Mandi, May 30

Apollo Telemedicine Centre at Kaza in Lahaul-Spiti district is proving to be a boon for residents of the Spiti valley.

The centre was set up in April 2015 to provide medical care on the doorstep of residents. As many as 9,480 persons have availed this facility since April 2015 to till date.

Sources said most key roads in the region remained blocked to vehicular movement during winter months. It was difficult for the residents of the Spiti valley to avail medical facility in such a situation. Therefore, a telemedicine centre was set up at Kaza to ensure timely treatment to residents.

Sher Singh, a Spiti resident, said whenever required, employees of the telemedicine centre connect patients with medical experts through videoconferencing. “We feel fortunate to have this facility in this remote region of Himachal round the year,” he added.

Lama Buteeth, a health coordinator at the centre, said, “There are 172 types of medicines that are provided free of cost to patients as per the doctor’s prescription. We connect patients with doctors via videoconferencing.” she remarked.

Buteeth said earlier, they had organised awareness camps on regular intervals to make people aware about the importance of the telemedicine facility.

She said 17 types of diagnostic tests were also performed at this centre.

Source: https://www.tribuneindia.com/news/himachal/telemedicine-centre-to-aid-of-spiti-residents-261079

It’s been more than a year-and-a-half into the pandemic, yet experts worldwide are struggling to completely understand the nature of the Coronavirus. This has led to Catch-22 leaving lakhs clueless about what to do next. MUSBA HASHMI brings you a report

Remember, last year, experts and even the World Health Organisation suggested that everyone need not wear a mask, but only those looking after COVID patients. Not only this, people even anticipated that the Coronavirus would die in summers because of the high temperatures, not to mention the perception that the elderly and people with comorbidities are at a higher risk of getting infected. There is more. A certain type of UV rays were believed to inactivate the virus. However, all these notions got nullified sooner than later.

“Few new reliable scientific studies say that temperature, humidity or UV rays do not play a significant role in Coronavirus spread. That means whether it’s hot or cold outside, the transmission of COVID-19 from one person to the other depends almost entirely on human behaviour. Weather influences the environment in which the Coronavirus must survive before infecting a new host. But it also influences human behaviour, which moves the virus from one host to another,” Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth, tells you.

Whenever a pandemic breaks out, the origin country knows more about the virus than  any other country and for all the right reasons. “When COVID broke, initially it was believed to transmit through droplets; hence, the mask was only mandatory for COVID caregivers. For the rest, a six-foot distance and hand hygiene was enough. But gradually, with time, it was found that the virus is air borne and can sustain in the air for about four hours. Hence, masks were made mandatory for everyone,” Dr AP Singh, Senior Consultant Physician, Yashoda Super Specialty Hospital, Ghaziabad, tells you.

That said, about two years into the pandemic, experts worldwide are struggling to completely understand the virus’ nature completely. So much so, that there are clashes of opinions even when it comes to treating the disease. Be it the use of common drugs like Remidesivir and Fabipiravir or steroids, dark clouds of confusion  have engulfed everybody’s mind resulting in a Catch-22 situation, and many people worldwide remain clueless of what to do next.

“Many are asking why experts haven’t been able to find a treatment or cure for the virus. The simple answer: there’s too much they don’t know. Two years feels like a long time, but it’s no time at all when it comes to medical research. COVID-19 is a novel virus, which means that very few have natural immunity to it and experts couldn’t research on it prior to the outbreak in December 2019,” Ali says.

While the reasons for the usage of unproven drugs are complicated, for once, it is difficult in a pandemic to treat a patient with only minimal care. “This pressure to ‘do something’ might nudge physicians towards creating guidelines for unproven drugs that are either considered innocuous, or may have shown promise in animal studies or theoretical models, based on biological pathways. Another reason is that constantly reviewing the rapidly changing evidence in a pandemic is an intensive exercise, which many doctors are finding it difficult correlating with individual patients and their conditions. Making quick changes to treatment protocols to reflect evidence may be challenging for everyone, given that they have to coordinate with people across institutions, States and local administrations,” Ali explains.

Singh adds and tells you that both Remidesivir and Fabipiravir drugs are repurposed for COVID. These are the drugs that helped fight several infections earlier, but for COVID, the efficacy was less and that we are yet to find anti-viral drugs for COVID. “These drugs are for emergency use only; they are not fit for long-term use,” he says.

This is not all. The use of steroids are under the scanner too. Steroids are a life saving medicine and have been used historically for a long time in conditions of acute stress and where the patient’s life is in danger. And they should, in the same way be used in COVID as well when the cytokine shower is starting, and is in imminently danger of becoming a cytokine storm that is when the steroids should be started.

“They should not be started too early, especially never during the viremic phase, because they suppress your antibodies, your immune response and will allow the virus to replicate in an unlimited form,” Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals, opines.

Singh agrees with Bajaj and says that steroids have been used in the treatment of several diseases for years and so is being done in COVID. However, it should only be started in the second phase of the disease where a patient experiences cough, chest pain and his oxygen levels start to fall.

“There are cases of Black Fungus in various hospitals which are being attributed to extensive use of steroids. However, in our hospital we haven’t seen a single case of this fungal infection. Like I said, steroids aren’t a new treatment. Then there are some, who call it a hospital acquired infection. The reason being the use of industrial oxygen and lack of hygiene practices. But, again there are no facts to support it. Hospitals are doing everything they could. It is too early to predict whether Black Fungus is a post-COVID complication or a hospital acquired opportunist fungal infection,” Singh opines.

The other side of the story is many people are avoiding hospital visits due to the fear of catching infection. Bajaj has a take on that.

“Hospital visits being avoided by patients is the right thing to do actually, patient should not be visiting hospitals unnecessary. What we see in India and especially North India is that people even for the smallest of ailments like common cold will go and visit the highest super specialty hospital. So it’s a good thing that now due to COVID patients are avoiding hospital visits most of the conditions, more than 90 per cent, can be solved easily at home, especially in these times with the availability of teleconsultation. And even if you don’t trust teleconsultations you can visit your neighbourhood clinic or the doctor who you want to see, I think most of them have their own standalone clinics. So you can go and visit them, only in very unavoidable cases should you go and visit the hospital directly,” Bajaj suggests.

Singh has a different take on the matter. He doesn’t find this as a feasible option. Many people with serious diseases, too, are avoiding their visits to the hospital. They keep on tolerating the symptoms; this leads to the advancement of the disease.

“Take proper precautions and visit the hospital if you are undergoing treatment for cancer of tuberculosis. Avoiding it can pose serious threat to your health. Remember, mortality rate of COVID is only 2 per cent, while for cancer, it is much higher. So, if it’s the fear of catching infection that is holding you back from going to the hospital, don’t forget there are other diseases that are equally or, for that matter, even more deadly. But, this doesn’t mean that you start taking the virus lightly,” Singh advises.

Doctors believe blaming experts and scientists worldwide for not finding a cure for the disease is not the right thing. It takes years to come up with a proper treatment for diseases.

“COVID is a new disease which none of us understand right now. So there is a lot of conflicting claims coming in. It was said that ventilators will be the only cure, then it was said maybe ventilators are not necessary, maybe you need to have high flow nasal cannulas. Then it was said that smokers will be most affected because their lungs are already weak and they will die. Later, it was changed to that smokers may be the only people who will survive this. So this is something that is coming back and forth. But it is, I think, exactly like how science functions. Science works on getting evidence. And we are unearthing a lot of evidences which will take some time to understand. Most of the diseases that came in usually took hundreds of years for us to understand and find an effective cure. We’ve seen this only for one year. So I think within the next one or two years, we will have a much better understanding and we will develop a sure shot cure for it as well. Historically, viruses have been difficult to cure. HIV we have not been able to cure even now, even after 40 years of its emergence. So it may take some time, but we will definitely find drugs to control it,” Bajaj asserts.

Ali adds that researchers are moving as quickly as they can to find a complete cure for this virus and as part of this scientists have spent the past two years developing vaccines and treatments to slow the pandemic and lessen the disease’s damage. “Healthcare professionals are working tirelessly to fight this disease, but they can’t do it alone. The people will still have to help flatten the curve by following all the precautions and guidelines,” Ali says.

Singh concludes by saying that the need of the hour is to to be patient. The focus of every doctor right now is to save lives. Research can wait. Having said that, there are people who are studying the virus, but they need time as well. Once, the situation is under control, we will be conducting research to get more insights about the virus.

Source: https://www.dailypioneer.com/2021/sunday-edition/covid—s-catch-22.html

Through preliminary assessment, telemedicine helps patients decide whether they need to make the journey for advanced treatment

Internet-propelled technologies that are shaping the new-age globalisation are also in some ways diminishing the need for trans-border travel for services. And telemedicine is one such technology-based service. With the ongoing pandemic leading to near crystallisation of all-round behaviour in terms of restricted physical and social fraternising, telemedicine has come to acquire a permanent value in our lives.

Particularly in the backdrop of the advent of medical value travel (MVT) as a specialised health-driven travel service in recent years, telemedicine has emerged as a potent alternative to those wishing to access quality healthcare outside their own countries.

India since time immemorial has been a huge draw for people outside by virtue of also being a repository of traditional knowledge and wisdom in terms of health and wellness.

And continuing this tradition, in more modern times too, it has retained its popularity and goodwill among global health and wellness enthusiasts.

In 2019, nearly seven lakh people or 6.4 per cent of total tourists, came to India exclusively for medical purposes. A year earlier in 2018, nearly 25 per cent arrivals from West Asia were for medical purpose followed by Africa (14.6 per cent), South Asia (13 per cent) and Eastern Europe (4.2 per cent). And of West Asians, 86 per cent of Iraqis, 54 per cent of Yeminis, nearly 29 per cent of Omanis and over 10 per cent of Saudi Arabian tourists came to our country for medical reasons only. In a similar vein, among our South Asian neighbours, 30 per cent of Afghans, 22 per cent of Maldivians and 14 per cent of Bangladeshis came for medical purpose alone.

And this flow of medical tourists is not restricted to these sources only. India is also a favoured destination of medical tourists from advanced countries such as the US. According to Medical Tourism Index that ranks American perception of 46 international healthcare destinations, for 2020-21, India ranks sixth in terms of medical tourism industry, sixth in terms of qualities of facilities and services, and tenth overall on the index.

Huge potential

Combining medical value travel with telemedicine is brimming with potential in terms of not just capacity building of client countries and improving patient outcomes but generating precious foreign exchange (through services offered), creating employment and, importantly, helping in soft power projections of a country.

The rising traction in telehealth cannot merely complement MVT but even serve as a force multiplier for the latter. And for the client country, cost-effective access to quality care without the need for physical travel would be a huge incentive. Fundamentally, telemedicine can help with preliminary assessment of patients before having to make medical value travel to another country. Given that radiology services are typically a high-cost proposition, teleradiology can help reduce costs by enabling transmission of patient’s images such as X-rays, CT scans and MRI images and thereby facilitating high quality analysis from locations in India. And once preliminary evaluation is done, a patient can make the journey for advanced treatment or relevant surgeries to a health destination country such as India.

As telehealth emerges as a critical component of the Indian healthcare delivery system galvanised by Covid-19, it can make invaluable contribution to the global medical value market for Indian healthcare. Apart from preparing a comprehensive policy blueprint towards this end, the government should also work out legal, technological and investment issues with potential client countries.

In fact, India could start by identifying a few client countries first and use that template for others subsequently.

The writer is CEO, Apollo TeleHealth

Source: https://www.thehindubusinessline.com/opinion/telemedicine-can-complement-medical-tourism/article34628548.ece

More than half a million people may have to go through the horrifying struggle to latch on to dear life after recovering from Corona, writes MUSBA HASHMI

A 69-year-old male Diabetic and hypertensive patient got down with fever earlier this month. At first, he thought of it as viral, but when the fever didn’t go even after two days, he underwent an RT-PCR test. Positive, the report said. He had mild COVID and was treated in home isolation with oral anticoagulants and other supportive drugs. The symptoms went away soon and he recovered in 15 days. The man and his family took a sigh of relief. However, this is not the end of the story.

To everyone’s surprise, one week later he complained of acute pain in the right leg. Something neither the patient nor his family members anticipated. Investigations revealed very high d dimer levels and deep venous thrombosis. It is a condition that occurs after a blood clot forms in a large vein, most often in the calf. Pain, swelling and sometimes pulmonary embolism (or a sudden blockage in the lung) can occur, making deep vein thrombosis a life-threatening condition. But, fortunately the doctors were able to save the patient because of early treatment.

However, not everyone might be as lucky as this man. Though the number of Corona cases is declining in India, the country is staring at the horrendous possibility of patients recovering from COVID, but succumbing to a heart attack or organ failure soon after.

Millions at risk

“It is estimated that 26 per cent of the COVID patients can exhibit post covid complications,” says Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth. The long-term effects may include fatigue, cardiac, respiratory symptoms, and neurological symptoms.

Looking at the current figures of recovered cases, more than half a million people may have to go through the horrifying struggle to latch on to dear life. Currently, India has seen 22,712,735 recovered cases, which is 99 per cent of the total cases with just one per cent deaths. The latest post-Covid complications story is giving a twist to the tale as the country might see more deaths in the months to come.

The post COVID complications are common in vulnerable patients such as patients above 60 years with or without comorbidities such as Diabetes, hypertension and cardiac disorders. The country has about 54.5 million cardiovascular diseases patients (according to a previous data), 77 million Diabetics, as of 2020, and similarly people struggling with serious ailments that are likely to get aggravated post COVID. Not only people with comorbidities, but the ones who have suffered severe COVID symptoms are equally at risk.

“It is found that individuals with a severe disease at the start of their illness have a greater risk of long-term cardiac complications secondary to COVID-19. But, recent scientific data suggests that even people with mild COVID-19 may develop long-term health complications that go well beyond the lungs,” Ali adds.

Dr Shuchin Bajaj, Founder & Director, Ujala Cygnus Group of Hospitals, says that deaths in such cases is not new in the second wave. It happens due to heart attack or because of developing severe post Covid pneumonia leading to low oxygen levels in the patient, requiring ventilator support and then dying. The reason for cardiac arrests in such cases is the increased thrombogenicity in the blood.

“The Covid-19 infection increases the thrombogenicity in the blood. This leads to thickening of blood owing to prothrombotic conditions. This virus makes the blood thicker, which leads to formation of blood clots which can later result in cardiac arrest. Also, COVID-19 has endothelial disease qualities that damage the inner lining of blood vessels of the heart and arteries which makes it difficult for the heart to pump blood as it is supposed to do,” Dr DK Jhamb, Director & HOD Cardiology, Paras Hospitals, Gurugram, tells you.

Struggle with Long-haul COVID

“It is found that individuals with a severe disease at the start of their illness have a greater risk of long-term cardiac complications secondary to COVID-19. But, recent scientific data suggests that even people with mild COVID-19 may develop long-term health complications that go well beyond the lungs,” Ali adds.

Although most people with COVID-19 get better within weeks of illness, some people experience post-Covid conditions. “Post-Covid conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes COVID-19. These post-Covid health conditions are known as “long Covid” or “long-haul Covid”. In such cases, a patient continues to experience symptoms of the disease four weeks after initial recovery,”  Dr Deepak Verma, Internal Medicine, Columbia Asia Hospital, Ghaziabad, tells you.

He agrees with Ali and tells you that Covid-19 is also affecting multiple organs and body systems, including heart and blood vessels, lungs, kidneys, skin, brain and nerves. This virus has the potential to directly involve lung cells, leading to lung fibrosis. They stimulate the fibroblasts, causing fibrosis of the lungs and that is a tripling problem. “That is, you land with a ‘triple lung’, leading to fatigue and you always pant for breath,” Verma says.

Available data indicates that about a quarter of those with COVID-19 suffer from symptoms four-five weeks after testing positive, and about one in 10 experience symptoms after 12 weeks.

“While there is no conclusive evidence, people may experience post-Covid conditions due to persistence of the virus in some parts of the body that are sheltered from the immune system,” Verma adds.

Certain post Covid complications can be quite severe ranging right from death to continued breathlessness, post Covid pneumonia, inappropriate sinus and anxiety. These can last anywhere between two weeks and five months.

“We have seen hundreds of cases till now. And, one of them was a famous paediatrician, who was admitted in our hospital. He suffered from inappropriate sinus tachycardia for about four months after recovering from COVID. Every time he stood up and walk, his heart rate would shoot up to 150 per minute. He would develop severe palpitations and would have to sit down immediately. A visit to the toilet was like preparing for a marathon for him. He would think 10 times before standing up. It was a severe case and quite unfortunate too because it was a helpless situation. Thankfully, he has recovered now and is doing perfectly great,” adds Bajaj.

Be alert, Be Safe

The only way, Jhamb says, to avoid these deaths is to take proper care even after recovering from the virus.

“The increased deaths can also be attributed to heart attacks and multiple organ failure as a result of post-Covid complications. It is disheartening to say that people with CVDs are at a higher risk of losing the battle against COVID. In such a scenario, patients with underlying diseases should be more careful than ever and should take proper care of themselves even after they have recovered from the infection. This is the only way deaths related to post-Covid complications can be reduced in the coming months,” Jhamb opines.

While, Ali suggests it is important to diagnose and treat the post-Covid complications early, in order to reduce mortality. “Early signs of post-Covid complications depend on the organ or the system involved post recovery. Complications range widely involving cardiac, neurological and respiratory systems. Take for example, if there is an impending cardiac complication then the patient can experience typical cardiac symptoms such as chest pain, palpitations, heaviness in the chest and others. This can further lead to increased chances of heart attacks. So, one has to be alert and should keep a watchful eye on the symptoms,” he says.

Mystery of Black Fungus

While we are still fighting the deadly second wave of COVID-19, many States are reporting a rash of mucormycosis aka black fungus cases.

While some doctors believe it is a post-Covid complication, there are no reports to back the fact. Also, several doctors disagree with the notion and say that it is simply an opportunistic infection and attacks people with a compromised immune system. It is also said to be a hospital acquired infection.

“Black fungus is an opportunistic infection and attacks people with a compromised immune system. Certain people like transplant patients, cancer patients and people on immunosuppression are at high risk. The fungal spores are present in our environment but can infect only when the immune system is down. Hence, we generally see these infections limited to a particular patient group,” Dr Sumana Arora, Vice President, Clinical Services, DayToDay Health, tells you.

However, we are seeing an explosion of black fungus infections lately in our country, especially with the COVID pandemic. Why, you ask?

“The novel Coronavirus infection by itself is diabetogenic. Further, the covid infection has two phases — the viral phase and the inflammatory phase. And not necessarily the infected patient goes through both phases. Most of the patients go through only a mild illness in the form of the viral phase and do not enter the inflammatory phase at all. However, for the patients who do enter the inflammatory phase of the illness, steroids are the standard of treatment. Unfortunately, we are seeing indiscriminate use of steroids even in the viral phase, which is doing more harm than good. This is leading to more patients entering the inflammatory phase,” she adds.

Additionally, poor sugar monitoring control and improper tapering of steroids add to the problem. The fact that India is the Diabetic Capital of the world doesn’t help either. “It is also suspected that the use of industrial oxygen, dirty masks and unclean tubes when using oxygen therapy is also leading to this infection, not to mention the unclean water for humidification for oxygen therapy,” she says.

Dr Archana Dhawan Bajaj, Gyneacologist Obstetrician and IVF expert, Nurture IVF, agrees with Arora and says that this is not per se a complication of COVID-19 alone, it can happen to anybody whose immunity is compromised.

“Patients with malignancies or HIV also have compromised immune system and are at a higher risk of getting fungal infection,” Bajaj says.

This fungus can enter through the sinuses into the brain and the lungs and from the brain. It could damage the eyes also. A very high mortality rate as high as 50 per cent found to be associated with mucormycosis. The disease can be easily cured if it is picked up at the early stages with drugs.

“If the disease gets at advanced stage which often happens in people with COVID-19, it becomes difficult to treat it. People with COVID and mucormycosis may have headache, breathlessness, difficulty in timing well or difficulty in vision along with other symptoms. Mucormycosis is potentially life-threatening condition and should be treated timely with adequate emphasis on all possible curative drugs and procedures,” Bajaj says.

Source: https://www.dailypioneer.com/2021/sunday-edition/covid-and-after.html

The COVID-19 pandemic has restricted children within ther four walls of their homes – drastically reducing their physical activity.

New Delhi: Coronavirus pandemic has hugely altered all spheres of our lives, with many of us wondering if we will ever get back to our pre COVID-19 lifestyle. The pandemic has sadly also impacted children we well, who for more than a year now, for many parts in the world, have not attended regular schools. They have also been restricted by their parents to go out and play with their friends and are largely home-bound.

Aryan*, a 12-year-old boy, who was a regular tennis player has gained eight to nine kilos in the last six months alone, shares Angelina Pillay, Dietician and Health Advisor, Apollo TeleHealth, about one of her client’s.

Due to lack of exercise and a sedentary lifestyle, Aryan gained weight so quickly. The young boy would also eat lots of namkeen packets sitting at home.

Sadly, he is not a lone case. “ Overweight and obesity have always been a problem in the urban population owing to rapidly changing lifestyle in the last one decade. The problem is exaggerated and has reached greater heights during the COVID pandemic,” shares Dr Meena J. Consultant, Paediatrics and Neonatology, Aakash Healthcare and Super Speciality Hospital.

Talking about how the COVID-19 pandemic is responsible for a spike in obesity among children, Dr Jesal Sheth, Senior Consultant-Paediatrician, Fortis Hospital, Mulund shares, “COVID has changed the lifestyle of children. Lockdown, sedentary lifestyle, restrictions, lack of play have increased the incidence of lifestyle disorders like obesity in children.”

It is important to look after children’s weight gain and manage it as early as possible. “Childhood obesity can lead to an increased risk of hypertension, diabetes and atherosclerosis in early adulthood,” shares Dr Sheth.

However, despite lockdown measures, there are steps that parents can be mindful of to ensure that their kids do not gain extra weight.

One of the easiest ways to look after both the physical and mental wellbeing of children is to actively engage with them and keep them involved in household chores as they are deprived of physical socializing. “Parents should take their children’s help in household activities like cooking, gardening, decorating or creating arts skills,” shares Pillay.

Breaking it down into 3 simple steps Pillay shares the secret of managing kids weight, “Develop healthy eating habits, limit calorie-rich temptations and limit sedentary time – this will help together to be active with children and ensure adequate sleep”.

Source: https://zeenews.india.com/health/exclusive-covid-19-induced-lockdown-is-causing-a-rise-in-obesity-among-children-2363211

‘The current data from India and other countries indicate that re-infections are rare. However, in some cases, it may occur any time beyond three months after recovery from COVID-19,’ says N.K. Arora

“COVID-19 is a recent disease and at times it displays symptoms which no other viral infection does. While we are developing understanding about the short and long-term impact on the body we now know that one may develop new symptoms six months to one year after recovering from COVID. The term given to this is long COVID,” said N.K. Arora, head, Operations Research Group which is part of the National Task force set up by Indian Council of Medical Research in response to COVID-19, speaking exclusively to The Hindu.

He added that studies have shown that after a COVID-19 infection, antibodies may persist for three to nine months, which prevent re-infections.

“The current data from India and other countries indicate that re-infections are rare. However, in some cases, it may occur any time beyond three months after recovery from COVID-19. Vaccines provide protection against severe disease for a longer duration,’’ he said.

Available data and research explain that not all but some people may experience long-term effects of COVID-19, said Mubasheer Ali, senior internal medicine consultant, Apollo TeleHealth. He noted that these long-term effects may include fatigue, respiratory symptoms, and neurological symptoms.

“This is long COVID and it refers to when people continue to experience symptoms of COVID-19 and do not fully recover for several weeks or months after the start of their symptoms. Although it is still unclear how many people have experienced long COVID, data from some COVID Symptom Study suggest that one in 10 people with the illness experience symptoms for three weeks or longer,” he said.

‘B.1.617 extremely infectious’

The virus strain B.1.617 was extremely infectious and virulent, said Sushant Chhabra, HOD, Emergency Medicine, Manipal Hospital, Delhi. He noted that currently some infected with this strain even after recovery were showing long-term injuries to the lungs which took a good four-five months for recovery.

“There are many cases which we have observed in the last few days wherein patients have COVID-19 like symptoms but their RT-PCR tests are showing negative results. Irrespective, we are treating them as COVID-19 patients,” said the doctor.

He added that they were seeing patients who recovered from COVID-19 in the first wave during October or November and had got re-infected in the second wave.

“The possibility of re-infection is always there in COVID-19 because their immunity is not a life-long thing. It generally stays for three-four months which is why patients end up getting re-infected,” he added.

Source: https://www.thehindu.com/news/national/experts-now-warn-against-long-covid-which-shows-up-after-6-12-months-after-first-infection/article34602234.ece

There isn’t enough data to back the widespread use of Ivermectin in Covid patients and it can be recommended only in some mild to moderate cases, experts say as three states go ahead with plans to distribute the anti-parasitic drug as a preventive de…

Read more at: https://www.deccanherald.com/science-and-environment/insufficient-data-to-recommend-widespread-ivermectin-use-in-covid-patients-experts-985885.html

https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/insufficient-data-to-recommend-widespread-ivermectin-use-in-covid-patients-experts/articleshow/82631246.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

While the second wave of COVID-19 continues to wreak havoc, doctors and experts are predicting the onset of the third wave, a killer for children. MUSBA HASHMI reports on how, in the absence of a paediatric vaccine, children can be protected. But for that a robust paediatric healthcare system is crucial

We are stuck right in the middle of what appears to be a very lethal second wave of COVID-19. With not less than 3.5 lakh cases per day, the curve seems to not flatten any time soon. However, the horror doesn’t end here. Doctors, scientists and experts have started predicting the third wave of COVID-19 which is expected to wreak further havoc. More so, because it may hit children in a hard way.

While this is a major cause of worry, the question here is how prepared are we to tackle the upcoming third wave? The answer might not be what we want to hear.

“Viruses hunt for a susceptible population. With schools closed presently, children will be that group once the educational institutes reopen. This will bring on the third wave which will hit children big time,” Dr Arvind Taneja, MBBS, MD (Paediatrics), Diplomat of the American Board of the Paediatrics, Fellowship — Infectious Diseases and Chief Advisor-Senior Consultant, Paediatrics, Rainbow Children’s Hospital, tells you.

In the absence of an effective vaccine for children, they become the most susceptible group and masking and sanitising is the only way out.

“When 70 to 85 per cent of the population is immunised ‘herd immunity’ kicks in to protect people, especially children. Till then masks, social distancing continues to be the norm for children too,” he advises.

The need, he says, is to speed up vaccine trials in children. “If adults vaccinated are safe so should children be. We have experienced this with polio, measles, mumps, rubella live viral vaccines for 60 years and viral influenza for 40 years in infants as young as months old,” Taneja adds and tells you that pediatric trials of vaccines are expected to be completed by October-December.

“However the onset of the third is wave unpredictable,” he says.

The disappointing fact is that we haven’t emphasised enough on paediatric care and as a result we are lacking in it.

“India’s preparation for paediatric COVID-19 is woefully inadequate. We have very few paediatric hospitals in the country, very few paediatric critical care specialists and pediatric trained nurses. In order to be prepared for the third wave, each major and medium sized city in India should have at least one dedicated children’s hospital to care for this fragile population so that we are ready when and if catastrophe such as COVID-19 strikes. This is expected to happen in the third wave,” he tells you.

However, the silver lining is that we may expect a decline in cases by May end, as per the doctors.

 “According to a study, we may expect a decline in cases by the end of May in most States. There could be one or two more peaks of Coronavirus cases but they may not be as huge as the current wave. Different States may see peaks at different times. The prediction is that we may see a declining trend by end of this week in India all together. But if we are to check as a nation, with all cumulative figures, we are either at our peak or are very close to it. Different states will have different trajectories,” Dr Yash Javeri, Critical Care, Anesthesia and Emergency Medicine, Regency Superspecialty Hospital, Lucknow, tells you.

The third wave, he says, may hit a few States in the next two-three months.

“If we put strict measures in place, the third wave may not happen at all places or might not be as huge as the second wave. It depends on how effectively control measures are implemented at the local level in the States, districts and cities everywhere. In a few months, when the naturally developed immunity of people or the one with the help of vaccination fades, the virus can strike again. The only thing that can stop the virus from bouncing back is how people are guarding themselves,” Arya opines.

He adds that if people follow COVID-appropriate behaviour in the coming months which includes  double masking, using hand sanitiser, maintaining social distancing and avoiding going out unnecessarily then we can probably cut the peak.

“If we are  able to vaccinate a majority of population then the magnitude of third wave will be decreased,” he says,

However, Dr Animesh Arya, Senior consultant in Respiratory Medicine, Sri Balaji Action Medical Institute, is of the opinion that it is hard to predict the declining trend. “There is no definite answer as to when we can expect a decline in cases, but epidemiologists feel that with all peaks there will be a fall after two to three months so decline is expected in June. But we can be way off our predictions as in the past,” he says.

Many scientists, infectious diseases experts and people from economics and modelling background are trying to predict the third wave, but from a scientific point of view which is based on the previous outbreak of severe epidemics especially Spanish flu, the expectations are all in the press and it may be in September-October. “It is also being assumed children in the age group 12-15 are likely to be affected largely in the third wave as they are naive and the new mutant strain is very potent and it challenges the immunity of people not naturally protected or partially protected by immunisation,” Arya explains.

He adds that as we all know building infrastructure of tertiary healthcare is essential to treat sicker patients and prevent mortality, we must not forget that primary aim to contain disease by early detection, extensive testing of all levels of contacts, isolating them and treating them well ahead of time of going into serious complications and mortality remains the key.

With that being said, there are several doctors who believe that children might not get affected as badly as it is anticipated, because all these predictions are based on statistics. Hence, parents need not angst too much. However, this doesn’t mean we can put down our guards. All precautions have to be in place, both in the presence or absence of a vaccine.

“There is no evidence that the third wave will hit children. It can happen, but these are only predictions. Though, the symptoms in children are usually mild till date, but this doesn’t affect the importance of vaccination for them. We can’t anticipate if the symptoms will turn severe in the third wave. However, in the absence of a paediatric vaccine, the only way out is to take precautions. Immunity is another important thing. Children should be given nutritious food, including lots of green leafy vegetables and fruits in their diet. Keep them hydrated. Coconut water, twice a day, can do the job. Avoid junk at all costs. And last, but not the least, increase their Vitamin C intake,” Dr Swetha Reddy P, Consultant Paediatrics, Apollo Telehealth, tells you.

Though several States Governments like Maharashtra have already started prepping up for the third wave by setting up paediatric centres, the need is to increase the number of paediatric hospitals, ICU beds and care centres to tide over the third wave with less fatalities and more recoveries.

“To curb the impact of the third wave, the need of the hour is to increase the number of ICU beds and hospitals for children, get more paediatric nurses on board and also to make sure there are ample doctors to attend to children. Our healthcare infrastructure basically needs a revamp, which is definitely not possible at this hour. Hence, now focus should be on building a robust healthcare system, well-equipped with proper staff so that doctors and nurses don’t have to deal with fatigue. The strategy should be to vaccinate 100 per cent children before the third wave hits. Also according to observations the mutants have been severely affecting the children,” Dr Aashish Chaudhry, Managing Director and Senior Consultant, Dept of Orthopaedics & Joint Replacement, Aakash Healthcare Super Speciality Hospital, Dwarka, says.

One of the many ways to prevent children from the risk of getting infected is to get the parents vaccinated quickly. “It is not the children that carry the virus, it is their parents or families who pass on the virus. There are no reports to back the fact, but this is an observation that is made during the first and second wave. Hence, in order to prevent children from catching the infection, the elders need to get vaccinated with both doses quickly. With the shortage of vaccine, this might seem a Herculean task, however it is the only feasible option to reduce the impact of a possible third wave,” Dr Gitali Bhagawati, Consultant and Head, Department of Microbiology and Infection Control, Dharamshila Narayana Superspeciality Hospital, tells you.

And apart from the rest of the measures, we need to prepare an army of young nurses and doctors on standby to move from one city to the other based on the COVID wave, to support busy hospitals. For this, we need to motivate and encourage them largely, because money alone, won’t motivate young people to risk their lives in COVID ICU wards.

And lastly, mildly symptomatic patients should be isolated immediately, in order to reduce the risk of them spreading infection. “In order to flatten the curve and reduce the exposure to vulnerable population of children who are at the higher risk due to lack of herd immunity or passive immunity, mildly symptomatic patients should be provided isolation facilities till they get infection free since the infection rate this time is high,” Arya tells you.

Youngvaccine

• While many companies like Bharat Biotech and Pfizer have started the second and third phase vaccine trials on children from two to 18 years, there is still a long way to go for the vaccines to be available in the market for use.
• The Drugs Controller General of India  has cleared phase II and III clinical trials of Covaxin COVID-19 vaccine for children from two to 18 years.
• US biotech firm Novavax had also started clinical trials of its proposed Covid-19 vaccine on children.
• Pfizer is running a trial for children 6 months to 11 years old.
• Moderna is also running a trial in the United States and Canada for kids between 6 months and 11 years old.

Source: https://www.dailypioneer.com/2021/sunday-edition/young-ones-on-target.html

Inputs by Dr. Mubasheer Ali, CEO – Apollo TeleHealth

Black Fungus or mucormycosis, a rare fungal infection with a mortality rate of 50 percent, is being reported from various parts of India among COVID recovered patients.

New Delhi: Black Fungus or mucormycosis, a rare fungal infection with a mortality rate of 50 percent, is being reported from various parts of India among COVID recovered patients.

The disease is caused by a group of moulds known as mucormycetes, which are naturally present in the environment. 

Black Fungus most commonly affects the sinuses or the lungs after inhaling fungal spores from the air. The illness can cause blindness, organ failure, brain stroke and can be fatal.

“Though there is no record of the official number of Black Fungus cases in India, estimation of fungal burden of the country, using computational models by international health experts, predict around 1750 to 2500 cases of mucormycosis daily in india. This is just a predictive model so the actual number may be higher,” says Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo Tele Health.

Dr Mubasheer shares the two main reasons why COVID recovered patients are getting infected with mucormycosis. “There are mainly two reasons COVID-19 patients are getting affected with mucormycosis; One is the presence of comorbidities such as uncontrolled diabetes mellitus, chronic obstructive pulmonary disease etc; and the second one is if these COVID patients are treated with corticosteroids,immunomodulators,mechanical ventilation and long standing oxygen therapy.”

Explaining how the use of steroids while treating COVID-19 put people at higher risk of getting  Black Fungus, Dr Bhavika Verma Bhatt, ENT Surgeon and Medical Consultant – ENTOD International shares, “Steroids reduce inflammation in the lungs of COVID-19 patients and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off coronavirus. However, the steroids also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic COVID-19 patients. It’s thought that this drop in immunity could be triggering these cases of mucormycosis.”

Source: https://zeenews.india.com/health/exclusive-there-could-be-2500-cases-of-black-fungus-daily-in-india-says-health-expert-2361214

COVID-19 outbreak has been a massive catalyst of sorts for telehealth in the country. Although it came to prominence in unfortunate circumstances, for a country like India with large swathes of remote and nearly-inaccessible terrain, as well as a large part of the hinterland remaining outside the ambit and reach of regular physical healthcare personnel and services, this has been a much-needed impetus. Particularly for millions of people in the country whose health conditions have been compromised for decades merely due to lack of access to quality professional services and infrastructure, the recent technology-driven push has been nothing short of lifesaving.

Yet, the take off of telehealth in the country has not been without its share of challenges, something which is inherent in any project of this magnitude. And data security and privacy are among the challenges that happen to be at top of the heap. Notably, in a recent instance, the Kerala High Court had to issue directives for protecting the privacy of data of COVID-19 patients, making it incumbent on the state government to anonymise the data before sharing it with a third party.

Private health information outvalues financial data

The ongoing digitisation of the health ecosystem is riddled with a welter of technical, regulatory, logistical and moral concerns. Some of those concerns could be: interoperability of data, integrity of digital platforms and apps, uniformity of EHRs (electronic health record), ambiguities and vulnerabilities around software compliance with data security norms, less-than-friendly user interfaces, presence of mass of untrained and undertrained healthcare personnel and patients, and inadequate foundational IT infrastructure. Of these, security of data and patient privacy has been one of the leading concerns. Remember, the Interpol had issued a purple notice in April last year on a possible cyber attack on critical healthcare institutions. In fact, there have been assertions made in some quarters that the private health information (PHI) outvalues even financial data or other personal information on the black market.

How the govt has sought to provide for health data security

Although the IT Act 2000 and Information Technology Rules 2011 have laid down that medical records and history as well as physical, psychological and mental health conditions constitute a component of ‘sensitive personal data or information’ (SPDI), these were obviously not enough. In 2018, the ministry of health and family welfare had come up with a comprehensive Digital information Security in Healthcare Act (DISHA) with a view to establish National Digital Health Authority and Health Information Exchanges. The Act had stringent provisions for data safety and privacy, barring the use, access or disclosure of data for any commercial purpose whatsoever, except for processing insurance claims by insurance companies. Then, the Personal Data Protection Bill (PDP), 2019, under section 3(36), has provided that the ‘health data’ of an individual constitutes ‘sensitive personal data’. Furthermore, the 2020 telemedicine guidelines have made the registered medical practitioner (RMP)/healthcare service provider largely responsible for the protection and privacy of data. Most recently, as part of the colossal Digital Health Mission, the government has sought to assure people of protecting patient data and privacy through a draft health data management policy. This has been approved by the health ministry after a due public consultation exercise. In this, the government has clearly defined several terms related with data protection such as personal data, personal data identifier (PHI), data principal, sensitive personal data, data fiduciary, consent manager, health information provider, and health information user among others while laying out a method of obtaining consent and securing the rights of data principals. With safeguards, the draft has stipulated that only a prior informed consent through designate consent managers would permit data fiduciaries to access data even as the ownership and control would remain with data principals.

What more could govt do

Yet, there are issues in most of these laws and rules that need to be addressed. For instance, on the most recent draft health data management policy, experts have pointed out drawbacks, ranging from allowing Aadhaar to be used for creation of health Id to excessive collection of personal data and leaving scope for data re-identification through allowing the sharing of anonymised and de-identified data. Similarly, there are seemingly different positions enunciated by DISHA and the PDP Bill. While DISHA takes a more rigorous view of individual’s control and therefore privacy of data in general and specifically in terms of non-consent based processing of data, PDP has a somewhat more lenient approach. DISHA requires consent at every stage of data use unlike the PDP. This impacts the health supervision of patients needing to use wearable technologies. Another difference has been that DISHA takes a more restrictive view of even the government using of an individual’s data, unlike the PDP Bill. So now that telehealth has been in a mode of ascendancy like never before, the authorities need to resolve these divergences through a comprehensive health data protection law. The sooner the PDP Bill becomes an Act and is enforced, the better.

In sum, data security and privacy remains an overriding concern in the field of telehealth. Just as the government has been pretty focused on the issue, the private telehealth players must become a partner of the government in maintaining highest standards of patient data security and privacy.

– By Mr. Vikram Thaploo, CEO, Apollo TeleHealth

Source: https://www.theweek.in/news/health/2021/02/23/as-telehealth-becomes-the-new-normal-data-security-a-front-ranking-concern.html

Vikram Thaploo is leading Apollo TeleHealth’s noble goal of turning affordability into a non-negotiable privilege from the front – with a signature mix of technology, leadership, and humane-ness.

Meet the Leader

Vikram Thaploo is the CEO-Telehealth at Apollo Hospitals. A result-first digital transformer with a sparkling track record of countless milestones behind him, he has been holding leadership positions in corporate decision making for over a decade. In fact, Mr Thaploo carries nearly twenty years of mission critical experience in setting up, operating and scaling up startups, expanding business for small-medium-large organizations, strategic planning, execution and management of diverse functions and portfolios which include modelling, customer service, administration, feasibility analysis, marketing, branding and more.
 
At different levels and in varying capacities, Mr. Thaploo has been part of winning teams at Jaypee Hotels, Barista Coffee (Lavassa, Italy), Patissier’s (Precision Group), Big Apple (Future Group) and Steeplejack (retail startup), to name some. 

He is currently leading Apollo Hospital’s global portfolio as CEO for the Group’s Remote HealthCare Vertical (TeleHealth & Government Businesses). His mandates include a larger than life duty that comes with the express goal of turning healthcare affordable using the convergence of Technology, Telecom, Medtech ecosystem and Healthcare.

Vikram Thaploo is the recipient of prestigious industry awards and accolades such as ‘CEO of the YEAR 2017’ (by Healthcare Achievers And Leadership Award Healthcare Awards) and ‘Leadership award in 2016’ (by ASSOCHAM) for significant contribution in the field of healthcare through innovation of new & effective business models, amongst many others

A proactive individual who believes that PLANNING must always be complemented by DOING, Mr. Thaploo’s logical approach to targets and challenges lets him take on pressures with calm and poise, organically amplifying outcomes. 
 
Picking a dynamic and values-driven ‘goal-digger’ like Vikram Thaploo as a VOH IDEA LEADER wasn’t difficult, therefore. In the quest of learning more about the man and the influences that shape his multi-dimensional endeavours and winning journeys, we caught up with Mr. Thaploo, armed with a curious mind that was ready to be overwhelmed with a flush of leadership inspiration. Mr. Thaploo didn’t just match up, but exceeded our expectations – kicking off the edifying session by capturing his life’s driving purpose – the force that makes him get up each morning – vividly for our readers: 
 
The fact that someone today will be impacted from the healthcare initiatives that I have been driving, gives me an immense sense of satisfaction and gratitude. Passion has been a powerful driver in my life and my biggest passion has always been about how through my work or otherwise, I can create a real difference in the lives of the needy, the marginalized and the underserved. And in telehealth in a way I have found my higher purpose. When someone’s health in the remote villages of Lahaul and Spiti,up in the Himalayas with no doctors in the vicinity, is stabilised through tele-emergency  or when someone living in an urban slum is effectively diagnosed and nursed back to health through telehealth services, I feel that I have achieved my higher purpose”. 

The Beginnings

Married with two kids, Mr. Thaploo has been living in Hyderabad (India) since 2010 with parents, wife and kids. He completed his Healthcare Management Programme from Indian School of Business (ISB) and PGDBM from Symbiosis, Pune after his Hotel Management. He briefly worked for the hospitality industry before moving on to retail, crowing his eventful journey with his current stint in healthcare, where he has completed over a decade now.

The Moment of Change

An interesting incident altered Mr. Thaploo’s perspectives of life profoundly, giving him a first person peek into the ground reality and bringing the issue of affordability squarely in the centre of his vision. He reminisces, “I think the big turning point came during one of my trips to Kashmir that I had made after joining the digital wing of Apollo Hospitals. I made this trip with a friend of mine who was a doctor by profession and incidentally whom I generally addressed as ‘Doctor’. We were in Gulmarg enjoying ourselves with the place being completely covered in snow. And the so-called turning point came during this one particular incident when I happened to be calling out my friend as ‘doctor.’ Some local people immediately approached us at the mention of the word ‘doctor.’ To our utter astonishment, these local folks came to us unannounced telling us about their individual health issues expecting professional medical advice from us. Someone had a pain in his knee, someone had breathing problem, or mostly chronic ailments. The volley of their questions and requests left me thinking hard and deep. I realized the extent of shortage of doctors and expert physicians in that area and how much these simple people suffered as a consequence. Since I could interact with them in their local language, I could really feel their angst and despair at the abysmal state of affairs. That was what really got me going, or as you call it, the eureka moment for me. I instantly knew that I had to do something. And so I decided to put all my efforts in making telehealth as a tool to make a difference to the lives of those people who until then had suffered for no fault of theirs. Making affordable healthcare accessible became my life goal.”

Exposures that Shaped the Persona

An adversity and learnings filled early life shaped Mr. Thaploo’s character lastingly, outlining it with steely resolve and strengthening it with uncrushable resilience. “I have had my fair share of setbacks that life offers to nearly everyone in this world. From living a happy childhood in Kashmir to being ousted and surviving in a refugee camp, adversity has played a great role in transforming my outlook towards life and gifting me the ability to think big and outside the box. The hardships that I went through have made me realise the immense value of basic necessities such as food, home and health. Adversities remained the best teacher of my life. Those days education was a privilege few could access given our exodus from Kashmir. And all my decisions and the choices that I made flowed from financial considerations or constraints. Yet, I never lost hope. Hope was the only driving factor for my survival. And so my younger days were a story of riches to rags. But as it is said – necessity is the creator of all inventions – I kept on learning, enhancing my skills and finding out ways to solve my problems. This has helped me achieve what I’m today. From being a “refugee” to a “refuge provider”, despite the innumerable personal setbacks, I count my blessings every day. At the same time, I must also express a debt of gratitude to my parents and wife, without whose unstinted support and inspiration, I would never be what I am today. It goes without saying that they have been my pillars of strength, every step of the way.

His Big Mission

We want to dig deeper into the big need-gap his current mission aims to address and disrupt. Mr. Thaploo explains into the nitty gritties of the noble task he has been entrusted to steer forward: “When I joined Apollo Hospitals to set up Apollo TeleHealth as Chief Executive Officer in 2010, it was clear as day that some of the challenges that bedevil the healthcare system in India needed fresh approaches and alternate delivery channels that had never been conceived before. And innovations in Healthcare IT were to form the cornerstone of that approach. 

One of the biggest drawbacks in our current healthcare systems has been the acute shortage of qualified doctors in the country. In order to bridge this gap and improve access to over-all healthcare, we worked towards a gradual transition of care delivery – from curative to preventive care and from hospitals and clinics to homes via virtual care. In these years, patients from across the country have availed of our telehealth services from the comfort of their homes, saving themselves unnecessary expenses and travel time. 

In effect, we conceptualized and executed a first-of-its-kind healthcare service delivery with innovation at its core in India. For instance, through Apollo’s Himachal Pradesh Tele Health Services programme, we provide the much-needed emergency, specialty and super-specialty consultation services to 4 different locations at a height of 14,500 feet in the Himalayan mountain ranges. The objective of this Information and Communication Technology-powered Telemedicine programme was to provide the required healthcare support system in the remotest and the most inaccessible terrains. Through this Tele-Emergency programme, we have stabilized over 1260 patients and performed more than 20,000 consultations thereby providing the much required healthcare support system, saving lives, and improving the quality of life of people. 

Envisaged initially as a proof of principle, technology-enabled service delivery model, this PPP is now a time-tested programme, which can be scaled up in different forms. Our innovative PPP model initiated with the Government of Andhra Pradesh helps to manage & operate 195 UPHCs (Electronic Urban Primary Healthcare Centres) across 9 districts in Andhra Pradesh. UPHCs serve the urban poor families which are below and near the poverty line, thereby catering to the healthcare needs of approximately 20% of the total population of Andhra Pradesh. 

Such innovations demonstrate that Tele Health PPPs that apply technological advancements in healthcare can completely recreate the healthcare landscape, thereby bridging the gap in terms of access to quality healthcare services making it equitable for one and all. Today, our PPP projects have been providing telemedicine access to 350,000 CSCs across India under the Digital India Initiative. Presently, we have over 700 public healthcare centres in Public-Private-Partnership (PPP) mode across India, spread across Andhra Pradesh, Himachal Pradesh, Uttar Pradesh, Jharkhand, etc., touching more than 12 million lives. 

With Covid-19 galvanising the all-round uptake of telemedicine in a huge way, Apollo is ‘carrying the torch’ even further. Adding force to the government’s Digital India movement, today Apollo runs the world’s largest Telehealth services offering over 20,000 tele-consults a day. We are also going to launch smart technology-based health kiosks across the length and breadth of the country. However, I must add that we are already thinking in terms of a post-COVID telemedicine landscape and working vigorously towards it.” 

Cometh the Crisis, Cometh the Leader

The COVID era established the crying need for telemedicine and remote diagnosis, creating a burning demand for good old traits like vision, innovation and humanity. Today most of us are in sync with the idea of consulting a doctor virtually without having to visit the hospital/clinic. This is where Mr. Thaploo and his organization’s vision has been working its miracles of late, rising to the ask and ushering a new age of home-based clinical care to COVID19-positive patients. He expands at length, “Flowing from the very exigent nature of the pandemic that was upon us and the consequent lockdown-driven restrictions on social mobility and distancing in general, there is no doubt that telemedicine did receive the much-needed impetus in the last one year or so. Although for Apollo TeleHealth particularly, this was familiar turf given that we have been operational in the field of telehealth for over twenty years now. Yet, in light of the abrupt halting of routine, non-communicable and lifestyle diseases-related visits to hospitals and healthcare facilities impacting tens of millions in the country on account of Covid-19 outbreak, the enormity and the scale of the challenge was quite unprecedented. As such at Apollo TeleHealth too, we had to scale up our operations several-fold, expand our services to regions and areas formerly uncovered and make provisions for those diseases and disorders which we hadn’t covered before Covid struck. These were truly game-changing initiatives and admittedly, only a pandemic of this nature and magnitude can precipitate such transformational initiatives in such a short span of time. The abysmal urban-rural gap in terms of healthcare infrastructure and services in the country perpetually affecting millions possibly necessitated such a shake-up in the system. Regardless, I am sure that in the coming future, the country as a whole would be better prepared with the help from initiatives like National Digital Health Mission.”

Every Highway has its Roadblocks 

Vikram Thaploo’s journey is no different. So what are the roadblocks he has had to crush along the way, and what have been the learnings and relationships gained thereof? The idea leader collects his thoughts before sharing, “Like everyone else and in most spheres of life, I did face roadblocks from individuals, institutions and even circumstances. Yet, there were several helping hands that did come along the way and enabled me to face and overcome the challenges. For one, Dr Prathap C Reddy, the founder & chairman of Apollo Hospitals Group and the visionary force behind the very idea of Apollo TeleHealth has been like a solid rock behind us for every initiative that we chose to take. However, it was Dr Sangita Reddy who has really mentored us, inspired us and taught us to dream big and shake off the challenges and hurdles almost effortlessly that came our way. So, I express my most sincere gratitude to everyone who has made our journey worthwhile and meaningful.”

Learnings and Takeaways

Looking back, what would he say his greatest  learnings have been? What have been the pearls of wisdom picked up over the years and stashed away in his personal ‘wisdom vault’? The ever-driven individual reflectively responds, “Apollo being the pioneer in telemedicine and by now the largest in the world, of such nature, had long back foreseen the transformative role that telehealth was going to play in addressing the doctor-patient gap in the country. Appreciating it and implementing those learnings on the ground has been my guiding force. We launched our first telemedicine center at our Chairman Dr Pratap C Reddy’s hometown through V-SAT back in 2000, which was inaugurated by no less than Bill Clinton, the then President of USA, who was on his official visit to India. Since then, although we faced challenges from doctors, patients, and even government departments during the implementation but we kept our focus on the larger goal. 

Advice for GEN Next

 
And what advice would he want to leave for the next generation / aspirants in his domain? A true leader builds more leaders, not more followers, and Mr. Thaploo shines as one by saying, “To the next generation, I would say that adaptability and resilience are the biggest attributes one must have. If you have faith in your purpose, don’t allow short-term hitches and hurdles to turn into long-term roadblocks. Work your way towards your goal always keeping the big picture in mind. Also, I would suggest that don’t try and do things single-handedly. Nurture and develop a team of like-minded and driven people. They would facilitate meeting your life’s goals.”

Legacy 

How would he like to be remembered? What would he want his legacy to be? Confronted with a question that can, admittedly, be a little uncomfortable, Mr. Thaploo frames his word characteristic judiciousness: “I have been associated with Telehealth for the past one decade and our initiative has touched more than 12 million lives by now. I share a common vision with our Chairman and our JMD, and that is to bridge the still-existing yawning gap between the number of doctors and the number of patients by way of deploying reliable and high-speed technology. In a country of 130 crore plus population with a woeful doctor patient ratio of about 1: 1450 against WHO-prescribed 1: 1000, I will not rest until every single individual, every single patient requiring a doctor’s expert consultation in the country is able to do so. 
 
To the next generation, I would say that adaptability and resilience are the biggest attributes one must have. If you have faith in your purpose, don’t allow short-term hitches and hurdles to turn into long-term roadblocks. Work your way towards your goal always keeping the big picture in mind. Also, I would suggest that don’t try and do things single-handedly. Nurture and develop a team of like-minded and driven people. They would facilitate meeting your life’s goals. 

Source: https://voiceofhealthcare.org/idealleader.php?id=1165&s=08

How workflow automation is helping organisations become more efficient by reducing errors and operational costs

When Reliance Jio started building its 4G LTE wireless network, it had the option of using a standard map to decide things such as the customers it will reach out to and places where it will set up its towers. This manual process would have taken several quarters before it could have been streamlined. In order to get going as fast and with as much precision as possible, it built maps based on a geographic information system. While Jio Maps helped find the best sites to set up towers for optimum coverage, Jio used the tool to coordinate materials for just-in-time deliveries and dispatch teams for network construction. Marketing executives, too, used the maps to understand demographics and zero in on areas where their efforts would yield the best results. The company is now leveraging the same systems/workflows to market its fiber-to-home offering.

Jio is not a one-off case. It is part of a trend where thousands of companies, across sectors, are automating workflow to make complicated business processes simpler with workflow system software that can automate manual, repetitive processes to save time and cost, apart from eliminating errors and accelerating execution. Be it scheduling orders and payments or conducting research and audits, workflow automation has brought consistency to processes and helped reduce errors and costs for companies in sectors as diverse as oil (Numaligarh Refinery Ltd or NRL), health (Apollo Hospitals Group and telecom (Reliance Jio).

HP India says the size of the Indian workflow automation market is close to Rs 500 crore. It has been growing at a compounded annual growth rate of 20-22 per cent for the last five years. Capgemini, a Paris-headquartered technology services company, says the global market will grow to $18 billion by 2023 with India having a 5 per cent (Rs 6,300 crore) share.

“Effective workflows can hide complexity from users, minimise mistakes and enhance responsiveness of an organisation to customer requests,” says Agendra Kumar, President, Esri India. Jio had used Esri’s ArcGIS platform to zero in on tower sites.

The Gains

Workflow solutions automate operations at scale, create unified data records and deliver better outcomes and cost savings. They also reduce the time to take a product or service to the market, bring down turnaround time and improve customer experience.

The return on investment (RoI) depends on several factors. “There are two measurements of RoI: hard RoI & soft RoI. Hard RoI refers to cost and/or time savings. Soft RoI refers to general efficiency gains or employee and customer satisfaction which can be difficult to quantify; these can be measured by CSAT (customer satisfaction) surveys,” says Ananth Chandramouli, MD, India Market, Capgemini.

Workflow automation is known to have reduced operational costs by 30-70 per cent in a number of cases, say experts.

Nuts & Bolts

Workflow automation refers to designing, execution and automation of processes based on workflow rules. Human tasks, data or files are routed between people or systems based on pre-defined rules. By automating workflows, especially processes that are primarily handled manually, significant improvements can be made in efficiency, productivity, accuracy and accountability. Being adopted across sectors, workflow automation at its core orchestrates multiple processes – straight-through, human-assisted or case management – of the organisation. Manual workflows, in contrast, are slow and run the risk of disruption. “Lack of transparency and dependence on employees can make businesses vulnerable to a variety of bottlenecks that create inefficiencies. Automating workflow provides a safeguard against potential barriers and empowers the organisation to directly participate in designing business solutions,” says Viswanath Ramaswamy, Vice President, Cloud & Cognitive Software & Services, IBM India/South Asia, a leader in this space. IBM Business Automation Workflow combines business process management and case management capabilities in a single integrated workflow solution. Case management is the work – recording, monitoring and analysis -involved in processing of data, procedures and related content that comprise a case (a case can be an investigation, a service request or any issue that must be resolved).

IBM’s solution unites information processes and users to provide a 360-degree view of work to drive better business outcomes. It even supports a hybrid cloud strategy and can be deployed on private cloud, public cloud or on-premises. It also supports a SaaS environment through Business Automation Workflow on cloud.

Assam-based NRL, as part of its roadmap for accelerating digital transformation, recently created a paperless office solution based on IBM Business Automation Workflow. The objective was end-to-end digitisation of its procurement cycle starting from requisition and tendering to release of payments to vendors and contractors. The application made the procurement process more secure and transparent by ensuring movement of proposals online and accessibility to everyone in the cycle 24×7, thereby making it the single source of information, with all approvals and annexures available in one single location.

Workflow automation is being used in industries too, including healthcare, manufacturing, ITeS and banking and financial services. “Automation of manual processes improves productivity and collaboration, turnaround times, minimises errors and lowers costs. Our customers have slashed costs by 20-25 per cent after moving to a Xerox IWS environment,” says Leo Joseph, Managing Director – India, Xerox. For example, Indraprastha Apollo Hospitals has adopted Xerox ConnectKey-enabled workplace assistants for streamlining document management by optimising document printing and costs. Even Apollo Telehealth, a unit of the Apollo Hospitals group, has adopted a workflow solution for various tasks that, among other things, ensures that while doing teleradiology, doctors don’t have to type the reports (they are printed via voice command). Also, artificial intelligence can be used to create alerts for abnormal fundus images in Tele Ophthalmology (fundus photography involves photographing the rear of an eye).

Apollo Telehealth has even designed an indigenous device integration layer. “This platform acts as a plug and play model for all new devices in the market. Earlier, integrating a new device would take 10-20 days, but with this platform, it takes only two hours,” says Vikram Thaploo, CEO, TeleHealth, Apollo Hospitals Group, India.

The cost and process optimisation is achieved either through faster processing of information or a more secure and less error-prone way of doing so. “The benefits of such exercises are very much dependent on the investment in the process being automated vs cost savings being achieved. This will be unique in each scenario. Moreover, as we move towards a new era of digital transformation, the need for enhancement of automation to support productivity will be crucial to ensure businesses continuity and resilience,” says Kavit Gupta, Director, Print Services & Solutions, HP India.

HP Document Workflow solutions are being used across industries. For example, manufacturing organisations struggling with overwhelming number of invoices as well as shipping and receiving documents are using HP Capture and Route Forms Recognition software to streamline repetitive document-based processes to reduce processing time and associated costs, especially in instances where workflow is controlled by data locked in forms and other content. “Using our Managed Print Services, which utilise document workflow solutions, one of our manufacturing clients was able to achieve 33 per cent reduction in contract approval time, from 45 days to 30 days and savings in paper, supplies and filing/labour costs. This also improved productivity and gave the companies capability to review contracts remotely. The solution also provided searchable/usable data for quicker, easier access and improved auditability and security of every document in compliance with the security policy,” adds Gupta.

The Covid Push

“Adopting workflow automation five to seven years ago would have given businesses a competitive advantage. But if you talk about today, it is a necessity if an organisation wants to innovate and make its operating model more efficient. The pandemic has accelerated adoption of a lot of these technologies,” says Ganeshji Awasthi, Partner, Deloitte India.

With focus on hybrid work, companies are enhancing the digital agility of their employees and actively identifying opportunities for automation and digitisation. As future of work demands more agility from businesses and expects employees to benefit from productive tools, businesses will move from basic workflow automation to complex Enterprise Content Management where content in multiple formats (documents, images, videos, etc.) is brought together to make processes even more efficient.

The future will also see the rise of Intelligent Workflows. “By integrating new-age capabilities like AI, analytics, cloud and skills, workflow automation can fundamentally change how work gets done,” says Ramaswamy. AI will even help in automating workflow decisions. Another key trend is the use of open source-based tools and low-code or no-code workflow software which require minimal or no coding. This will make the solution more accessible to the organisation. As users utilise highly specialised workflow automation tools, customisation will be a key feature of workflow automation software.

Source: https://www.businesstoday.in/magazine/technology/streamlining-workflow/story/431657.html

Health experts discuss causes, treatment, and ways to reduce the risk of heart failure on Heart Failure Awareness Week.

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

Source: https://thedailyguardian.com/what-you-need-to-know-about-heart-failure/

World Cancer Day: Understanding Role Of Nutrition, Lifestyle Changes To Control Cancer

People across the globe need to be aware regarding nutrition and other lifestyle changes that can be implemented to help them recover and potentially reduce the risk of the same cancer recurring or a new one developing.

World Cancer Day, which is observed to spread awareness, inspire change and reduce the global impact of cancer, is celebrated on February 4, every year. On this World Cancer Day, let’s dive into the role of nutrition and lifestyle changes in order to reduce the risk of the deadly disease.

• ANI: https://www.aninews.in/news/health/world-cancer-day-understanding-role-of-nutrition-lifestyle-changes-to-control-cancer20210204130323/
• Businessworld: http://www.businessworld.in/article/World-Cancer-Day-Understanding-role-of-nutrition-lifestyle-changes-to-control-cancer/04-02-2021-373650/
• INDIA TV: https://www.indiatvnews.com/video/lifestyle/world-cancer-day-understanding-role-of-nutrition-lifestyle-changes-to-control-cancer-682808
• ZEE5: https://www.zee5.com/zee5news/world-cancer-day-understanding-role-of-nutrition-lifestyle-changes-to-control-cancer
• yahoo!news: https://in.news.yahoo.com/world-cancer-day-understanding-role-072011001.html

The finance minister announced an allocation of Rs 64,180 crore over the next six years for the healthcare sector in the 2021 Union Budget. The budget allocated is in addition to the National Health Mission which is already in effect. One of the key initiatives proposed in this year’s budget is the addition of 17,000 rural and 11,000 urban health and wellness centres which is a supportive move for better patient care and will also pave way for more public-private partnerships. Also, the government has proposed to set up integrated public health labs in each district with 3,382 block public health units across 11 states. Another welcoming move is the outlay of Rs 1.41 crore for the Swach Bharat 2.0 mission which will help improve sanitisation and transform the lives of millions. Considering the government’s effort to curb the pandemic of COVID-19, it has also planned to set aside Rs 35,000 Crore for COVID-19 vaccine in FY22. Though it must be admitted that the government has red-shifted its focus on healthcare in this budget, considering the rapid integration of digital technology into healthcare, no major developments around digital healthcare or telemedicine was announced. 

Source: https://indiamedtoday.com/budget-reaction-vikram-thaploo-ceo-apollo-telehealth/

The significant increase in budget outlay for healthcare has been particularly promising at a time when the COVID 19 pandemic has severely affected healthcare goals. With COVID 19 consuming the entire focus of the healthcare sector, a series of important health goals such as NCD prevention, disease screening, malnutrition control and even regular immunization programmes had taken a backseat last year. While more than doubling the budget allocation for healthcare this year, the Finance Minister has committed to improve primary, secondary and tertiary healthcare services. The increased expenditure has also been committed to strengthen critical care in the country and on supporting the massive vaccine roll out.

A sharp increase in capital expenditure is another notable aspect of the budget as it promises to infuse significant spending in building infrastructure projects and public transport systems that will help generate much-needed economic activity and employment in an economy struggling with a recessionary phase.

While the focus on easing tax compliance and improving dispute resolution mechanisms is welcome, we had hoped to see a greater rationalization of GST and its compliance structure.” said Mr. Madhusudhan HK, President, India and South Asia at Alma Medical India.

“Healthy India is core to India’s economic growth reflects in the 137% increase in outlay for health at Rs 2,23,846 crore in budget 2021. The focus on healthcare with ‘Atmanirbhar Swasth Bharat Yojana’ with an outlay of Rs 64,180 crore over 6 years shows that healthcare capacity building is now a key priority for the Government. The Rs. 35,000 crore earmarked for COVID 19 vaccination drive will create the safety net for the country. The overall capital expenditure increase of 26% should drive infrastructure acceleration, the much needed GDP growth driver. Insurance sector which is an important pillar for any country should see an exponential growth with enhancement of FDI limit to 74% from 49%. Overall a forward looking budget to drive the 11% GDP growth for India in FY22 as pegged in the Economic survey 2020” said Mr. Vishal Bali, Executive Chairman, Asia Healthcare Holding.

“The Finance Minister, Nirmala Sitharaman announced an allocation of INR 64,180 crore over the next 6 years for the healthcare sector in the 2021 Union Budget. The budget allocated is in addition to the National Health Mission which is already in effect. One of the key initiatives proposed in this year’s budget is the addition of 17,000 rural and 11,000 urban health and wellness centres which is supportive move for better patient care and will also pave way for public-private partnerships. Also, the government has proposed to set up integrated public health labs in each district with 3,382 block public health units across 11 states. Another welcoming move is the outlay of INR 1.41 crore for the Swach Bharat 2.0 mission which will help improve sanitisation and transform the lives of millions. Considering the government’s effort to curb the pandemic of COVID-19, it has also planned to set aside INR 35,000 Crore for Covid-19 Vaccine in FY22. Though, it must be admitted that the government has re-shifted its focus on healthcare in this budget, but considering the rapid integration of digital technology into healthcare, no major developments around digital healthcare or telemedicine was announced.” said Mr. Vikram Thaploo, CEO, Apollo Telehealth.

Source: https://ehealth.eletsonline.com/2021/02/the-finance-minister-has-kept-the-focus-of-the-budget-on-economic-revival-and-healthcare/

Budget 2021 Reactions LIVE: Modi added that this was one of the rare Budget speeches that elicited so many positive reactions from experts.

Union Finance Minister Nirmala Sitharaman on Monday presented the Union Budget 2021-22. FM Nirmala Sitharaman has made a number of announcements pertaining to textiles, manufacturing, railways, startups, health, infrastructure, income tax and other domains. Welcoming the announcements made by FM Sitharaman, PM Narendra Modi said that Union Budget 2021-22 contains the vision of self-reliance as well as inclusiveness. Modi added that this was one of the rare Budget speeches that elicited so many positive reactions from experts.

Here are all the LIVE updates on top quotes, reactions of India Inc. about their take on Budget 2021:-

• Budget 2021 Reactions LIVE UPDATES: Chandru Kalro, Managing Director of TTK Prestige
  “There were great expectations around this budget and I am pleased to say that it delivered. This was a positive investment oriented budget demonstrating fiscal responsibility. Investment in infrastructure and new labour codes are particularly noteworthy as it will result in more jobs. The affordable housing push will definitely see an increase in the consumption of kitchen appliances. We appreciate the measures announced by the Finance Minister to improve ease of doing business, re-invigorating improving human capital and focusing on innovation.  It is commendable to see an increase in revenue without higher taxes.’’
• Budget 2021 Reactions LIVE UPDATES: Sanjiv Navangul, MD & CEO, Bharat Serums and Vaccines Ltd, (BSV) 
  “The union budget has given a substantial increase to bolster the healthcare sector in India. INR 35000 cr for COVID-19 vaccine and the commitment to the pneumococcal vaccine to be rolled out nationwide to avert child deaths is a massive boost.  A well spent allocation of INR 64,000 cr under the new Atmanirbhar Swasthya Bharat Yojana scheme will show significant results thus labelling #healthyindia as an encouraging effort. And, the infrastructural push will certainly create many more skilled jobs revitalizing the overall ecosystem”
• Budget 2021 Reactions LIVE UPDATES: Dr. Ajay Data, Founder and CEO, VideoMeet
  The announcement by the Honorable Finance Minister regarding the startups was much required at the moment and will help the fledgling startups with meager resources to continue with their business operations without worrying about the compliance with complex taxes. The announcement comes soon after Prime Minister announced setting up of Rs 10,000 crore fund for seed funding of startups. These moves by the government make the intent of government clear that it wants to promote entrepreneurship and help the enthusiastic young entrepreneurs in the country.The setting up of separate administration structure to promote ease of doing business is a laudable move by the FM. Also, as predicted startups were given importance under this budget and the industry is poised to be greatly benefited with the Tax holiday extended by another year till 31 March, 2022.
• Budget 2021 Reactions LIVE UPDATES: Dr. Harish Pillai- CEO, Aster India, Aster DM Healthcare
  “The increased investment towards Health Infrastructure and focus on a holistic approach to health is seen as a testimony of the commitment to building stronger health systems. The launch of the Atmanirbhar Swasthya Bharat Yojana with an outlay of Rs. 64,180 crores will boost the healthcare ecosystem. The investment will aid in developing capacities of healthcare systems, develop institutions for detection and cure of new and emerging diseases. This in addition to the National Health Mission, will support rural and urban health care centres. The all-inclusive approach through the launch of Mission Poshan 2.0 to improve nutritional outcomes and continued focus on cleanliness through Swachh Bharat Mission & potable drinking water through Urban Jal Jeevan Mission will subsequently bolster public health. The commitment to Rs. 35, 000 crores for the COVID-19 vaccination program and the promise to further provide funds if required, will accelerate the vaccination across the population. Strengthening of the National Centre for Disease Control (NCDC) & setting up of a National Institution for One Health, Bio-Safety Level III laboratories and regional National Institutes for Virology will provide a thrust for the improvement of the healthcare sector in India, which is commendable. Overall, it is a landmark budget to help fill-up the growing needs of improved healthcare in the country.”
• Budget 2021 Reactions LIVE UPDATES: Ashish Bhutani, MD, Bhutani Group
  It is to be seen what kind of easing government will carry out in InvITs/REITs. Hopefully, there will be changes in the mandated time gap between two institutional placements, and changes will be made with respect to pricing of units by REITs and InvITs for preferential issues. In view of the pandemic, we expect that there will be relaxations for raising of equity capital. Having said that we hope that the relaxations will be good for the market, and people will see more REITs moving in.
• Budget 2021 Reactions LIVE UPDATES: Samir Sathe, Executive Vice President, Wadhwani Advantage at Wadhwani Foundation
  “ The current budget has a thrust on globalising supply chains in manufacturing and increased investment in hard infrastructure, which together is a welcome step for SMEs, albeit indirectly and with a lag, since the SMEs will need to experience on the benefits of such investments only in the latter part of 2021 or 2022. I am hopeful and happy about the changes on the healthcare, which is an important area for India, for the Foundation and for the Advantage program. The key is in its implementation.
  
  Also. the act of increasing the threshold limits of the small company definitions is symbolic not fundamentally disruptive. While this will make more companies beneficiaries of the sops and concessions that the government has with a view to protect them, this does not change fundamental competitiveness of the small companies unless they build management capabilities to address and make the best use of the concessions or protection they will enjoy. It is like offering more playground without skilling the players how to win. I was hopeful of deeper, capability building budgetary changes for them.”
• Budget 2021 Reactions LIVE UPDATES: Sanjay Borkar, CEO and co-founder, FarmERP
  “The Finance Minister has proposed to increase the agricultural credit to INR 16.5 lakh crores which was the highlight centring the Agricultural Budget. This credit can be used by smallholder farmers for CapEx, may it be their vehicles or cold storage and other facilities that they require and also as working capital during the crop cycle.  
  
  One of India’s major concerning factors when it comes to agriculture is the infrastructure. The Agriculture Infrastructure and Development Cess (AIDC) proposed in this year’s budget can bring in good revenue to help farmers overcome these shortcomings by allowing them to store their produce in cold storages, stores or typical warehouses and get better value for their produce. This will play a vital role in strengthening the agricultural supply chain which can ultimately benefit the farmers and the stakeholders. 
  
  The ‘Digital India’ movement initiated by the Government can help the farmers greatly. Though this movement is not directly focused on farmers, focusing on digital projects will promote the use of technology. This can be revolutionary for the rural sector including farmers as it can aid to improve the standard of living, manage finances, help provide better services and products to the end consumers.”
•  Budget 2021 Reactions LIVE UPDATES: Sanjay Jain, Director, Elan Professionals Pvt. Ltd
  “We are delighted that the government has recognised and considered strengthening the healthcare system for betterment of individuals, healthcare workers and hospitals along with the required infrastructure. It is an opportunity for a brand like ours to step forward and support the government’s initiative by fully utilizing our portable vaccine carrier which will not only ease the transportation but will also lower the wastage of COVID-19 vaccine. Along with this, I think it is important to consider our industry under the PLI scheme to boost Atma Nirbhar Bharat packages. The manufacturing of commercial refrigerators is important and it will help in improving the agricultural industry as it would help avoid the wastage of vegetables and fruits due to lack of improper cold chain facilities. Also, almost 50% of cold chains are still import dependent. Hence, I look forward to the Government considering this.”
• Budget 2021 Reactions LIVE UPDATES: Rohit Sarin, Co-Founder of Client Associates
  “It’s a growth focussed budget which is the need of the hour. The Government has done well to bite the bullet of expansionary fiscal policy with 6.8% fiscal deficit in FY22 after 9.5% deficit in FY21. This would bring in much needed investment in healthcare, manufacturing and infrastructure which shall show up in higher growth of the GDP in the years to come. This has been balanced with staying away from populist schemes and tinkering with direct tax structure as distractions. Overall a growth oriented and focused budget.”
• Budget 2021 Reactions LIVE UPDATES: Harvinder Singh Sikka, MD, Sikka Group
  Long pending demand of the real estate sector has not been met. We have been asking for industry status for the whole sector and single window clearance for smooth functioning, the government did not comment on these requirements. Overall, the budget announcements made by Hon’ble FM seems to be a mixed bag from the real estate perspective. While the proposed easing of InvITs/REITs and the extension of tax holiday for affordable housing one more year are some of the positives for the sector.
• Budget 2021 Reactions LIVE UPDATES: Vinay Jain, Founder and CEO, Grafdoer
  The Union Budget FY 21-22 has brought a ray of hope for the general public as the government has extended eligibility of tax SOP on home loan, which is beneficial for the sanitary-ware industry, and will also provide tax exemption for affordable rental housing projects. Moreover, the new custom duty structure that has been introduced on the steel products is somewhat a relief as it has reduced duties on copper from 5% to 2.5%, it has also cut duty on copper scrap from 5% to 2.5%, and exempted duty on steel scrap for a specified period. The industry has seen a hike in the products comprising of metal constituents but this will now, somehow help the manufacturers to see stability in the pricing of the products and is a matter of relief for the people
• Budget 2021 Reactions LIVE UPDATES: Ashwani Rawat & Amarsh Chaturvedi, Co-Founder & Director, Transerve.
  “The Union Budget 2021 can be rightly considered as path breaking as it was the ground-level of the country and not just sector specific. The budget laid much-needed importance to the country’s healthcare system considering the recent and ongoing Covid pandemic by allocating Rs 64,180 crore for Atmanirbhar Swasthya Yojana, thus strengthening healthcare in India. We also appreciate an outlay of Rs 1.41 lakh for Urban Swachh Bharat 2.0 Mission, Rs 2.87 lakh crore for Jal Jeevan Mission Urban, Rs 1.41 lakh crore for Urban Clean India Mission and announcement of 5 new Smart Cities under PPP mode in collaboration with states, to reinforce the Urban India. Technology being the core suite to build on a successful business ecosystem, we welcome allocation of Rs 8,000 crore for National Mission on Quantum Computing & technology and building data centre parks. The honourable Finance Minister has left no stones unturned to give a boost to new age technology like AI, ML and Data Analytics across sectors with the launch of MCA Version 3.0 which shall target simplification of E-Scrutiny, E-Adjudication and Compliance management.”
• Budget 2021 Reactions LIVE UPDATES: Dhiraj Jain, Director, Mahagun Group
  “The Union Budget presented today by Finance Minister Niramala Sitharaman paves the way for faster recovery in the real estate sector which was badly impacted by the corona pandemic. The measures announced today will provide the right impetus and help the industry rebound across the country. Although the real estate sector has shown tremendous resilience in the last 10 months or so, such a step by the government was much required by the government. The real estate industry is standing at a crucial juncture at the moment and the extension of deduction of the home loan interest will definitely do wonders for the sector. The luxury housing sector does not have much to rejoice though
• Budget 2021 Reactions LIVE UPDATES: Prof (Dr.) Sanjiv Marwah, Director, JK Business School
  “The budget presented by the honorable Finance Minister tried to address many facets of the educational sector. The overall allocation of Rs. 93224 Cr for the education sector is a welcoming announcement. The budget emphasized the recent trend of tinkering at the edges of the problems that confront Indian Education System. Madam Finance Minister announced strengthening of more than 15,000 schools, starting 750 Eklavya schools and 100 new Sainik schools which will have a great impact on the school education. On the other hand, Legislation of the Higher Education Commission of India will resolve the various challenges faced by higher education in our country. The budget consists of the apt strategies which will help in speedy implementation of National Education Policy (NEP).
  
  Another point which deserves huge appreciation in the budget is the development of the National Research Foundation, which outlayed Rs.50,000 Cr over 5 years. It will strengthen the overall research ecosystem of the country and help India emerge as the R&D epicentre of the world.”
• Budget 2021 Reactions LIVE UPDATES: Sagar Saxena, Project Head, Spectrum Metro
  “The real estate has been provided the right kind of impetus today by the Finance Minister. The measures announced by her will make the industry more resilient and also help the industry to blossom further. The intent of the government is clear, it wants to lend a helping hand for the sector to grow and achieve the twin objective of providing housing to the masses as well generating more jobs in the sector through increased sales of houses. The retail and commercial real estate was also looking at some support measures but has to contend with little though.
• Budget 2021 Reactions LIVE UPDATES: Teo – Shaan Sarin Founder and CEO
  “Needless to state, pandemic impact on every sector. This Union budget 2021 should look into the need of an hour i.e., GST relief. As Finance Minister Nirmala Sitharaman said that the budget is going to boost Indian economy. Being one of the largest industry sector members we are looking forward towards spurt in our sector. After pandemic restaurateur’s industry and lease in certain areas of management of restaurants and bars. Mr. Shaan adds, upgrading in the regulations is required as time passes so that recovery can be done in this sector. States to get 41 per cent share of taxes as per the 15th Finance Commission recommendation. The government has accepted the recommendation. Yes, on exports seems to be fruitful for this financial year.”
• Budget 2021 Reactions LIVE UPDATES: Ricky Sethi Co-founder, Talli Station
  “We are expecting that the rusty dusty clouds of pandemic are going to clear the sky and sunshine will secure the land in restaurateurs’ industry as well. Highlighting the need for a sharp sun beam amidst licensing and other compliances Mr. Sethi said the boost is indeed to take back the restaurateur industry to the growth track in FY21-22. Budget 2021 relies on 6 pillars, says Finance Minister Nirmala Sitharaman. As it is India’s largest hospitality industry, we are hoping to get an opportunity to optimize our offerings and boost revenue too. Competition spike is a fierce point in this arena as consumer demand and preferences are transforming towards digitally under account of the government’s Digital Bharat Scheme.”
• Budget 2021 Reactions LIVE UPDATES: Deepak Kapoor, Director, Gulshan
  The Finance Minister has come out for a robust roadmap for the real estate sector which will help the government vision to achieve ‘Housing For all’ by 2022. The steps announced by the FM give a sense of the seriousness and intent of the government to support the important realty industry that can provide jobs to millions of people and strength to the GDP. Various announcements by the FM today to improve the infrastructure today will also go a long in improving the real estate industry as these measures will help formation and sustenance of new micro markets on the back of new highways and expressways
• Budget 2021 Reactions LIVE UPDATES: Kanz- Dilpreet Singh Wasan, Partner, Kanz
  “It is very encouraging to see the focus on healthcare in the budget and a 137 per cent increase in outlay in healthcare and wellness over last year. Budget 2021 provides every opportunity for economy to capture pace and grow sustainably. Govt proposes capital expenditure for FY22 at Rs 5.54 lakh crore. We are looking forward to attain good results from Union Budget presented by Finance Minister Nirmala Sitharaman. “

Read More: https://www.zeebiz.com/india/news-budget-2021-reactions-live-who-said-what-about-nirmala-sitharamans-announcements-top-quotes-from-india-inc-148147

BioSpectrum brings to you the post-budget reactions of the pharma & healthcare industry

Soon after the Union Budget 2021-22 was presented by the Finance Minister Nirmala Sitharaman where she strongly positioned Health & Wellbeing as one of the 6 crucial pillars of Aatma Nirbhar Bharat, industry’s responses started pouring in.

BioSpectrum brings to you the post-budget reactions of the pharma & healthcare industry-

“I am happy to see the investment in healthcare increase to such a level because it has been long overdue.”

Kiran Mazumdar Shaw, Executive Chairperson, Biocon, Bengaluru

“Setting up of rural and urban health and wellness centres could be an opportunity to create a PPP model. The partnership-driven approach is a sure step for the entities to bring to these hospitals their inherent areas of strength, thus building a quality model of care. This also allows the private sector to take part in addressing the health needs of the country more effectively.

Overall, we feel that the budget is encouraging as it will strengthen access to healthcare in India. And we look forward to partnering with the government on the disease surveillance project and establishing innovative lab solutions for the healthier future of the country.

Narendra Varde, Managing Director, Roche Diagnostics India and Neighboring Market, Mumbai

“The FY22 Budget is in line to support recovery of Indian economy while keeping the overall policy stability and fiscal discipline in perspective. COVID 19 pandemic is an unprecedented time and has brought importance to healthcare in India. The focus on healthcare infrastructure in FY22 Budget is a positive step towards growth with a 137% increase in allocation to the sector at Rs 2,23,846 crore. All these initiatives are pointers to increased investment in healthcare infrastructure and will strengthen the sector going forward.” 

Sudarshan Jain, Secretary General, Indian Pharmaceutical Alliance, Mumbai

“It’s a great step ahead, and far-reaching budget announcement, providing Rs 35,000 crore for Covid-19 vaccination in 2021-22. The Finance Minister commitment providing more funds in order to contain the Coronavirus pandemic spread in the country and provide an effective, smooth path for the vaccination scheme will help contain, and lead our nation towards accomplishing a covid-19 disease free Bharat. With this landmark budget the Government of India has signalled its intention to make health a cornerstone of the future success of our country. The allocation to vaccines signals a shift to preventive health care, a validation of the fact that vaccines are the most cost effective health care interventions.”

Dr Krishna Ella, Chairman & Managing Director, Bharat Biotech, Hyderabad

“On innovation and R&D, the additional allocation of Rs 50,000 crore over five years through the National Research Foundation marks a good beginning in improving the research eco-system in the country.”

Satish Reddy, Chairman, Dr. Reddy’s Laboratories, Hyderabad

“It is very encouraging to see the focus on healthcare in the budget and a 137 percent increase in outlay in healthcare and wellness over last year. There appears to be an integrated attention to epidemiology, diagnostics and treatment at all levels including district and blocks.”

Charu Sehgal, Partner and Leader, Lifesciences and Healthcare, Deloitte India, Gurugram

“The ground-breaking focus on health which will provide access to medical care for all in our country, fuel job creation and boost economic momentum.

 India’s efforts in managing the pandemic have been exemplary – our frontline workers and scientists have been working tirelessly to save lives and develop indigenous vaccines. Now the allocation of Rs. 35,000 crores for COVID-19 vaccines and more if required, makes our glorious nation stand tall as a model for the world.

We must now look at the next crisis of Non Communicable Diseases, which will be responsible for 80% of deaths and cause a 3.8 trillion USD burden to the country by 2030.  It is important to focus on prevention, early detection and possible cure to protect Indian families from grief, financial burden and to help the GDP grow.  India having proven its clinical excellence, should now focus on clinical trials, research, innovation and technology. There is potential for India to become the largest global health technology center.  As an additional opportunity, India can generate employment and be a healthcare service provider for the world.”

Dr. Prathap C Reddy, Chairman, Apollo Hospitals Group, Chennai

“We are happy to see the alignment with the 6 pillars defined in the budget and wish to partner with the government and other players to strengthen and bring to reality the newly launched Atmanirbhar Swasth Bharat Yojna. We continue our promise to be a partner to the government’s effort for a self-reliant India especially during early intervention in the areas of mother & child, cardiology, oncology and trauma & stroke.”

Dr. Shravan Subramanyam, Managing Director, Wipro GE Healthcare, Bengaluru

“The union budget has given a substantial increase to bolster the healthcare sector in India. Rs 35000 cr for COVID-19 vaccine and the commitment to the pneumococcal vaccine to be rolled out nationwide to avert child deaths is a massive boost.  A well spent allocation of Rs 64,000 cr under the new Atmanirbhar Swasthya Bharat Yojana scheme will show significant results thus labelling #healthyindia as an encouraging effort. And, the infrastructural push will certainly create many more skilled jobs revitalizing the overall ecosystem”.

Sanjiv Navangul, MD & CEO, Bharat Serums and Vaccines, Mumbai

“Making specific funds available for the vaccination for COVID-19 as well as pneumococcal will help to combat the pandemic and save precious lives. It is really encouraging that the government is trying to promote the growth of hospital infrastructure through PPP mode.”

Dr. K Anand Kumar MD, Indian Immunologicals, Hyderabad

“A record total outlay of Rs 2,23,846 crore for health and wellbeing aimed to boost the health and well-being of the nation, is also a well-thought announcement in this budget, with focus on preventive, and curative health. It’s encouraging to note the creation of 9 Bio-Safety Lab-III (BSL-3) in this Budget, that will boost research & scientific discoveries.”

Suchitra Ella, Joint Managing Director, Bharat Biotech, Hyderabad

“Healthcare in India is at the cusp of transformation.  Advancements in biotechnology, smart medicines, virtual & augmented reality, AI & IoT in healthcare are likely to gain momentum. This calls for patient-focused healthcare ecosystem wherein community health, mental health and other such critical areas are properly represented.  The Government’s focus on self-reliance, especially with the attention on scaling production capabilities of vaccines and other medicines,  demonstrates its commitment to build a healthy India.  While 2020 has accelerated the foundation for a digital transformation and innovation of the healthcare system, 2021 will support in further widening access and increasing digital inclusion in the remotest corners of the country.

Having said this, there is a need to further bolster the research and innovation ecosystem in the country in order to ensure that Indian patients receive new treatments and cures. An increased collaboration between stakeholders from industry, academia, governments, non-governmental organizations (NGOs), regulators and patients’ organizations is essential to promote a robust research framework which recognizes and rewards innovation.”

Rehan A Khan, Managing Director- India Region, MSD, Mumbai

“The proposals made in the Budget 21-22, would make quality healthcare accessible and affordable, besides standardizing healthcare infrastructure across the country. We await the on ground implementation and operational details of the scheme now.”

Dr. Alok Roy, Chair, FICCI, Health Services Committee and Chairman Medica Group of Hospitals, Kolkata

“Healthcare spend is proposed to more than double and this  will help in rolling out the vaccination program as well as strengthen the delivery system and build better capability and capacity to combat any future pandemics. India is rolling out the world’s second largest vaccination program and the Government has provided for almost $5 billion in the next year’s budget to make it happen. Besides curative care the focus on preventive and well being will usher in a more holistic approach to reduce morbidity and mortality.”

Dr. Rana Mehta, Partner and Leader Healthcare, PwC India, Gurugram

On the flip side

While many industry players are calling the Union Budget 2021-22 a progressive and ambitious one, others are raising their doubts and disappointments-

138% increase in healthcare expenditure is good and shall boost health infrastructure.  However, there should have been more allocation than Rs 50k cr (in 5 yrs) for research & innovation.

Ravindra Boratkar, President, Maharashtra Economic Development Council, Nagpur

“The Indian Medical Device Industry is disappointed not to notice any changes in custom duty as done for other sectors and are very hopeful that the fine print of the Union Budget would have possibly acted upon our recommendations on a Predictable Tariff Policy for a Make in India push for Phased Manufacturing Plan for Components and Finished Medical Devices and allocations for Testing infrastructure as well as for Med Tech Parks and Cluster developments. Supporting Policies are needed so that Indian Medical Devices Industry can make quality healthcare accessible and affordable for common masses, aim to place India among the Top 5 Medical Devices manufacturing hubs worldwide and help end the 85% import dependence forced upon us and an ever increasing import bill of over Rs 42000 Crore.”

Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD), New Delhi

“India’s health challenges are huge and require a high degree of collaboration between the public and private health sectors to improve healthcare access, increase insurance cover, bring down out of pocket expenses and ensure a good supply of new innovative drugs. The Indian pharmaceutical industry needs strong incentive to invest in making India a pharma research hub for the country and the world.”

Suresh Pattathil, MD, Allergan India, Bengaluru

“Healthcare budget increase is a great move by the government. Especially like the move away from sick care to a more holistic well being with a focus on preventive care. However the proof of the pudding will lie in implementation which hasn’t been great in the past. Would love to see how the government thinks of accountability and non performance.”

Karan Chopra, Co-Founder, Doc On Call, New Delhi

“Though, it must be admitted that the government has re-shifted its focus on healthcare in this budget, but considering the rapid integration of digital technology into healthcare, no major developments around digital healthcare or telemedicine was announced.” 

Vikram Thaploo, CEO, Apollo Telehealth, Hyderabad

“The budget focuses on improving healthcare services in a holistic manner tackling prevention and treatment, as also primary, secondary, and tertiary care. However, some areas have not been addressed in the budget. There were expectations regarding additional tax incentives on insurance premiums for senior citizens, providing deductions for R&D expenditure to encourage innovation, measures to encourage and expand insurance coverage to missing middle classes, etc. These additional initiatives could have accelerated sectoral development making Indian healthcare stronger. The government, with limited resources, has tried to balance long-term infrastructure and capability development along with immediate needs such as vaccination.”

Ravindranath Menon, Senior Business Adviser, APAC Healthcare, SKP Group, Bengaluru

“The Union Budget announcement with an increased 137% in the Healthcare budget is a very progressive and bold move, especially for the recovery and economic growth of the nation. It will be much appreciated by the rural and also the urban population alike. This is considering GOI’s intent on borrowing instead of raising taxes on high-income individuals and substantially investing in the Health infra sector. I was expecting that this budget would focus on personal health insurance adoption that would necessitate mandating health insurance subscription for every voter in the country. I hope that in the future, they revisit this policy and help reduce the burden and out of pocket expense of the common man.”

Dr. G. Surender Rao, Managing Director, Yashoda Hospitals, Hyderabad

“On the taxation side, the government did not meet the expectations of the industry which looked forward to tax benefits on R&D investments in pharma and lower GST for life-saving drugs.”

Parvathavardhini Natarajan, Associate Director, Ratings, Chennai

Source: https://www.biospectrumindia.com/news/17/18021/industry-calls-union-budget-2021-22-progressive-ambitious.html