India must act now to protect its health workers
At the very least, they require quality personal protective equipment. Here are ways to meet this urgent demand
As we congratulate the government for its herculean efforts to stop the spread of the coronavirus disease (Covid-19), through the countrywide lockdown and complete social distancing, there is another urgent issue which has arisen. While social distancing and the lockdown will buy us time, there is the inevitable disease escape, which is likely to happen imminently, and a community-to-community spread which 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 hospital and outpatient management of Covid-19 are the 3 Ps —place, provider, and personal protective equipment (PPE). The health care provider and PPE are closely intertwined — a relationship that has to be understood to fight the virus. The most precious resource is the health care provider. India has a shortage of health care providers and has also been reeling under a nursing shortage for years. If not protected by PPE, health care providers have a very high chance of getting infected, which will render them invalid, forcing them to drop out of the workforce. They then may require treatment and care, and they may die, as happened to the doctor in Wuhan, who was among the first ones to raise the alarm about coronavirus, but who succumbed to the disease. Also, you cannot send infected health professionals back to their families as they will infect them and perpetuate the community cycle. Herein lies the crux of the matter, which all administrators and planners must understand.
An adequate supply of PPE is the foundation to defeat the virus. What are the measures we need to take to get the PPE supply chain to ensure safe and quality services? Radical measures include both, ramping up PPE production and supply unlike ever before, and ensuring that it reaches hospitals, Covid-19 centres and clinics. On Monday, to its credit, the government announced measures to enhance the procurement of PPES. But the ground reality in India remains grim. India is ill-equipped in this regard, with hardly any PPE in the system. This has resulted in manufacturing and distribution systems finding themselves overwhelmed with hitherto unprecedented demand which they cannot meet. Hospitals then find it difficult to admit a deluge of sick Covid-19 patients.
Here are suggestions to meet the extraordinary PPE demand and dwindling supply:
One, an emergency PPE law must be enacted for production, distribution and utilisation. This must be a stringent law and must be implemented appropriately and effectively. In addition, many players are selling PPES at an enhanced price, and there is uncertain quality control. PPE must be brought under reasonable price control and expedited quality and approval by a nodal review agency with cascading state units.
Two, a central PPE distribution system must be implemented with military precision to ensure there is no wilful or inadvertent waste. Transport times are enhanced due to the lockdown, and this is leading to delay in delivery for the end-user.
Three, Covid-19 centres must be audited and approved by an external team of experts to ensure there are no short-cuts for Ppe/personnel. The current isolation beds are merely cosmetic if they cannot last, at the very least, a month with adequate personnel/ppe.
Four, educating the ublic and health care providers about PPES is imperative. Not every health care provider needs the highest level of PPE, such as the N95 respirators. The workforce must be quickly trained to optimise its use. India already has advanced digital infrastructure in place for this. Educating the public about this is also important. Unnecessary panic had earlier led to the hoarding of N95 masks by people across the country. A call can be made to buy them back from the public to augment the current supply.
Five, innovative measures such as mask reuse (with appropriate sterilisation in lowinfectivity areas), cloth masks, and bodysuits can be pursued to meet escalating demand. This can buy us some time while production is ramped up. A think-and-do-tank needs to be formed to explore safe alternatives.
The sword of Damocles hangs over the heads of health care workers as they prepare to fight on the frontlines against the Covid-19 onslaught. These critical frontline workers are also going through extreme personal anxiety. It is incumbent on the system, administrators and the government to take stock of this and provide some form of relief for them on a war footing. Health care personnel are the most valuable people at the frontlines 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 proper interventions for the safety of our health workers. If we don’t, they may drop out of the workforce in large numbers, as was seen in Spain and Italy. We owe it to them, and to the rest of the country, to win the war against this pandemic.