An area of concern is the rising number of doctors/frontline health workers getting infected, as they are constantly on the job. Staff shortage is also an issue. With the cases in Chandigarh rising rapidly, how do you think can this issue be addressed? What can be done to reduce this exposure and also the pressure on the hospital staff?
Definitely, the frontline health care workers are at higher risk of getting infected with Covid-19 infection. They treat both symptomatic and asymptomatic patients. The risk from an asymptomatic patient is much higher, as neither the patient knows that they is carrying the virus, nor is the doctor aware. As per various published studies conducted in various countries, it is now clear that 10 to 75 per cent patients remain asymptomatic. With higher rates of infection among Healthcare Workers (HCW) in India, major hospitals dealing with treatment of Covid-19 patients have started facing staff shortage and if the situation continues over the next four to five months, staff shortage is going to be a major challenge for the country.
Like many other states, the cases are also increasing in Chandigarh over the last 20 days or so. The major challenge for City Beautiful is the influx of cases from neighbouring states. A large number of cases coming to the emergency of PGIMER and GMCH are a major challenge in terms of risk of bringing infection, plus utilising the COVID beds and ventilators. Approximately one-third of Covid-19 patients in GMCH are from neighbouring states. The problem can be tackled if the neighbouring states start looking after their Covid-19 cases.
In the beginning, most of the cases in Chandigarh were coming from two to three crowded pockets, however, over the last 20 days; most of the positive cases are coming from various sectors. Here the role of the citizens becomes important. The only way to control further spread in Chandigarh is to protect ourselves by using face masks, keeping at least six-feet distance while meeting others and washing hands with soap and water after touching any object outside the house and avoiding crowded places. Since Chandigarh has high literacy rates, it should be possible to educate the people of Chandigarh.
The HCWs are working under a lot of pressure. The citizens should recognise their hard work and show their support by acknowledgement. Small gestures will boost their morale.
In view of the sharp rise in Covid-19 cases in Chandigarh, what in your opinion can be the various strategies or road map to ensure adequate testing and treatment? What are the challenges that you foresee ahead?
In order to ensure judicious use of testing kits, PGIMER and GMCH have been following ICMR guidelines for testing. However, some of the states have been more liberal in testing and thus there was a feeling among the policy makers in the Ministry of Health and Family Welfare, Government of India that Chandigarh has conducted less tests. Over the last week, the number of testing has been almost doubled and the high-risk population like patients coming to emergency with severe medical and surgical illness, pregnant women and persons with severe mental illness are being tested.
We have seen many positive cases among medical and surgical patients who did not show any symptoms of Covid-19, but on routine screening they were found positive. Recently, three patients with severe mental illness who came for admission tested positive. Since it is very difficult to educate them and keep them on the bed, they would have spread infection among other patients and doctors. Their diagnosis has minimised the spread of infection among the HCWs. The major challenge before the heads of institutes is to keep the morale of the HCWs high, as the situation is likely to go on for many months.
How important is to increase testing among shopkeepers, chemists, vendors…people who interact directly with the common people?
It may not be justified to test all the shopkeepers, chemists and other vendors unless someone comes in contact with a positive person or develops symptoms. The most important thing is to follow standard guidelines of prevention by using face masks, keeping distance, and washing hands with soap and water. The shopkeepers, chemists and other vendors must wear face masks while serving the customers. If both the shopkeepers and customers use precautions, the spread of Covid-19 can be minimised.
Government hospitals in the city are inundated with patients from nearby states who, when tested, rush to Chandigarh. How can local hospitals step in to combat the crisis?
The problem can be tackled if the neighbouring states start looking after their coronavirus cases unless the tertiary care hospitals of neighboring states lack the specialised care. The doctors posted in the emergency cannot refuse admission as many patients are brought in serious conditions and they need immediate medical treatment. However, many patients get stabilised and can be transferred back to the referring doctor from the neighbouring states. This will vacate emergency and ICU beds for needy patients from Chandigarh as well as from other states.
GMCH has recently purchased six transport ventilators which can be used for shifting patients who need oxygen and ventilator support. It is also possible that the doctors from the neighbouring states can be provided phone numbers of nodal officers from PGIMER and GMCH to provide them telephonic consultation in managing serious patients of Covid-19.
What are your hopes for the Phase 2 and 3 clinical trials of the Covishield vaccine?
The launch of the Covid-19 vaccine is most crucial for India because the country has a large population and cannot wait for herd immunity to develop. The current estimated death rate among positive patients is approximately 2.6 per cent and with this figure India cannot afford to lose a large chunk of its population. Thus, early availability of vaccine for the country is very crucial.
The launch of Phase II and Phase III trial of COVISHIELD vaccine will help us to find out the safety and efficacy of the vaccine among larger population as compared to Phase I. If the Phase II and Phase III remain successful, the vaccine can be launched in the country after an approval from ICMR. However, the major challenge for India will be to manufacture large quantity of vaccine for use in the general population. Maybe to begin with, the government can give priority to high-risk population that is elderly people, people with medical and surgical co-morbidities, pregnant women and persons with mental illness and intellectual disabilities.
(Dr B S Chavan is also Professor and Head, Department of Psychiatry, GMCH-32 )
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