 Good evening everyone. This is Sunita Rao from Times of India and welcome to the Times of India's FB live session on COVID-19. Today we have with us a restinguished guest who is a known personality in Karnataka. Dr. Head Sudarshan Ballal, who is the chairman of Manipal Hospitals and a leading nephrologist in Karnataka. In addition to his father now is also the member of COVID-19 expert committee set up by the state government. Dr. Ballal sir, welcome to the show. Thank you Sunita as always. It's a pleasure to interact with you at the Times of India group. So I'm sure I'll enjoy this interaction. Yes sir. So we started the FB live sessions basically to create awareness on the new normals that we are now living in. And to engage experts like you to talk about COVID-19 and pertaining to the disease further to create awareness to all our audience who would be watching this live session now. I will be asking you certain questions and further we move on to the questions that are asked by our audience on the Times of India FB page as well. So we're actually online now. Sure. It's a great initiative because I think in the future, face to face contacts will be far less than online and digital media. So it's a great initiative you have taken but I still like my newspaper and print, even though I keep watching many of these programs. Thank you so much. Yeah. So the lockdown has been relaxed from today onwards, as you're aware. Is that a matter of concern or are we in the right direction sir? We have various cases after the lockdown is relaxed in one or two days, as it happened in Singapore, which we have seen. And also, how do you make sure that preventive measures like the social isolation, the physical distancing, can all be implemented with the relaxation, sir? At the outset, I must compliment the government, both Prime Minister Modi at the center and Honorable CM, Mr. Yaduropa in the state. They have been extremely proactive and I honestly believe the disease has not spread far and wide because of the lockdown. If we didn't have the lockdown, maybe we would have gone the US, Italian or European way, which would have been disastrous for India. It's a very thin line that you have to walk between lockdown and economic hardship versus opening up and spreading COVID. So I think that's a very tightrope walk and the government is trying to do that. I think they have opened up only in bits and pieces and they have been very careful about which areas they open up. There are hotspot areas that are completely sealed off. So I think lockdown cannot go on indefinitely because it will affect the livelihood of people. So I do believe that lockdown has to be phased out over a period of time. But phasing out should be very gradual and we should still make sure that the vulnerable, the elderly, diabetics, people with immunosuppression, so on and so forth, still maintain the same kind of precautions. And also, we learn and continue to use the good habits we have learned, like cough etiquette, social distancing, nose pitting, hand washing, cleanliness of your surroundings. All those things should continue even if the lockdown is phased out. Yeah, but that's where I think the challenge is, isn't it? Yeah, it is. But I must admit, as much as we must compliment the government, I compliment the people of India. It's not easy for 1.35 billion people, twice the population of Europe and America, to follow the rules so strictly. We don't see such kind of rules being followed either in America or in Europe, but India has followed it very strictly and the compliments to the Prime Minister and the governments of the various states who have taken the people with them because this is not a top-down kind of initiative where you said we'll impose curfew, bring in the army. It's not that. It's the people who have agreed to be under a lockdown based on the interventions of the Prime Minister and the various chief ministers because they feel it's for a good cause. Yeah. So what would be your assessment of Karnataka's handling of COVID-19 situation right from our preparedness in as early as January 2020 to till now? What do you think Karnataka has done as the best of measures and what do you have to say? I think Karnataka has been unusually proactive and I must compliment the government on this. I call it very proactive and very many measures that they've taken, which is unusual and also very different from many other states. The first thing that the government has done is, of course, they have followed the lockdown which the center has brought in, but they have taken the private sector and the public with them. They've had multiple meetings with the Honorable CM, Deputy CM, Medical Education Minister, Health Minister, Home Minister and a whole senior level of cabinet and bureaucrats. And they've been very, very proactive and wanting to know how the private sector could interact with them. And in fact, this must be the only state where the government has set up a separate COVID hospital in many places for COVID patients. The private sector have worked with the government. Our hospital, based on the request of the CM and the Health Minister, has set up a task force committee which oversees the ICUs and tele-councils for many districts. Based again on the request of the government, we said we'll be happy to deploy a team of intensivists and specialists at Victoria if the numbers go up. And the Manipal Group has set up 150 bedded specific COVID speciality hospital in Udupi. And the good news is that we only have one patient there. So, which means that we are underutilizing our facilities, which is good as far as COVID is concerned, which means we have not seen the kind of devastation that's been seen in Europe and America. So, as we have seen cases in Bengaluru have seen us for today. We have had some nine cases today. But for the last four days. Hello, I cannot hear you. There's some audio problem, I think. I'm sorry. There was someone who called me in between. I have not a problem. Yeah. So, am I audible now? Yeah, loud and clear. Yeah. So, the cases in Bengaluru and Mysuru looks like they're getting controlled. But the number of cases in northern Karnataka's districts like Vijayapura, Vedar, Bagelkot, Kalburgi, they look like a tougher challenge to handle. So, being a part of the government's experts committee, how are you analyzing the situation? I think the government is very aware of these facts. In fact, the last meeting we had was specifically to talk about the increase or rise in numbers in North Karnataka. And as I said, the government has set up a task force, including the private sector where we do EICU and virtual consults for the ICUs of various district hospitals. I'm sure other group, private groups are also working with the government. So, anyone who's sick, we offer the services of intensivist, pulmonologist, medicine person, nephrologist and anesthetist on a need-based thing, which is done every day. It's a virtual round every day. And initially it was started off in the Health Commissioner's office. Now we do it in our from our own hospital. So, I think that's a great initiative. I think some rise in the numbers is to be expected. But for a country of 1.35 billion, 20,000 plus cases, 650 deaths is a phenomenally great achievement. Even if people say that we are underreporting the cases because we're not testing everyone unlike the western world, I would still say we would pick up the very sick patients. If the patient is very sick, they would have to go to the hospital. And certainly if there were increased deaths, the government and the hospitals would know. And we haven't seen that kind of a mass increase in patients coming to the hospital or getting admitted to ICU. I don't think you can take any hospital in India, which has a picture similar to what you see in New York and Italy, where people are in the corridor. People are in the footpath in parking spaces being ventilated. Those kind of situations we have not seen. In fact, our resources are underutilized fortunately for the time being. So, which is a good sign. Yeah. There seems to be some technical problem, isn't it? Yeah, I can hear you, Sunita. I can't see you now, but I can hear you. One second, sir. Yeah, now I can see you too. Okay, great. So tell me, Manipal hospitals happens to be one of the very few private hospitals that started taking COVID-19 patients and shouldering the responsibility with the government. After your experience of treating COVID-19 patients and how did you make sure that, you know, it is free of infection for your doctors, your staff, and also for other non-COVID patients in the hospitals? Now, as you're aware, when the COVID epidemic became more evident, the government has signed quite a few private hospitals. There was also just one of them. I think there are more than 40 or 50 hospitals of the private sector, Karnataka, which were assigned to take care of COVID. But fortunately, the numbers were not high. And right now, almost all of them go to the government hospitals. And as I said, our private hospital will be as only as one patient. So your question on how was it as an experience? I think this is what we learn in medicine, the techniques of isolation, PPEs. And to be honest with you, I think we should take everyone as being infected. Because when a patient walks into the ER, you don't know. Now, because there is a COVID epidemic, we are worried about COVID. But there are so many other diseases that people can transmit to the doctors, healthcare workers, and to their own. So we have to make sure that we take adequate precautions. Specifically in the COVID era, we had a lot of training for our doctors, for our nurses. We had some dry runs, believe it or not. We had patients, mock patients coming in. And then, of course, the first few patients we took in one went off very well. This is a patient came in an ambulance. And within 90 seconds, the patient was in the isolation room and was seen by an infectious disease specialist. And the entire corridor was kept open, sanitized, including the elevators, ward boys, nurses, technicians, and doctors. All of them took adequate precautions. Unfortunately, the few patients that we have had have all gone home well. We haven't had any serious incident. And that seems to be the norm of many other hospitals in the private sector too that have taken care of patients with COVID in Bangalore. Yeah. But the collateral damage that the non-COVID patients have gone through is huge. I'm sure you would agree with me on that. We know that probably the dialysis cases are coming to the dialysis units. But I think there has been a tough time for patients with cancer, patients with cardiac diseases to reach out to the doctors. Do you think this lockdown could have led to the progression of other diseases and maybe the timely medical help was probably not accessed by many patients? So you bring up a very valid point. I think we have been very adequately prepared for COVID, thanks to all the measures taken by everyone. And I think the example was set by the Western world just not prepared enough to take care of the COVID patients. But in the bargain, I think there has been some collateral damage. The non-COVID patients are not coming to the hospital. And initially, many hospitals also discourage them thinking that the load of COVID would be very high and we may not be able to take care of everyone. Now, you bring up an interesting question whether treatment was denied, not intentionally, of course, because the patients couldn't come to the hospital or hospitals were not open. The fact of the matter is the hospitals are open, outpatients, inpatients, operating rooms, emergency rooms, everything is open. And as you rightly pointed out, dialysis is 100%. In Manipal Hospital alone, we do close to 150 dialysis per day. And we also help them and the police and the government also helps them in transportation and other things. But elective cases certainly have come down. But if you ask me, is there a progression of disease? I would think that if someone can get all of the doctor, many of them would advise them if they think the disease will progress rapidly to come to the hospital. In fact, we have norms of which are the diseases that are likely to progress if not treated and will take extraordinary measures to have them come to the hospital and be treated. This is specifically so in cancer treatment, emergency surgeries, emergency cardiac issues. But obviously some people may not want to take the risk of going to the hospital unless the symptoms are severe or they're aware that the disease could progress. Certainly the outpatient, inpatient and surgery numbers have come down. But I still believe that all of us are making an effort to make sure that patients who are sick can need to be treated and have a risk. If they do not get treated on time, we encourage them to come to the hospital. And what we tell all patients is at least talk to your doctor on the phone or avail his services or her services as a tele-counselt and let the doctor and you decide to get that whether it's safe to wait or not. So do you think it is going to be the new normal now? If I'm a patient, I consult my doctor with the tele-conversation or Zoom camera service of this kind. The video consultations are becoming the new normals? Yeah, it certainly is more popular now. And my own feeling is that this will continue in the future. Once people have tasted a video consult or a tele-conselt and they're comfortable with that, I'm sure many people would still like to see the doctor or the healthcare worker face to face. And especially if you are ill, there's no other way out. You have to be in the hospital. But I think routine colds, coughs, rashes and all those things, people were consulting doctors on the phone. And now it's a little more sophisticated. I'm sure we'll probably increase our tele-conselt numbers even if the COVID disappears from Mother Planet of ours. Sir, I also get to hear that as much as the patient's history is sought out by the hospitals and doctors, the patients also are interested to know if the doctor had travelled or if he had any symptoms. I'm sure you must have similar anecdotes. Yeah. And it's a very interesting question that you asked. And I think this, to me, is a great sign that the patients are educated and aware of what's happening. I recently spoke to a very senior doctor and he said that a patient had called him for an appointment. And he said he gave an appointment. And then the patient sort of said, doctor, if you don't mind, could I ask you whether you have been tested for COVID before I come and see you? I think it's well within the normal of the patient's rights to ask for it. Just like we would ask for various tests in the patient before they undergo surgery or procedure. I don't think there's anything wrong with the patient. And I think we have done a good job of creating awareness about the disease. I was quite amused and also happy to hear that. And this is, I'm sure, happening to many doctors. Yeah. It's good as long as it doesn't take the stigma with it, isn't it? Yeah. I think, see, any new disease will have some stigma. I was in the U.S. when AIDS, the HIV virus, was not yet discovered. Yes, I wanted to ask you that. Yeah. In the 80s. And when we first found out that the patient was HIV positive, people were scared, stigmatized, just like an open case of PB or something like that. People shunned them. In fact, believe it or not, when I was in training, my fellow resident was sick and I had to rush him to the ER. And it's only about a week or 10 days later, I found out that he had HIV. So no one knew that people are hiding facts just like how people would do with a new disease because they don't want to be stigmatized. But I think soon it will be fashionable to say I had COVID and I've gotten better. Absolutely. Yeah. There is another thing I wanted to check with you. The private hospitals have not largely been in agreement, if I can say, with the government interfering in any of their functionaries. But now we have reached a situation wherein the financial losses are also seen in private healthcare segment. And the day before, a couple of doctors along with the Federation of Healthcare Associations in Karnataka have met the chief minister and have sought for financial assistance to pay the salaries for the staff. 25% of the staff salary for the next six months is what the private hospitals have asked the government. It means that the situation is quite alarming for the private health sector to further come up. Clarify, I think we have always worked with the government. There may have been some difference of opinion, which is that even in between husband and wife and then families. I don't think we have had any serious differences and most of the times it has been sorted out even a serious instance like KPME was sorted out with the dialogue between the government and private sector. So I think there will be some differences, but I'm sure they can be sorted out with dialogue. Obviously, as we talked about earlier, there's a huge collateral damage. The patient, non-COVID patients are not coming to the hospital for various reasons. One is, of course, initially the hospitals also didn't want people to come in if they were not very sick because if suddenly a large number of COVID patients came, then they had to stretch the infrastructure. And of course, the lockdown would inhibit some free travel and two large action patients were also scared of this new disease that is up in the air. You just walk out, you'll get it and those kind of things. So there has been a significant decrease from what I hear anywhere around 60 to 70% of occupancies, outpatient visits, surgeries have come down in most hospitals. And the infrastructure and the salaries have to be going on. So I'm sure there is some financial stretch or stress in many of the private sector hospitals. And usually whenever there is a sector that is distressed, there is a dialogue with the government. And I do not think that should be the only reason that we should only think that we should be worried about. Sooner or later, this will be fixed. I think it's a matter of one or two months before some increase in the numbers happen. And this will not hopefully not be a long term, one year, two years shut down. I think there are sectors that are completely wiped out like the hotel industry, aviation industry. My concern right now is that people from the weaker sections of the society, the daily wages and people who have to work day to day to earn a living should not be affected. So also the agricultural sector, which is the backbone of the Indian society, they also need some leeway. They have to do harvesting, sowing, so on and so forth. So health sector certainly is stressed out and I'm sure there's a dialogue going on with the government. And the government has come out with some measures to help the various sectors, including the health sector. But that's an ongoing dialogue, but I'm sure that will not come in the way of treating the patients who require treatment. Yeah. Doctor, but do you think the Indian data of COVID-19 is bit of deceptive? I certainly would not say it's deceptive. I think the number of cases may be more than what is publicized, because we may not be testing in our number of patients. I do not think it's underreporting probably not enough tests being done. So unless you're symptomatic or you visit the hospital for other reasons, you may not be tested. There may be more number of cases that have not been tested. Hence, you cannot call them as documented COVID cases, but I do believe we don't have too many sick people. Otherwise, that would be captured in our data, whether in the hospitals, ICUs or in the death rates. And the paradox of COVID is that there's a significant decrease in the serious cases in ICU due to other respiratory illnesses. Maybe all the social distancing and other things have helped. And certainly there's a big decrease in deaths due to road traffic accidents. Absolutely. Yeah. Doctor, am I frozen? No, no, I can hear you and also see you. I couldn't see you for a second. Yeah. I know that not just you, but your hospitals also has been working with the government. Some of the doctors in Manipal hospitals are also working with the trauma care center of Victoria in analyzing some of the tough cases. I think whenever there is an epidemic or a national disaster, I don't think we should differentiate between government and private. We should work as a team. That is the need of the country and also need of the society. And we are very happy that the government has been proactive. The chief himself has been leading from the front as called for a lot of meetings with the private sector. And I'm sure they have asked many other groups to including ours. And as I said, we set up a COVID hospital in Rootpee, 150 bed hospital, but fortunately it's underutilized. And in Bangalore, we are working with the government in setting up EICUs and virtual councils for from the district headquarters hospitals. We have also dedicated an ICU team if it is needed to go to Victoria hospital for their ICU and emergency care. But so far, really, the need has not been very much, which is fortunate. So we will work with the government and we should work with the government in cases it is needed. Yeah. Doctor, we also have as I told you earlier, we are going live actually on our FB page. So there are multiple questions that I get to see from my team. There's one gentleman who is asking, how effective is teleconcentration? Can it replace the doctor's healing touch? We all grew up at that time, at least I grew up in a time where it was very important to say namaste to the doctor and meet him or her. But now the life is changing. I think teleconcentration should be more of the norm and it's good in many instances. For instance, in dermatology, radiology and the common coughs, colds or minor illnesses. I mean, in the olden days, it used to take two hours to travel from Bansankari to Manipal Hospital. So if you could manage with a teleconcert or 15 minutes or 20 minutes, that certainly would save about three hours of travelling, your gasoline, damage to the planet, environmental destruction. So I think we should encourage teleconcerts. But I think there's still a role for the human touch. I think no technology will ever take away the human touch. So it could be used more selectively. I hope that answers your question, Mr. Abhishek. Another person who is asking this, what is your opinion on mass rollout of a COVID vaccine? And the timeline and the timeline. Yeah, I think you bring up a very important issue. How do we learn to live with COVID? There are only two ways. One is that herd immunity which develops over a period of time because there are a lot of subclinical infection. Second is effective vaccination. But that is something we'll have to wait and see because vaccinations have not always been effective. The most effective vaccinations that I am aware of for the human race has been polio and smallpox, which is pretty much eradicated because of the vaccines. But there are so many other vaccines that are not as effective. For instance, H1N1 vaccine, the flu vaccines and all that, even though the vaccines exist and people still develop the flu. So we do not know. It's too early for us to know, but it will be a great move if we can get an effective COVID vaccine. Then people will be a lot more confident to sort of go about their normal activities. Thanks for that, sir. We have Ms. Sandhya asking as what is the current mental state of the doctors who are in the frontline treating COVID-19 patients? Any interventions from the hospital management and government to take care of this? I mean, you have handled the situation yourself in Manipan hospitals when you treated multiple COVID-19 cases. I think my face should tell the lady that we are still cheerful and smiling. But on a more serious note, I think it is a very stressful job, especially for the frontline workers. And I don't mean only doctors. The nurses, the ambulance drivers, the ward boys, they are also a hard hit. So there is a lot of stress and the stress is not only for the individual self, but also for their families. Because a lot of doctors have families, young children, and they don't know whether they should go home or not. So I think it is a stressful situation. But as doctors, most of us are trained to sort of manage stress better because it's a long, arduous course of 10 years or so before you become a specialist. And you see, you have seen a lot of illness, death and misery. So I think you get somewhat tuned to the stress. But certainly help is needed for many people and many centers, including our zone, offer counseling to the doctors, healthcare workers, and they are free to speak to any one of them and constant counseling sessions go on with the senior personnel and experts in the field talking to them. Yeah. So now this is Dr. Balal as nephrologist, if you can tell us, there are multiple patients of yours who whose transplant is probably on hold, even the life donor transplant for various reasons during the lockdown. And the cadaver donations have almost come to a heart temporarily. There are no vehicular movement and good or bad, there are no accidents also. What is the hope for patients with renal failure now, sir? So I agree with you that the transplant numbers have drastically dropped. This donor cadaver is almost non-existent now, but even living donors have come down significantly. Fortunately for us in the kidney area, you have dialysis an option. You can be in dialysis for weeks, months or sometimes years. So it's not like it's a medical emergency. And we do offer transplants to patients who actually need it. We have done liver transplants for people with acute liver failure. And so also in kidney transplant, if we think that the patient cannot survive on dialysis, there's a serious problem. We do offer transplants, but it is more laborious now because you know, travel restrictions and also the committees sometimes find it difficult to meet because they're held up with so many different things. But because there is dialysis available for most patients with kidney failure, it's not life threatening in many instances. Yeah, yeah, I get that. There is another question on an app that was launched by the government. I don't know how relevant is this question that I should be asking you, but the question is, you take on ROG C2 app. Is it the right method to tackle COVID-19 when smartphone usage is limited in our country? Actually, I think any creation of awareness that will prevent the disease is useful. And the phone usage now is quite rampant. In fact, everyone can use the phone, may not be a smartphone, but most people now get information through the phone rather than any other form of media or other things. So I think it is good. I'm sorry to interrupt, but maybe I think what Ms Ratna probably meant is that we do not have great internet facility 3G network in our rural areas and India being, you know, quickly populated country in rural areas and the penetration in mobile network could be low in these areas I think is what she meant. Yeah, fair enough. Fair enough. I think information. Many of the things cannot be spread to every area, but at least in the areas that it can be spread it's useful. We should look at other means of spreading awareness in the villages. And I must tell you that I didn't realize the government had so much of power and they could do so much in such a short period of time. Every DC of every district has been so active. I don't think they have slept for weeks together. I've seen DCs of different districts, extraordinary things they've done in the power that they have. So I think it's good to know that people can act when it is needed and can act in a hurry and that's a good sign. So I'm sure there is a lot more awareness today. I'm sure that patients asking the doctors, have you tested yourself for COVID before I come and see you. So obviously, some of these are good signs. Yeah, there is another person who is saying. Okay, so we spoke about the telemedicine and the video consultations, and this gentleman is asking apparently he's a patient for the last 15 years. He hasn't mentioned of what illness it is, but he's asking telemedicine is fine, but what about the blood investigations and and other tests that require to be done. See that has to be decided by the doctor who is treating him. Yeah, and obviously some areas home collection is still available. And some areas they can go to the nearby lab and get that done, but whether the testing is needed or not is something that he has to discuss with this doctor. Okay, but I'm sure this is something that has come up in during your video consultations as well. So during the lockdown how do you arrange I mean how does the patient reach out to the hospital. I mean, I'm sure there are numbers that are distributed for help with the teleconsultation, then obviously the ambulance services are open all the time. And the police has been using very extensively their hoisela for moving they even helped our dialysis patients move back and forth. So I think there are ways and means of reaching out in case that is an emergency. The other question is pertaining to the blood donation during the COVID-19 crisis and is there a shortage. You as head of the hospital and also being a part of the COVID-19 expert committee. What has been done by the government to make sure that the blood shortage is tackled. See, there are two interesting things that you bring out one is of course donation of blood would obviously be less when there is restrictions of travel lockdown. But the consumption of blood also to some extent has come down because number of surgeries have drastically dropped. Yes, yes. So most of the blood is used during surgeries. That is one aspect. The second is trauma has come down so much that you know we don't see very patients who have had major accidents bleeding in the emergency room. So the consumption of blood also has come out and there are a lot of good samaritans in this world whenever we said that we need blood. A whole bunch of our consultants along with many of our other staff went and donated the blood. We have many of our senior doctors, nurses, everyone go and donate blood whenever the blood bank has said that there's some shortage of blood. So I'm sure there are good samaritans all over the country, including our own city of Bangalore and whenever there's a shortage, they'll take care of it. Obviously it may not be as much as what was happening earlier, but it is happening. Okay. So far that's all the questions that I get to see in our page. I think we probably can now close the session with your remarks and your suggestions to our audience on what is the best way that they actively engage them at home during the lockdown till May 3rd, sir. And to all your patients who I'm sure would be watching. I think the first thing I would like to say is that Corona has changed this world and certainly it will not be the same world and hopefully some of the things will be better in the future as I said earlier, like social distancing, cleanliness, self etiquette, concern for others, more civic sense and so on and so forth. And one strong message I would like to give as far as Corona is concerned is that don't be scared of Corona, be prepared for Corona, let Corona be scared of you. Only then you can get rid of Corona. And the question that you raised, I think a lot of us were thinking of maybe retiring in five years, and this is a forced retirement and I'm sure now I've decided not to retire. I mean, it's difficult to stay home. Of course, retirement would be very different. You would not be locked down in the home when you're retired, you could still be traveling, playing golf, whatever. So I think now you're confined to your home, which is more difficult than just not going to work. So I think all your social engagements have gone. So my advice is one indulge in activities that you could not indulge before. Do not lose track of your exercise. Do not lose track of your diet because it's easy to gain weight if you're not working. And the third thing is spend as much time as possible with the family. Yeah. I think these are these are the great takeaways from today's session. So thank you so much, Dr. Bala for agreeing and engaging our audience with almost 30, 40 minutes of conversation and, and you're such, you know, answers that are quite enlightening. I want to thank all the viewers once again catch up with us for our next FB live sessions once again. Thank you so much, Dr. With this week, we, you know, stop this particular session. Good day, everyone. It was a great program and I love being here. Thank you. Thank you. Bye bye.