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Antibiotics – A Magic Bullet; But, Not For All!

The word Antibiotics comes from the Greek words ‘anti’, meaning ‘against’, and ‘biotikos’, meaning ‘concerning life’.  Antibiotics are mainly active against bacteria.  They do not cure infections caused by viruses or parasites or fungi, though some antibiotics may act against parasites.  Looking at the second part – “biotikos”, whose life is at concern?  It’s not just the life of bacteria, our lives too!  Antibiotic usage goes with the idiom ‘double edged sword’ – something that can be seen as a benefit and a liability.’ A diligent restrained use of antibiotics is a must for a secure tomorrow!

Antibiotics are one of the most commonly prescribed medicines only next to paracetamol!  There are several reasons for this (ab)use.  To list a few –

  • Parental anxiety/Parental pressure/Parental Misconception– A common scenario found in most of the outpatient clinics.  Any child with high fever, a runny nose, loose stools, vomiting etc., parents’ first remark would be, “Doctor, my child is having an infection, please give him some antibiotics to make him feel better as early as possible!”
  • Physician’s anxiety – Mostly seen with young or newly started physicians.  “What if I don’t write an antibiotic and this child doesn’t get better?  What if the child is taken elsewhere and doesn’t come back?  I may lose more patients because of this one parent who may say to others – ‘this doctor is not good.  He did not prescribe antibiotics and my child’s condition deteriorated’ and so on.”
  • Pharmaceutical companies – They pressurize the health care professionals to meet the target or to move the products in exchange for some incentives.
  • Luxury of insurance coverage This has been trending over the last few years.  It is commonly heard from parents – “Doctor we have insurance.  Please write the best possible antibiotic.”
  • Corporate or Private Health center’s pressure – A pharmacist or the supervisor walking into the doctors’ chambers saying “Doctor, look at this list of antibiotics, not moved at all…expiring in next few months!”
  • Weekend Syndrome – This syndrome owes its origins to the busy life schedules of the modern world. A busy parent may think, “Today is friday/saturday!  Doctor may not be available for the next 1-2 days.  What if my child doesn’t recover?  Better to take an antibiotic.”  A Doctor’s thought, “Let me give them antibiotics, just in case?”  Both these thought processes aid each other – with the end result being an antibiotic prescription.
Living weekend to weekend - causes tremendous pressure among working couple
Living weekend to weekend – causes tremendous pressure among working couple
  • Lengthy Line – Lack of Time Syndrome – This mostly happens with busy practitioners.  To evaluate any child with fever, it takes at least 10-15 minutes.  If there is a line of 60-80 children, the evaluation time can range anywhere between 10-12 hours nonstop.  Practically impossible for a human mind to focus on such extended periods of time.  The easiest option would be to prescribe anti-biotic – thereby saving time.
  • Play safe policy – “Why take chances?”
  • Let’s make others happy attitude!  Quick antibiotic – Parents are happy.  Pharmacists and pharmaceutical companies are happy. It all looks like a win-win situation.  
  •  Lack of forethought – Not thinking of what will happen if the antibiotic becomes useless tomorrow due to development of resistance, which by the way is not a farfetched idea. The devil is just around the corner.
  • “Quack – Quack” Found mostly in sub urban or rural areas.  In many rural areas where there is dearth of qualified doctors, unqualified practitioners prescribe anti-biotics as quick fix – without understanding the consequences. In many cases these “Doctors” acquire their knowledge through internet and through “Medical Representatives’ University”.
  • Working parents’ apprehension: More the number of days lost in taking care of a sick child, more to lose at the workplace.  They end up pestering the doctor for antibiotics.

Myth Busters –Clinical scenarios commonly we come across

  1. Myth: Fever = Bacterial infection.  Many parents believe that fevers are due to bacteria and don’t get cured without antibiotics. 

Buster:  Most of the fevers in pediatrics are viral and don’t need antibiotics.  Good nutrition and hydration, fever control and adequate rest are all that is required.

  1. Myth: Loose stools (diarrhea), vomiting, abdominal pain = Food poisoning due to bacteria and an antibiotic is a must.

Buster: Most of the gastrointestinal symptoms are either due to a virus or preformed toxins or self-limiting bacterial infection.  A good (re)hydration with ORS or tender coconut supported by proper nutrition, adequate rest, probiotics (benefit of doubt) – yoghurt or commercially available probiotics and other micronutrients like Zinc should suffice and/or anti-emetics.

  1. Myth: Runny nose, fever, throat pain = Throat infection due to bacteria.  Better to start antibiotics early!

Buster: Most of the upper respiratory infections are due to viral etiology, unless proved otherwise.  Supportive care should work most of the time.

  1. Myth: Injury/ Wound = Antibiotic is needed to prevent further infection.

Buster: Unless it is case of major or contaminated wounds – proper cleaning and local care should do the trick.

  1. Myth:  Too much cough = Severe bacterial infection.

Buster: Most kids cough either due to a viral infection or some allergy which should be taken care of without anti-biotics.

  1. Myth: Fever has disappeared after 2 days of antibiotic; So why take it for a prescribed number of days?  Let’s save it for the next fever/infection!

Buster: Properly diagnosed and treated bacterial infection usually responds to antibiotics in 48-72 hours.  That doesn’t mean the infection is totally cleared.  It is necessary to complete the prescribed course to eradicate the infection completely.  

  1. Myth: I have the same symptoms as last month – so I bought the same medicines from pharmacy – but it’s not working this time- what’s wrong?

Buster: There are several bacteria which can cause similar symptoms; Let the doctor do his assessment. A doctor is professionally trained to identify these subtle differences and prescribe suitable medicine. Do not try to be a doctor! 

  1. Myth: “Doctor!  The antibiotic you gave worked like magic.  One dose and I’m alright.”

Buster: Effectively treated an infection responds quickly; if the response is so quick with one dose, it is most unlikely a bacterial one.

With an effort to supervise judicious prescription of antibiotics by clinicians and followed adequately by the patient/parents,Antibiotic Stewardship program was brought into existence.  Stewardship program would guide us to use antibiotics diligently, in a restrained manner for securing tomorrow’s concern while treating infections.

To Be Continued…

Disclaimer:  The above article is only to create awareness regarding antibiotic use.  The given information should not be used as a substitute for doctor’s consultation in case of any clinical symptoms mentioned above.

Ramesh aged 35 Years, an IT professional, has an annual income of around Rs.15 lakhs. He lives with his spouse, a homemaker, and a daughter of 4 years age. One of his close friends, Suresh, met with an accident. The hospital bill came to Rs. 3 lakhs and unfortunately Suresh did not have any insurance. To foot the bill, he had to close his bank FD. This FD was earmarked to fund his child’s educational needs, which is not a possibility now. His child’s educational needs remain underfunded.

Suresh was the sole bread winner of his family and was asked to take complete rest for four months. This is a double whammy for people like Suresh – one being uncovered medical expense and another being loss of income. Suresh was rightfully worried as to how he would manage his family expenses for the next four months without any income. Looking at the situation of Suresh, Ramesh felt its high time, he takes up insurance cover. But he was not sure what kind of risk he is exposed to and how does he go about estimating and managing his risk?

So, let us analyse the above situation and understand how to “Cover Your Risk

Step 1 – Cover Your Risk – Life Insurance

Ramesh is a very energetic and positive person; he takes good care of his health and strongly believes he will live longer. But let’s be realistic, death is certain and only the timing is uncertain. Ramesh has another 25 years of work life. Assuming he will earn the current income for the next 25 years (without taking any growth), he has the potential to earn Rs 3.75 Crore (Rs 15 lakhs/year X 25 years). Ramesh should take coverage of Rs 3.75 Crore to protect the income loss for the family in case of his demise either natural or accident. So, let’s see the different kinds of products available in life insurance for Ramesh to safeguard his family’s financial position in case of his demise.

  • Term Insurance — Term insurance is a pure risk cover and a very good product. The premium would depend on age, health condition, and other factors. This product gives very good coverage for a very small premium amount, for example, it would cost approximately Rs 35,000 per annum for Rs 1 crore coverage, and if he pays a premium of around Rs 1.30 lakhs he will get a coverage of Rs 3.75 crores.
  • Insurance cover + Savings (Conventional product/Non-market linked) — These products specify the returns for the investors which can be either fixed or variable. The coverage varies between 10 to 15 times the premium. Here Ramesh shall pay a premium of Rs 1 lakh per year, to get a coverage of Rs 10 to 15 lakhs. In the case of his demise, the family will get an amount between Rs 10 to 15 lakhs. It is equivalent to Ramesh’s one-year earnings. How can his family survive on this amount for the rest of their life? It is not possible. So always treat this product more like a savings product and less as an insurance product.
  • Insurance + Investment (Market Linked or ULIP) – ULIP products are the flavour of the day, it is an investment product that invests in Equity & Bond market. The investment return depends on the market performance and the re-balancing strategy you deploy to move funds between bond and equity markets. In terms of coverage, it’s like a savings product where the coverage varies between 10 to 15 times the premium. If Ramesh pays Rs. 1 lakh premium, the coverage would be between Rs. 10 to 15 lakhs. So, again this is more of an investment product and less of an insurance product.

Step 2 – Cover Your Risk – Health Insurance (Disability Cover) – Income loss due to sickness or accident

Ramesh, realized life insurance will only cover for death; but what if Ramesh falls sick or meets with an accident which might reduce his earning ability?

Accidents could be the reason for loss of income
  • Critical Illness Cover—Health Insurance companies offer critical illness cover policy. Critical illness products cover pre-specified critical illnesses. In case the policyholder is diagnosed with any pre-specified critical illness under the policy, then the policyholder will get the sum assured or pre-specified amount. This can be used towards the hospitalization expenses or can be invested to create a regular source of income.
  • Personal Accident Cover (PAC)—Personal Accident Cover can offer financial support in case of loss of income due to accident. Ramesh can get a PAC for Rs 1 crore at an approximate annual premium of Rs 8,000. In case Ramesh meets with an accident and it leads to either disability or death, based on the extent of disability he will get compensation. This can be invested and that can offset the income loss due to disability either fully or partially.

Step 3 – Cover Your Risk – Health Insurance – Hospitalization Expenses due to sickness and accident

Health cost in India is on the rise. A report by Mercer Marsh Benefits said the forecasted Medical trend rate will be 10% in India, higher than the general inflation. Ramesh, when he heard Suresh had to close his bank FD to make the payment towards hospital expenses – he could see that happening to him too if he fails to take adequate cover. If he opts for a family cover (himself, spouse & child) of Rs. 10 lakhs for hospitalization expenses, it would cost him close to Rs 20,000-25,000 per annum. But he can have peace of mind, that in case of medical emergency he does not have to sell his investments, assets or borrow money.

Conclusion

Insurance is one of the most important financial products which mostly gets lower priority compared to other products. Buy an insurance product with the primary objective of covering risk and not for returns or tax benefits. If you can pen down five friends or relatives, who will financially support you and your family for the rest of the life, in case of your income loss due to disability or death, then you don’t have to consider insurance. If you cannot pen down the names, then insurance is a product you should look at seriously and Cover Your Risk.

The COVID-19 pandemic cases are increasing globally, and the number of confirmed cases in India has crossed more than 1.5 million. COVID-19, which started as a health concern, with continued lock-downs and social distancing, normal business activity has taken a back seat leading to economic slowdown. The International Monetary Fund (“IMF”) in its latest report projects the global and Indian economy to contract by 4.9% and 4.5% respectively in 2020.

The pandemic has made a difference in each and every one’s life. Positive changes include – individuals becoming more health conscious, more quality time with family and children, slowing down from their busy life schedule and taking life easy, becoming more technology oriented. Negative changes include heightened fear on health, job safety, and financial stability.

Now let’s look at real life cases of how the pandemic has affected the financial position of individuals

  • Mr Kumar is a website designer and digital marketing professional in Mysore. His monthly income more than doubled over the last three months.
  • Mr Bharath, an IT professional in Bangalore – had to take a pay cut of 20%
  • Mr Ram, who owns a fast food restaurant in Bangalore, had closed his business for three months. But he still managed to pay the rent and staff expenses from his personal savings
  • Mr Chandan, who was working as a travel consultant, has lost his job and is searching for new job.

Loan moratorium is helping individuals manage their cash flows; however the financial situation could worsen after the moratorium period ends. Many have lost their jobs or taken a pay cut in this on-going pandemic, exposing the financial vulnerability. Individuals who had a financial plan in place, would be in a better position to weather the storm, while those who did not have a right financial plan would be under financial stress.

Boost your Financial immunity at COVID Times

Key principles of personal finance are simple and effective, but many don’t follow the same as it requires a lot of discipline. Here are some of the key principles which can help boost financial immunity during current times.

  • Boost Your Income—COVID has changed the way businesses operate. We might witness a structural shift in certain sectors and industries. Individuals who have lost their job or who have got a pay cut should be cautious as the demand for their skill set is reduced or has become obsolete. So they should hone new skills which can make them more employable.
COVID Times: Boost Your Financial Immunity
Best time to develop a new skill
  • Never depend on single income —Make investment income your second source of income.  During good times, you need to save for your rainy days. Have a target saving every month, so that you will be well prepared for the future
  • Keep your expenses under control—COVID has brought in forced discipline. Many used to spend Rs 4,000-5,000 on a weekend pre-COVID, so their total spending was close to Rs.20,000-25,000 over weekends in a given month. Now all this unnecessary weekend expenses have drastically reduced. It would be better, as we get back to normal—to cut down unnecessary expenses.
  • Have a health insurance—COVID being a medical crisis, an individual is exposed to health risks. In an unforeseen event of hospitalisation, the financial burden can be significant. It’s better to take a decent health insurance cover, so that the financial risk would be reduced to great extent. You can even think of topping up your current health insurance limits. Most of the insurance companies have come up with top-up policies specifically for COVID times.
  • Avoid getting into new debts – During uncertain times, loan or debt can hurt very badly. It’s better not to take any new loan or debt. Also be wise in using credit cards. In this environment, it is easy to come across a lot of offers and discounts which might entice us to use our credit cards or get into debt. It would be better to postpone purchase, instead of getting into a debt trap.
  • Build an emergency fund – Three to four months of expenses as emergency fund which will come in as handy during tough times.

Conclusion :

An economic slowdown can significantly affect the financial position of an individual. The basic principles of personal finance though simple, need lot of discipline to be on track. Please remember the current economic slowdown, is just one of the slowdowns; We might have to see more in the coming years. If you were not well prepared for the on-going slowdown, you can start building your financial immunity with the above-mentioned key pointers.