Kasturba Hospital in Mumbai on Saturday. (Express photo/Ganesh Shirsekar)
Written by Dr Ravindra M Mehta
As we laud the government for its herculean efforts to stop COVID-19, especially with the countrywide lockdown, and with complete social distancing, there is another urgent issue knocking at our doors. It is important to understand that social distancing and the lockdown will buy us time. But then there is the inevitable disease escape, which is likely to happen imminently, and community-to-community spread will get increasing numbers of the sick to our hospitals. If that happens, the trillion-dollar question arises, is our system ready to take care of them?
The pillars of hospital and outpatient management of COVID-19 are the 3 P’s -- Place, Provider, and PPE (personal protective equipment). The healthcare provider and PPE are closely intertwined, a relationship which has to be understood to fight the virus. The most precious resource is the healthcare provider. In India, we have a shortage of healthcare providers and have been reeling under a nursing shortage for years. If not protected by PPE, the healthcare provider has a very high chance of getting infected. If infected, he becomes invalid, drops out of the workforce pool, sometimes himself needs healthcare and can die, as happened to the doctor in Wuhan who succumbed to the disease. In addition, you cannot send infected health professionals back to their families as they will infect them and perpetuate the community cycle. Herein lies the crux of the matter, which all administrators and planners have to understand.
An adequate supply of PPE is the foundation for defeating the virus. What are the measures we need to take to get the PPE supply chain in order to ensure safe and quality services? Radical measures include both ramping up PPE production and supply like never before and ensuring that it efficiently reaches hospitals and COVID 19 centers and clinics. At the moment, the ground reality is that we have hardly any PPE in the system. The manufacturing and distribution systems are overwhelmed with a hitherto unprecedented demand, and our hospitals are currently not equipped to accept a deluge of sick Covid-19 patients.
Here are suggestions to meet the extraordinary PPE demand with dwindling supply:
* An emergency PPE law enacted for production, distribution and utilisation. This must be a stringent law and be implemented appropriately.
* A central PPE distribution system with military precision and implementation to ensure there is no willful or inadvertent waste.
* Covid-19 centers must be audited and approved by an external team of experts to ensure there are no short cuts for PPE/personnel. The so-called current isolation beds are merely cosmetic if they cannot last at least for a month with adequate personnel/PPE.
* Education of both public and healthcare providers: Not every healthcare provider needs the highest level of PPE such as N95 respirators. We must quickly train the workforce to optimise their use. Luckily, an advanced digital infrastructure already exists in the country for this. On the public front, earlier panic has led to hoarding of N95 masks, and a clarion call can be made to buy them back from the public to augment the current supply.
* Innovative measures: Mask re-use with appropriate sterilisation in low infectivity areas, other options such as clothe masks and bodysuits are innovative options which need to be pursued to meet an escalating demand. This can buy time while production is ramped up. A think-and do-tank needs to be formed to explore safe alternative options.
* In short, the ‘sword of Damocles’ hangs on the head of the healthcare worker as he prepares to fight in the frontlines against the COVID19 onslaught. These critical frontline workers are also experiencing extreme personal anxiety. It behoves the system, administrators and the government to take stock of this on a war front. Healthcare personnel are on the front lines of caring for patients; are the most valuable people in this war, and we can't stop COVID-19 without protecting our health workers. Let there be no ambiguity – let’s immediately create all the proper interventions for the safety of our health workers – they will drop out exponentially otherwise like Spain or Italy. We owe it to them first, and it will also help the rest of us to win the war with this pandemic.
Dr Ravindra Mehta, MD, FCCP is Chief of Pulmonary, Critical Care and Interventional Pulmonology at Apollo Specialty Hospitals, Jayanagar, Bangalore