Dr Surendra Ugale - Talks about COVID-19 and Healthcare

Dr Surendra Ugale, Sr. Consultant – Obesity, Diabetes Bariatric & Metabolic Surgeon, speaks to us about metabolic and bariatric surgeries amid COVID-19 and elaborates on the areas where the nation needs to work on to contain the virus. Dr Surendra is known as one of the pioneers in Metabolic and Advanced Laparoscopic surgeries. Here’s more from him. 

Are metabolic and bariatric surgeries suitable for patients who are also suffering from COVID-19? 
Only emergency surgery would be taken up for them; if it’s semi-elective/non-emergency, then we suggest waiting for two weeks, after which we can operate them. 

When surgery is unavoidable, as an emergency situation, then tests like High Resolution-CT scan of Chest, D-Dimer, CRP, Ferritin, LFT, CBP, are done, and levels are monitored; blood thinners, antibiotics, respiratory exercises, monitoring of oxygen saturation are important. Anaesthesia team, all operation theatre staff and surgeons use PPE and double masking with N95 or N100 respirator masks for additional safety measures in this manner, laparoscopic surgery can be done safely.

For those whose surgeries have been postponed for two weeks, by then they become non-infective to others, their own immunity and health is normalised, after which we can operate them safely.

Patients who have already gone through the surgeries in recent past, are they more prone to coronavirus?
People, who have diabetes and obesity, also sleep disorders due to obesity, are all prone to infection if they don’t use N95 masks and physical distancing; especially for first two weeks as they already have lowered respiratory effort and saturation.

But if they maintain these precautions, continue walking and breathing exercises, and then they become safer as their metabolic functions improve immediately after surgery, their tissue oedema goes down, their oxygenation improves very rapidly, and their body’s inflammation starts reducing; this makes them much safer and better equipped to fight any infection.

How does the virus affect obese and diabetic people? What are the measures that could be practised by such patients to stay safe? Any advise that you would like to give?
As mention earlier, obese and diabetic people are more prone to get the infection, as they have lowered immunity and greater inflammation of the tissues in their body; their respiratory effort is lower, oxygenation is reduced.

Safety Measures that they can practice are --control sugars levels, so pranayama, spirometry and good breathing exercises, fresh vegetarian nutrition (including turmeric and spices in cooking) walking exercises and nutritional supplements like Vitamin C, Vitamin and Zinc. 

Bottom line is -- They must normalise their weight & control sugars, either themselves or get a surgery done to rectify it.

How has COVID-19 changed the picture of metabolic and bariatric surgeries?
Many people have taken chronic health issues very lightly in the past; with this pandemic, it has become very clear, that if one has reduced immunity, then chances of infection are higher and once infected, the possibility of getting into a serious state is greater. Hopefully, people who have diabetes, obesity, hypertension, will all take this very seriously and either fix the problem themselves or consult doctors and proceed with surgeries.

Since most of the hospitals are full and no beds are available for COVID patients or even the ones with other body problems, what according to you could be done to empower the hospitals? 
The COVID pandemic has instilled a great fear amongst society and healthcare workers, resulting in many people who can easily be treated at home rushing to the hospitals and occupying vital beds that could have been used by more serious patients.

People, who have no facility to isolate themselves at home, could be provided with a neat and clean isolation bed with clean bathroom; this can be done in specially designed quarantine facilities by converting function halls, guest houses and private facilities by NGOs into centres. The second group of infected people who need oxygen support and don’t have any comorbidities or alarming blood sugar level can also be shifted to similar facilities, where they would get oxygen support, tablets of supplements, antibiotics and multiple agents being used as an ancillary treatment for COVID infections. 95% of such persons would recover in this manner. Only when in spite of all this, either their blood tests are highly abnormal, or their oxygen saturation worsens, then they need hospital beds for greater monitoring and intravenous medication, possibly needing expensive drugs like Remdesevir or Tocilizumab or Itoluzumab as life-saving measures.

How can we contain the virus?
Everybody needs to follow social distancing and basic hygiene guidelines. Additionally, there are few things that the government can work on- 

Give a free hand to private hospitals, NGOs, Clubs, Residential Societies to help expand facilities and reduce the strain on the private hospitals. 

Make a single rapid window clearance, for procuring and distributing at the correct prices, life-saving drugs which are in short supply this will get rid of black-marketing and scavenging by unscrupulous people, in this time of dire emergencies

Give all patients the option of either seeking tests and treatment in government centres for free, or in private hospitals with payments; let the people choose, so everyone can take care of themselves and avail of the necessary facility.               - Srivalli