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Saving the Saviours!

A Delhi Cancer Institute has been shut for a day after a doctor tested positive for Coronavirus. The same thing happened in one of the leading medical institutes of South India. The pattern has been the same worldwide. A study published in British Medical Journal reports that some hospitals in Italy were closed down because of Coronavirus infection among doctors and nurses. Coronavirus has caused an unprecedented havoc in the healthcare systems of the most developed western nations. In India, the analogy has been raised in a global war with parallels drawn from iconic mythological war “Mahabharata”. India with its already constrained healthcare infrastructure is very much at risk and we just cannot afford this pattern to continue.

While combating COVID-19, let’s be clear – the battle is going to be long and tough so every resource matters and Health Care Worker (HCW) is one of the most precious resources. We can create Intensive Care Units (ICUs), build isolation beds, purchase ventilators- but nothing of that will work without trained manpower to run those. They cannot be produced overnight; it takes years of right training to make a HCW capable enough to save a life. Already, our number of doctors and nurses is much less than recommended and we just cannot afford to watch it reducing further. The risk of infection is exponentially higher for an HCW. In Wuhan, it was almost three times more with nearly 3300 HCWs infected. In Spain, nearly 14% of all diagnosed cases were HCWs.

Why preventing this is so vital and what happens when HCWs get infected – It creates a Cascading Effect. Let’s see how-

Contrary to what social media posts like us to believe, the treatment protocol is same –isolation, tracing, testing the contacts and isolating them as needed – this could mean a lot of people can get infection including other HCWs. A doctor in a government clinic in Delhi getting infection meant 900 of contacts falling in risk bracket. The fear of infection in the mind of other team members is reinforced. If many get infected, it compromises the hospital’s ability to serve as highlighted earlier. Also, HCWs like any other human have the anxiety of not only getting infected but of transmitting the infection to other family members. There have been stories in the U.S. of HCWs making their will.

Adequate supplies of appropriate PPE (personal protection equipment) which as per W.H.O includes – masks (Surgical and N95), goggles, gowns, hand sanitizers, soap, and water must be ensured. Along with this, a refresher training in infection prevention and control, proper usage, taking off and disposal of PPE is needed. Sharing age-old saying popular in ICUs – -Hand Washing Saves Lives- – needs to be reinforced with clear repeated communication.

As highlighted brilliantly by Dr. Atul Gawande in New Yorker, there should be a symptom check for all HCW’s reporting for work – whether they had any fever or flu-like symptoms and testing should be available as a priority for them.  

Indian Council of Medical Research has recommended the use of Hydroxy Chloroquine for the prevention of infection in personnel caring for Coronavirus patients. But due to panic created on social media, so many people who didn’t need it have bought and stocked it, which may lead to a potential shortage. The additional risk is that those who need it may not get it on time. Also, indiscriminate use can lead to resistance against the drug and even unwarranted side effects.

Equally important is to stop the hospitals from getting overcrowded. 80% of Coronavirus cases as per W.H.O. have mild disease and do not require hospitalization but just good nutrition, hydration, and isolation. In a study published in the New England Journal of Medicine, author Mirco Nacoti advocated the same as they found that hospitals in Italy were themselves becoming a big source of infection. Up to 41% of cases in Wuhan resulted from the hospital-related transmission. Dedicated hospitals for Coronavirus patients are the need of the hour. Virtual channels and Telemedicine can help more in chronic disease management, which may prove cost-effective also and help cut down Non-emergency hospital visits.

What hurts most is the lack of compassion and care for HCWs! There have been news reports that reflect stigma and ostracization when doctors living on rent were asked to evict for the fear of spreading the infection. This is a shameful and reckless social attitude.

It was great to see people coming out to applaud HCWs -that helps boost morale, but India needs more than just clapping and lighting Diyas.

It’s imperative to take concrete judicious steps because protecting the HCWs is the foundation of building a healthy India post-Covid battle victory.