Healthcare personnel are at the frontline of caring for patients, and the most valuable people in the fight against Covid-19. To win this war, they must be protected
By 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/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 that arises is whether our system is ready to take care of them?
The pillars of hospital and out-patient management of Covid-19 are the 3P’s—place, provider, and personal protective equipment. The healthcare provider and personal protective equipment are closely intertwined, a relationship that has to be understood in order 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 personal protective equipment, the healthcare provider has a very high chance of getting infected. If infected, they become invalid, drop out of the workforce, sometimes themselves need healthcare and can die, as happened to the doctor in Wuhan who succumbed to the disease. In addition, one cannot send infected health professionals back to their families as this will spread the infection, perpetuating the community cycle. Herein lies the crux of the matter, which all administrators and planners have to understand.
An adequate supply of personal protective equipment is the foundation for defeating the virus. What are the measures we need to take to get the personal protective equipment supply chain in order such that safe and quality services are ensured? Radical measures include both ramping up personal protective equipment production and supply like never before, and ensuring that these efficiently reach hospitals, and Covid-19 centres and clinics. At the moment, the ground reality is that we have hardly any personal protective equipment 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 Covid-19 patients.
Here are suggestions to meet the extraordinary personal protective equipment demand with dwindling supply:
An emergency personal protective equipment law for production, distribution, and utilisation. This must be one of the most stringent laws ever seen, and be implemented appropriately.
A central personal protective equipment distribution system with military precision and implementation to ensure there is no wilful or inadvertent waste.
Covid-19 centres must be audited and approved by an external team of experts to ensure there are no short cuts for personal protective equipment/personnel. The current so-called isolation beds are merely cosmetic if they cannot last at least for a month with adequate personnel/personal protective equipment.
Education of both public and healthcare providers: Not every healthcare provider needs the highest level of personal protective equipment such as N95 respirators. We must quickly train the workforce to optimise their use. Luckily, an advanced digital infrastructure for this already exists in the country. 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 are reusable with appropriate sterilisation in low infectivity areas. Other options such as cloth masks and body suits 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 they prepare to fight at the frontline against the Covid-19 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 footing. Healthcare personnel are at the frontline of caring for patients; they 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 us immediately create all the proper interventions for the safety of our health workers. Else, they will drop out exponentially as has happened in Spain, or Italy. We owe it to them first, and it will also help the rest of us win the war with this pandemic.
The author is Chief of Pulmonary, Critical Care and Interventional Pulmonology, Apollo Specialty Hospitals. Views are personal