LIVING UPTO THE HIPPOCRATIC OATH IN CORONA CRISIS
As the nation faces an unprecedented and indiscriminate rampage of Covid-19, the medical fraternity has risen to tackle the virus working in tandem with the authorities, like men in olive fatigue. In the Pink City of Jaipur, Dr C.P. Srivastava, Director & HOD - Cardiac Surgery at Narayana Multi-speciality Hospital, a highly respected name among the leading cardiac surgeons of North India, in a conversation with India Today, shares his views about care of cardiac patients in the midst of the lockdown. WHEN DO YOU ENVISAGE THE CORONA PANDEMIC TAPERING PARTICULARLY IN CONTEXT TO INDIA?
We are fighting an unknown and invisible enemy which attacks human life indiscriminately. As there is no definitive treatment available against corona virus, the battle seems to be long drawn. It may go on over months and probably years as research to find an effective medical antidote requiring many trials, tests etc. Thanks to the strict clamping of lockdown by our Hon’ble Prime Minister, we could avert a possible catastrophe in terms of infection as well as mortality rates. Considering India’s humongous population of 130 crores, we are much better off than many advanced countries with lesser population and best medical services, where the death rates are shockingly high. The tendency of any epidemic is first to peak then gradually come to a plateau and then start declining. In the last 2-3 days we have witnessed a plateau in infection and mortality rates which is an encouraging sign. We can only pray, hope and put in our best efforts to stop the contagion.
WHO ARE THE MOST VULNERABLE TO CORONA VIRUS?
Patients, both with pre-surgical and post-surgical history have to be extra cautious. It has been observed that 60-70 per cent patients who come to us are diabetic, hypertensive or have pulmonary conditions or are predisposed to these conditions. People aged 65 years and above are most vulnerable to the virulent virus and therefore, the death rates are the highest amongst them. The virus primarily attacks the lungs and in severe cases lead to blood clotting. If clotting happens in the brain it can present with brain stroke and if it occurs in the heart, then it results in heart attacks or heart failures. Patients having cancer, diabetes or history of heart ailment must take extra precautions. The golden rule is to stay inside the house and firmly maintain social distancing.
IN THIS LOCKDOWN WHEN EVEN HOSPITALS ARE SHUT OR OPERATING LIMITEDLY, HOW DO PATIENTS GET MEDICAL CARE?
Patients must be in touch with their respective doctors even in lockdown phase and this also goes for the case of normal incidence of heart ailments. Considering the pandemic emergency, the health and medical bodies have relaxed some norms to ease the trauma of patients. Phone consultancy has been allowed. I get several calls from patients. Hospital video consultancy has now been made legal, which is a boon to both the doctors and the patients. It helps us to physically see the patient enabling us to ascertain their medical conditions more precisely. Also, the trust and comfort factor are much higher when the patient gets to speak and see the doctor, which is half the battle won in this time of leading isolated lives. However, the traditional doctorpatient consultation conducts face-to-face in person is most ideal. For surgery, the patient must test corona negative or else chances of clinical infection is high and could turn positive needing shutting down of the hospital and placing the entire staff under 14 days quarantine.
EMERGENCY CARDIAC INCIDENTS CAN OCCUR ANYTIME AS IT DOES NOT KNOW OF THE LOCKDOWN RESTRICTIONS. IN SUCH CASE HOW DOES THE HOSPITAL ASSIST THE PATIENTS?
This is indeed a very sensitive situation considering that the hospitals are focused on treating corona infected patients and quarantine is to be adhered at all cost. We have formulated 4 levels for tackling cardiac cases intelligently and scientifically, a practise followed world-wide in this pandemic situation. Emergency cases needing immediate lifesaving treatment such as angioplasty or myocardial infraction (MI) come under level 1. We doctors’ place ourselves at grave risk in such situations and the only defence available to us is the safety PPE dress and mandatory precautions. Under level 4, patients can be treated by medication and surgical intervention can be postponed by several months. Between these two extreme levels, in the next middle level the cases can be pushed ahead by a few weeks which gives us time to conduct corona test on them before the surgery and only if they test negative, do we operate them. Likewise, in the next level chronic patients can wait.
COULD YOU TELL US MORE ABOUT THE PANDEMIC AND PRECAUTIONS TO BE TAKEN?
India has benefitted immensely with complete lockdown and cordoning off of hot spots and social distancing all imperative to break the cycle and flatten the curve. I would once again reiterate to maintain social distance, wear a mask, maintain hygiene, the sick should continue to take their medicines as advised by the doctor, eat food high on immune boosters etc., which are in fact lifeline to recovery and beating the virus to its dance of death. These measures have helped us control the pandemic to a great measure. Having achieved this considering the good immune system of us Indian’s it is expected that there is potential for 80 percent to develop immunity against the virus over a period of time. One must understand that the virus changes its physique because of which it is unpredictable whether it would take a virulent form or weaken. The strain of virus in Gujarat and Indore are said to be more malignant resulting in greater death toll. So, the situation still requires sharp vigilance. Also, recovery of a patient depends on the impact the virus has had on the lungs and its aftermath effects depending again on the extent of damage caused and the coping ability of the lungs and the body.
HOW WELL IS INDIA’S HEALTHCARE EQUIPPED TO TACKLE THE CORONA PANDEMIC?
One must understand that many specialities and the expertise of their practitioners come together and is paramount in treating corona infected patients requiring handling of specialised equipment. For instance, India has only 40,000 ventilators in all and an equal number of anaesthesia doctors out of which only 25,000 doctors are able to tackle corona infested patients, because the rest are above 60 years of age and so more susceptible to the virus attack. Also, one must understand that apart from the virus afflicted patients, there are chronic renal patients needing dialysis and other such illnesses needing handling of medical equipment for which a substantial number of trained hands are also required. Though we are acknowledged globally for medical expertise, number of personnel and equipment are still inadequate necessitating judicious use of resources. The only solution available to us is first to prevent further outbreak by adhering to the directives of the authorities and guidelines of the medical bodies in keeping the corona virus at bay.