key: cord-0812790-v36lrg3p authors: Iyengar, Karthikeyan; Mabrouk, Ahmed; Jain, Vijay Kumar; Venkatesan, Aakaash; Vaishya, Raju title: Learning opportunities from COVID-19 and future effects on health care system date: 2020-06-20 journal: Diabetes Metab Syndr DOI: 10.1016/j.dsx.2020.06.036 sha: f8c8de4dbc735bae3997ea3e2b795067541749b1 doc_id: 812790 cord_uid: v36lrg3p BACKGROUND AND AIMS: COVID-19 has had a crippling effect on the health care systems around the world with cancellation of elective medical services and disruption of daily life. We would like to highlight the learning opportunities offered by the current pandemic and their implication for a better future health care system. METHODS: We have undertaken a comprehensive review of the current literature to analyse the consequences of COVID-19 on health care system. Using suitable keywords like ‘COVID-19’, ‘telemedicine’, ‘health care’ and ‘remote consultations’ on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May we gathered information on various aspects of effect of COVID-19. RESULTS: There has been a shared drive worldwide to devise strategies to protect people against viral transmission with reinforcement of hand hygiene and infection control principles but also to provide continuity of health care. Virtual and remote technologies have been increasingly used in health care management. CONCLUSION: COVID-19 has offered unique learning opportunities for the health care sector. Rationalizing and optimizing available resources with resilience shown on the coronavirus frontline during the crisis are some of most important lessons learnt during the crisis. Importance of personal hygiene and re-enforcement of infection control measures have been acknowledged. Telemedicine revolution will be a vital factor in delivering health care in the future. COVID-19 has had a crippling effect on the health care systems around the world with cancellation of elective medical services and disruption of daily life. We would like to highlight the learning opportunities offered by the current pandemic and their implication for a better future health care system. We have undertaken a comprehensive review of the current literature to analyse the There has been a shared drive worldwide to devise strategies to protect people against viral transmission with reinforcement of hand hygiene and infection control principles but also to provide continuity of health care. Virtual and remote technologies have been increasingly used in health care management. December 2019 and spread worldwide [1] . It has now spread to over 200 countries and the latest World Health Organisation (WHO) reports there are over 4 million confirmed cases of COVID-19 with more than 300,000 deaths (17 May 2020). [2] Predominantly a respiratory illness, the novel coronavirus respiratory spreads predominantly by droplets and is highly contagious [3] . Serious illness requires hospital admission [4] . To prevent the spread of this contagious virus, national governments have introduced 'lockdown' measures with infection control strategies including 'social distancing' and 'self-isolation' guidelines which severely restricts the movement of people and affects their daily life [5, 6] . Lockdown and strategies to prevent COVID-19 viral transmission has caused significant economic, geopolitical and health consequences all over the world [7] . COVID-19 has had significant effect in normal working of health care organisations. ( Figure 1 ) It has made patients staying away from accident and emergency departments and reaching out for urgent medical conditions such as heart, cancer illnesses. [17] . This has shown the versatility and the spirit of support and unity of all community sectors to help out during a disaster. 2.3. Government initiatives -COVID 19 has exposed health care system of many countries including India. In India public health-care system in grossly under-funded and patchy while private health-care sector is unregulated. The Indian government's expenditure on health as a percentage of GDP is around 1·5%. There are several gaps in India's preparedness for COVID-19 pandemic [18] . This pandemic could be the much-needed wake-up call to the necessity of long-term changes to India's health [19] . Recently taking in account during pandemic the Indian government has increased expenditure in the public health system to reboot healthcare. The government has launched an ambitious project 'aatmanirbharbharat' to become more self-reliant with investment in acquiring and building lifesaving equipment's like PPE, ventilators, building hospital infrastructure, ICU beds, oxygen supply in hospitals, strengthening of laboratories, hiring of additional human resources which were scarce before pandemic [20, 21] . All this will improve the health care system and facilities in India. 3.1. In COVID-19, organisations have accepted that telemedicine has a key role, developed their departments to facilitate telemedicine [11] . Current and evolving telecommunication technologies play a key role in exchange of valid information for diagnosis and management of diseases and injuries. The main modalities for remote 8 consultations include telephone consultations, virtual fracture clinics and video consultations [22, 23, 24] . These innovations are going to be main-stay in how we deliver health care in the future. 3.2. Face to face consultation is common in India and has and has its own drawback. Recently Telemedicine or delivery of health care services using information or The Indian Medical Association has adopted the necessary regulatory frameworks for supporting wide adoption of telemedicine and issued an advisory for its use in few situations. When the pandemic will end, doctors will prefer to see patients directly, but at the same time due to increased experience in tele-medicine will help them to see patient if they skip the doctors' visits. There is a myriad of medical conditions that are self-limiting. E.g. traditionally orthopaedic doctors have been receiving referrals before the pandemic and had to counsel patients regarding these conditions (e.g. patellar tendinitis, ganglion swellings) [26] . During the pandemic, patients with those conditions were given advices over the phone and guided to online resources by which they were satisfied. We believe patients with those conditions would benefit from the education and positive message that can be 9 provided by accessing designated online websites and online physiotherapy services. This saves plenty of consultation time and help offload our health care systems and outpatient services Teaching is a mandatory part of medical training in all specialities. Different online applications have been used to continue delivering teaching sessions to trainees at variable levels. This has proven to be more convenient, flexible and bringing education. Also, this has given us the chance to meeting international interesting people and gain real world skills at our homes. Smartphone technology allows conferences, seminars, workshops, and other forms of online teachings [15, 27, 28] . Webcams captured hospital rounds; 3D images replaced cadavers, Zoom classes, virtual simulators, webcasting, online chatrooms, virtual dissection, E-anatomy with Virtual Reality [29, 30, 31] . The global lockdown during this pandemic has given a unique opportunity to the researchers and clinicians to complete their pending paper publications and research works. There have been an unprecedented number of publications during the peak of the COVID-19 pandemic across all the medical journals of the world [32]. This positive trend might continue in future and help the healthcare industry to benefit from these research 10 and innovations, including finding effective means of dealing with the future epidemics and pandemics. Human crisis like COVID-19 pandemic has also offered some unique opportunities for the healthcare sector. It has allowed us to revisit the healthcare delivery. Rationalizing and optimizing the available resources during such crisis are some of the most import lessons learnt from this crisis. Although, there has been severe disruption in the healthcare delivery during this time globally, but several positives have also come out of it viz., the effective use of telemedicine, importance of personal hygiene, and the importance of infection control. The virtual means of teaching, educating, and sharing knowledge has now become popular and acceptable. The research and publications have also seen a significant rise during these difficult times. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study World Health Organization. Coronavirus disease (COVID-19) advice for the public Effects of COVID 19 pandemic in daily life World Economic Forum. The economic, geopolitical and health impacts of COVID-19 The BMJ Today: The versatility of medical careers Guidance on supply and use of PPE Health workers are the frontline soldiers against COVID-19. Let's protect them | Africa Renewal Attend Anywhere COVID-19 and remote consulting strategies in managing trauma and orthopaedics Telemedicine for Diabetes Care in India during COVID19 Pandemic and National Lockdown Period: Guidelines for Physicians Roadblock in application of telemedicine for diabetes management in India during COVID19 pandemic COVID-19 and applications of smartphone technology in the current pandemic Augmenting Critical Care Capacity in a Disaster Challenges and solutions in meeting up the urgent requirement of ventilators for COVID-19 patients Gaps in India's preparedness for COVID-19 control India under COVID-19 lockdown Government of India. Transforming India A brief guide to telephone medical consultation Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting: a quality improvement approach Government of India. eSanjeevani. An integrated telemedicine solution Jumping off the Merry-go-round Twelve tips for rapidly migrating to online learning during the COVID-19 pandemic Do Not Neglect the Children: Considerations Integrated virtual and cadaveric dissection laboratories enhance first year medical students' anatomy experience: a pilot study