India must act now to protect its health workers | Opinion – analysis
As we congratulate the government on its Herculean efforts to stop the spread of the coronavirus disease (Covid-19), through the nationwide blockade and complete social estrangement, another urgent problem has emerged. While social distancing and blockage will save us time, there is the inevitable escape from the disease, which is likely to happen imminently, and a spread from community to community that will bring increasing numbers of sick people to our hospitals. If that happens, we will have to answer the big question: is our health care system ready to take care of them?
The pillars of Covid-19 hospital and outpatient management are the 3 Ps: location, provider and personal protective equipment (PPE). The healthcare provider and PPE are closely intertwined, a relationship that must be understood to combat the virus. The most valuable resource is the healthcare provider. India has a shortage of healthcare providers and has also been suffering from a shortage of nurses for years. If they are not protected by PPE, healthcare providers have a high probability of becoming infected, which will invalidate them and force them to leave the workforce. Then they may require treatment and care, and they may die, as happened to the doctor in Wuhan, who was one of the first to raise the alarm about the coronavirus but succumbed to the disease. Also, you cannot send infected healthcare professionals to their families, as they will infect and perpetuate the community cycle. Herein lies the crux of the matter, which all managers and planners must understand.
An adequate supply of PPE is the basis for defeating the virus. What are the measures we must take to ensure that the EPP supply chain guarantees safe and quality services? Radical measures include both increasing the production and supply of EPP like never before, and ensuring that it reaches hospitals, Covid-19 centers and clinics. On Monday, to its credit, the government announced measures to improve the EPP acquisition. But the basic reality in India remains grim. India is poorly equipped in this regard, with almost no PPE in the system. This has resulted in manufacturing and distribution systems being overwhelmed with hitherto unprecedented demand that they cannot meet. Then hospitals find it difficult to admit a deluge of sick Covid-19 patients.
Here are suggestions to meet the extraordinary demand for EPP and the decrease in supply:
First, an emergency PPE law for production, distribution and use must be enacted. This must be a strict law and must be properly and effectively implemented. Also, many players are selling PPE at an improved price, and there is uncertain quality control. PPE must undergo reasonable price control and accelerated quality and approval by a nodal review agency with cascading state units.
Two, a central EPP distribution system must be implemented with military precision to ensure that there is no intentional or inadvertent waste. Transportation times are improved due to blocking, and this is leading to delivery delays for the end user.
Three, Covid-19 centers must be audited and approved by an external team of experts to ensure there are no shortcuts for PPE / staff. Current isolation beds are purely cosmetic if they cannot last a minimum of one month with proper personnel / PPE.
Four, it is imperative to educate public and healthcare providers about PPE. Not all healthcare providers need the highest level of PPE, such as N95 respirators. The workforce must be quickly trained to optimize its use. India already has an advanced digital infrastructure for this. Educating the public about this is also important. Unnecessary panic had led to the accumulation of N95 masks by people across the country. A call can be made to buy them back from the public to increase current supply.
Five, innovative measures such as mask reuse (with proper sterilization in low infectious areas), cloth masks and overalls can be carried out to meet the growing demand. This can save us some time as production increases. You need to form a tank of ideas and activities to explore safe alternatives.
Damocles’ sword hangs over the heads of healthcare workers as they prepare to fight on the front line against the Covid-19 attack. These critical front-line workers are also experiencing extreme personal anxiety. It is up to the system, the administrators and the government to take stock of this and provide them with some kind of relief on the war footing. Healthcare personnel are the most valuable people on the front lines of this war, caring for patients, ensuring their treatment, and containing the spread of the virus. We cannot stop Covid-19 without protecting them. Let there be no ambiguity: we must immediately create all the appropriate interventions for the safety of our health workers. If we don’t, they can leave the workforce in large numbers, as seen in Spain and Italy. We owe it to them, and to the rest of the country, to win the war against this pandemic.
Ravindra M Mehta is the Chief of Pulmonary Medicine and Critical Care at Apollo Hospitals, Bengaluru.
The opinions expressed are personal.