With COVID-19 lockdown in place, what next for the health sector

Now that a countrywide lockdown is in place, health practitioners say it’s time for citizens to strictly follow safety and quarantine protocol and for the government to streamline the country’s medical infrastructure to handle the increasing cases of coronavirus in the coming days.

Even though the Union government maintains that India is still in stage 2 of coronavirus, scientists say with many escaping airport screenings and quarantine facilities, the country might be well into the third stage.

Also read: Preventing community transmission key in India’s COVID-19 fight

This means community transmission may have already begun and the number of positive cases (415 as of Monday) could be much higher.

India has 20 days to act

In an article published in the Business Today on Monday (March 23), renowned cardiac surgeon and founder of the Narayana Health chain of hospitals Dr Devi Prasad Shetty says India which is lucky to have seen the “trailer” of the devastation (in China and Italy) that COVID-19 can cause precisely has just 20 days to act.

“We have just 20 days to act, sorry, with today gone it is 19 days,” he wrote.

A few days ago, Dr Shashank R Joshi, a renowned endocrinologist and dean of Indian College of Physicians in an interview with The Print had said that India which has a vulnerable working population, may witness an explosion of the virus into Stage 3 by mid-April when it infiltrates deeper into communities, making it difficult to contain it if a lockdown is not implemented.

What healthcare industry should do?

Giving the example of an action plan recommended for Karnataka a la UK, Shetty says it has been suggested to convert two busy 1,000-bed government hospitals in Bengaluru to COVID-19 centres. The centres should have critical care beds with piped oxygen, suction and compressed air supply to run 1000 ventilators by next Sunday.

Suggesting hospital staff to judiciously use oxygen, he says all air conditioners in rooms with COVID-19 patients should be switched off if the hospital management is not sure about the air quality.

He recommends the ministry of health to create two teams – one to consisting of physicians, pulmonologists and infectious disease experts headed by a senior physician from the government hospital with members from both government and private hospitals and another to be an ICU team of anaesthesiologists and intensivists headed by a physician from the government hospital with members from both government and private hospitals.

Stating that patients should first approach government hospitals, he says the critical cases should be sent to private hospitals which usually are equipped with modern ICU facilities and skilled staff.

He suggests that at this point of time, the government should launch fever clinics across cities which will screen patients for the virus and follow up with them.

When the virus assumes epidemic proportions, Shetty says hospitals may have to accommodate patients on the corridors when rooms fill up. To avoid such overflowing of hospitals, he recommends the government to allow positive patients to be quarantined at home at the discretion of doctors, as COVID-19 is a mild disease for a majority of healthy people. In such a setup, he says the patient should be supervised by a monitoring team at regular intervals.

An ICU team should meanwhile take stock of the infrastructure in government and private hospitals.

Shetty says the workforce should have adequate number of anaesthesiologists, intensivists, pulmonologists, ICU-trained nurses, junior doctors with basic knowledge of ICU care, nephrologists, radiologists, gastroenterologists, neurologists and cardiologists. There should also be enough availability of ICU beds, ventilators, cardiac monitors, syringe pumps, portable X-Ray machines for Chest X-Ray, beds with oxygen, compressed air and central suction lines, blood gas machines, N 95 masks, protective eyeglasses and Personal Protection Equipment (PPE), disposables like endotracheal tubes, suction tubes, PPE for two months, he adds.

That apart, at least 2,800 nurses, 800 resident doctors and 400 anaesthetists would be required to be deployed for 24 hours to take care of 2,000 ICU patients. The staff could be divided according to a six-hour long shift, Shetty says.

To boost the healthcare workforce, he says PG students should be given an opportunity to work in the ICUs as part of their course and junior doctors should be trained to work with PPE in non-COVID-19 ICUs for two weeks before working in COVID-19 ICUs.

What citizens can do

While the Centre has imposed a lockdown to encourage citizens to self-quarantine themselves to avoid exposure to the virus, doctors say not everyone with coronavirus symptoms should rush to the hospital to get tested.

“This is a message specifically for India. In India we have a peculiar problem. Everybody who has coronavirus or is suspected of it should not go to get tested. India has 1.4 billion people and the kits we have is less than 1,50,000 at this point of time. So the coronavirus infection will be asymptomatic or will be mild only like a respiratory viral fever for 85 per cent of the population,” said Dr Santhosh Jacob, director of Orthopedics and Sports Injury Management, Be Well Hospitals, Chennai

In an audio clip which he posted on social media in a bid to sensitise people on the dos and don’ts of coronavirus, Santhosh says those with symptoms of flu or cold to isolate themselves and follow the symptoms, especially till Day 9 when they will seem to subside.

“On day zero you will just feel a little fatigued. On day three you might have a mild fever with cough and an itchy throat. For a mild headache on and off day five, you might have some gastrointestinal symptoms like diarrhoea or cramps, along with headache and your fever might be normal or it might increase. Day six, day seven, you will feel more body pain and headaches will reduce, diarrhoea might increase or might reduce, and but you will still have stomach upset like loss of appetite like symptoms. Now here it is what is very important. Most of your symptoms will reduce on day eight and day nine that is where you have to keep watching,” he says.

Stating that while the symptoms will reduce to lower fever and body pain, patients left will a runny nose and cough at this stage would have developed resistance against the virus.

In case, the condition gets worse on Day 8 or 9 instead of getting better, it is then when patients should seek medical help by calling the coronavirus helpline.