As Coronavirus outbreak took place in India, the India council of medical research (ICMR) allowed doctors to take recourse to telemedicine. It is a modern healthcare practice around the globe. Telemedicine is provided by the doctors since 2000 in India but as the COVID-19 outburst took place it has received the necessary statutory support. The state medical councils revoked the ban on telemedicine which led to it being fully legal and beneficial for the patients and the doctors. The step became necessary despite the fact of whether the healthcare teams and patients were ready or not. 

On 7th July 2020 Niti Aayog made a statement on twitter- A study shows that 50 million Indians have accessed online healthcare and in-person doctor visits are down by 67 per cent. What a feat!

BENEFITS OF TELEMEDICINE

Telemedicine gives the patients to make decisions and teaches them self-care. For example, in the case of diabetes patients visit doctors once in 2-3 months to get advice on change in the dosage of medicines. Such visits can be skipped. The patients can get in touch with a specialist of their choice located in another city through video calls or other mobile applications. We have various communication platforms like WhatsApp, mail etc., the time has come to adopt all these technologies. Some of the benefits are-

• Reduces healthcare Costs- It helps to reduce healthcare costs by avoiding transfer of patients from one location to another, reduction in hospital costs etc. 
• Improves quality health-care delivery- It can help improve the quality of delivery with both mental and physical conditions. 
• Enhances traditional face-to-face medicine- The practice of telemedicine should support the traditional practice rather than replacing it. The medical practitioners shall pay a visit to patients from time-to-time while still providing convenience and flexibility of seeing patients remotely.
• Provides engagement and satisfaction- The practice makes it easy for patients to maintain their health while engaging in the practice of taking care of themselves. 
• Provides access to care- The time gap that travels brings between care providers and patients can create a hurdle in access to care. It can be beneficial for people in rural areas and locations with undermined facilities.

DISADVANTAGES OF TELEMEDICINE

• Lack of Personal relationship– If a patient prefers a face-to-face relationship with their doctor or a more intimate treatment, then telemedicine might not the option for them. The patient may never meet the doctor in person.
• Availability and Cost- For health care providers, it can be difficult to set up and maintain the process. It can be very costly for small healthcare clinics.
• Insurance- Not all countries allow insurance coverage for telemedicine. Currently, only 26 states require insurers to cover or reimburse the costs.
• Protection of data- Hackers can access the medical information of a person, especially when the patient uses a public network.
• Delay in Care- In case of requirement of emergency care, accessing telemedicine first may cause a delay in treatment because a doctor cannot provide life-saving tests or laboratories digitally. 

AVAILABILITY OF APPS FOR TELEMEDICINE CONSULTATION

These applications are need of the hour now, we must be careful while using them as we cannot avoid them completely. Nowadays most of the urban patients keep blood pressure machine, thermometers etc. with them, but when these apps are connected to the apps the information goes to the doctor directly which can help him advise the best treatment. Some apps have diagnostic centres attached to them, the information goes to the doctor and the patient is provided with the timely and best advice. Smart-phone parameters help to maintain a record of patients which helps in tracking the changing health parameters, it is an elaborate and trendy way to provide help to the patients. 

HOW DIFFICULT CAN IT BE TO ACCEPT THIS CHANGE?

In the last few decades, people have adapted themselves to many technological changes. It is time that we learn to live with the novel coronavirus. The doctors have made themselves ready for it, now the patients need to get accustomed to this practice too; so that crowd, long queues at doctor’s clinic can be avoided. Hospitals will always be available for emergencies but consultation from home is the best option in current times. Primarily developed for providing assistance in rural areas, it has found a fresh lease of life during this pandemic. 

The fear is running high which is making it easy for people to get people on board with telemedicine. Based on a study of 5 crore people who accessed online healthcare between March and May by Health tech platform Practo shows how virtual appointments increased by 500% out of which 80% were first-timers, signalling a possible shift in healthcare delivery. The older people might find it difficult to accept these changes given the fact that they are not familiar with smartphones and the digital world.

CONCLUSION

Despite being in existence for decades now, the telemedicine was not an active practice given the ambiguities around it. The uncertainty of rules and legislation that came along with it, made it a risky practice and patients, as well as the doctors, choose to stick to the forever-old practice of in-person treatments. However, pandemic changed the situation. From the past few months, given the amount of risk around the world people became ready to divert to remote healthcare practices. While it has its own pros and cons, the practice is the need of the hour.

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The first case of novel-coronavirus was reported in the state of Kerala on January 30, 2020 and as of June 31, 2020 the total number of positive cases stands at 5,86,056 including 2,20,728 active cases, 3,47,851 discharged/recovered and 17,411 deaths have been confirmed across India (Source). To effectively prevent the spread of COVID-19, well-organized testing programs, and extensive efforts to isolate infected people, contact tracing and quarantining people they have come in contact with is the need of the hour. Indian Council of Medical Research (ICMR) on June 31 informed that till then 88,26,585 samples have been tested of which 2,17,931 samples were tested in the last 24 hours.

Right from the outbreak of the COVID-19 several preventive strategies are adopted by the central government in consultation with states. After the lockdown is lifted there lies a huge burden on the states to work on containment of the virus. Recently through social media, COVID-19 comparison ratios are becoming widely popular where certain states and their administration are being widely criticized for their testing rates and inefficiency.

Flatten the Curve – State’s Difficulties.

It is relatively easy to design for the perfect cases, when everything goes right, or when all the information required is available in a proper format

 Donald Norman

Adequate testing and proper information are the only means through which public health intervention by the state can be done both diagnostically and therapeutically to flatten the curve. But the figures released cannot be perceived in isolation, they should be tallied with the population (test per million) of the state or test positivity rate in the state which captures the size of epidemic and scale of testing in number. 

Delhi has one of the highest testing rates per million but in terms of test positivity rate, it is relatively performing low. Also, the test positivity rates show wide variations in Delhi at 23 per cent positivity rate and Telangana at 18 per cent whereas West Bengal is at 3.5 per cent. Test positivity rates show the prevalence of infection and approach adopted where the epidemic is growing and tests are lagging. 

This presents a huge problem with respect to expanding the amount of testing base in the country because even though the testing rates are increasing in the country as a whole, positivity rates are constant at 7.4 to 8.1 per cent. So this presents a picture that there is no proper circulation of data which can show the exact incidence of the disease through which we can estimate whether we are testing enough. Overburdening of Government hospitals and reduced testing needs to be encountered as part of expanding the testing base in the country.

Testing Deregulation as a Way: Private players

With the rise in the risks of community spread of the virus, the Telangana government is often being criticized for its approach of not engaging private labs in testing even after demands pertaining to that was made by ICMR and Telangana High Court. 

Engaging private players in the fight can always be treated as a viable option because of efficiency. Also, these players are controlled by an incentive-based environment where performance is always rated. Germany’s success in testing for the virus proves the mechanism engaging the present approach. Germany has been testing more than one hundred thousand people per week since late February. By April 20, it had tested more than twenty-five persons per thousand. Compare this to India, where the testing rate is less than one person per thousand. One reason for Germany’s success is a relatively freer market for medical testing compared to India. Private companies in Germany were able to mass-produce the test kits early on, as they were less burdened by a central regulatory body like the Indian Council of Medical Research. 

In the name of quality maintenance, there is a heavy licensing mechanism for private labs inserted by Indian Council of Medical Research but it has forgone the key idea that then government organizations private players predict the probabilities of demand in the community concerning testing as they need to make living out of it. It is just the way they predict stock prices.

Conclusion

The primary question that arises most often in the community is “How many tests are enough tests?” and “When will we reach normalcy?”. The only answer for that would be that all states should ideally keep a watch at the indicators such as positivity rate and condition of spread in an epidemic that needs immediate attention. Thus till vaccine comes into the picture we can flatten the curve only by considering the epidemiological indicators and rampant testing through the inclusion of private players.

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