positive. Then we will, in parallel, do the testing and make the next level of plans for the individual. And this is taking a cost for the hospital and the patient.
Govindraj Eithiraj: As the lockdown lifts in phases as you pointed out, the other crush you are going to see is of people who have been waiting for treatment, which perhaps they could not come earlier but desperately need to now. Are you seeing a surge of patient inflow, may not be COVID but even otherwise?
Sangita Reddy: See, the underlying disease will remain and naturally people have to come. But I think the rate of individuals coming back to the hospitals is directly proportional to the mechanism of the fear lifting. So, it is not that the lockdown opens up and the next day you are going to see huge lines because the public is still scared and there are a lot of misconceptions. The only thing we can say is that even while you are staying at home, please should use tele-consulting. Use the delivery mechanism and make sure that you are taking the medicine. If you need testing, we will send you people home to draw the blood, who are safe and screened people. Do not neglect your underlying disorder, not just from the long-term of your disorder but even now for COVID because the numbers and the statistics are showing that co-morbidities increase the mortality. So, it is very important to keep diabetes under control, have your heart in good condition. Keep your immunology and fitness level to the highest possible, so that you can fight COVID well. So, for all these reasons, using whatever mechanisms possible, we request everyone to stay fit and stay in touch with their doctor.
Govindraj Eithiraj: On tele-consulting, I know you started it 20 years ago, I am guessing that you must be doing 1000 of tele-consults every day now. So, have you seen a dramatic, increase in that number, do you see that number rising further?
Sangita Reddy: (We have seen) Unbelievable, fantastic adoption in tele-consults. You know this is a good thing, and this is adoption on the doctor's side and the patient's side. Very realistically, for the doctor who is super busy, sitting in his consulting room, he is not going to take the trouble to do the tele-consulting unless he is especially motivated, or we have requested. So, everybody did. And you are right, we started it 20 years ago.
But today we have millions of people on the app and are doing 1000s of tele-consults every day. The biggest satisfaction is our NPS levels on tele-consulting are very high and this is where our experience is showing. We are not just opening up WhatsApp windows and saying talk to your doctor. This is a platform that we built over the years, it has an appropriate capture of medical data, it has a proper scheduler, a payment gateway and then at the backend of it, when we are doing the GP consults, we have what is called as clinical decision support engine. So that is proactively prompting to make sure that the doctor's interaction is of the highest quality and capability. So, you know, I am actually feeling like one of the good things that have come out of COVID is really the digital (aspect).
They say, you know, when the winds of change are blowing, some people build walls and other people build windmills. So, what India is doing is building digital and Apollo is definitely building digital because this is our way of staying in touch and this is not just, you know...our app is doing it 24x7. The areas where we support the government in our primary healthcare using tele-consult, is a project that we created "Stay I", where we partnered with hospitals to create isolation rooms. We have put our tele-medicine on top of it so that this minimizes the number of times a medical person needs to go into the room. So once a day the medical personnel goes, but three times a day we are using the tele medicine consult on the phone for this individual to stay in touch and feel safe. So, we are using digital and technology across the board and eICU, which is again a programme we have had for a very long time, we are now supporting nursing homes and some government hospitals in ICU.
And then there is a whole aspect of tele-learning. On our e-learning platform, the first course we created an update on COVID had 1.7 lakh users globally. The next thing that we created in partnership with the Critical Care Society of India is a ventilator training project. This was what one of the secretaries in the Central Government had asked me to put together. So, we did the content, we did a fantastic simulator in partnership with an international group who had a simulator, then we did a one-on-one connect using the Critical Care Society and the new learner. We are now using technology to train people on how to get up to speed on ventilator use and how to mentor others. Because if the doctor is over 60 years old, he is probably staying at home and not coming in. But he can stay at home and mentor a young person, on using the ventilator and getting up to speed on this. So, these kinds of partnerships are also happening.
Govindraj Eithiraj: I am going to come to a question on infodemics, that is something that we fight a lot. You know another question on people at the frontlines—doctors, ventilator care, experts or nurses, all of them need to stay motivated at this time, more so than anyone else perhaps in the country at this time. How are you as a large chain of hospitals ensuring that and do you see any challenges there too?
Sangita Reddy: I think in the early days there was this initial fear about how and where, and people had seen these scary images from Italy and heard the numbers of the medical workers. I think we went about it is asking those who want to come forward to please come forward voluntarily. Second is, we assured that we would do whatever we could in our capability to keep them safe. So, we invested in proper separate rooms. We never put a large number of patients in a big general ward. We created the rooms, we created the negative pressure, we bought the right PPEs, gave them (the staff) training on how to wear them and then we never overworked them.
So, we did proper staffing, we cut the shift and we quarantined them separately so that they were not mixing with other staff. So, if a nurse is working in a COVID ward, she will not meet a nurse working in a non-COVID hospital of ours, till the period she is working or the 14 days of quarantine. We put down all these protocols. I personally went. I wore the mask and everything, went into the COVID ward, to greet our teams and tell them that we are with you and we appreciate the kind of risk they are taking and by God's grace so far the number of staff has been very proactive, they are safe, and we have been able to care for a lot of people.
Govindraj Eithiraj: The infodemic—the misinformation, the false news around COVID 19, which causes cascading problems for everyone including the medical community, any thoughts on how we can fight this battle better?
Sangita Reddy: This is multi-dimensional. My first request to society or individuals is to find a credible source of information whether it is doctor or hospital, medical group and use that as your source and then there are so many doctors now doing free consults, so verify your knowledge before you pass it on. And if you have verified your knowledge and passed on the good stuff, you are doing a public service. But if you are creating an atmosphere of fear, it is actually a disservice.
I must also say that our own knowledge is changing and updating every day. We have a weekly update with AAPI (American Association of Physicians of Indian Origin), our own doctors' group are talking to their colleagues, then we are evolving the Apollo Protocol. First, we did the protocol for doctors and care guidelines. We keep updating that—first it was hydroxychloroquine, then it was remdesivir, then it was heparin, and then it is the combined treatment regime. So, we are bringing out our own bulletins for doctors, for factories and industries, for the lay public. Today, we started talking about separate protocol for children. I mean the conversation was the children are protected and now we are seeing the Kawasaki Syndrome in children in New York. So our paediatricians quickly got together and discussed if they should do anything different for people. It is a proactive, continuous exchange of knowledge which is credible, validated but we do not have the luxury of large clinical trials. So its best intent and a lot of reading and research which is going on continuously.