Control the spread of infection in hospitals

What we have learnt from the experience of other nations is that coronavirus gives very little room for mistakes. The best time to take strong action is when the threat appears to be small. The large number of healthcare workers in quarantine compared to the modest number of positive cases should serve as a wakeup call that a rethink is required to get the system in fighting shape.

Noor Shergill

Supreme Court advocate and former civil servant

The whole world is dealing with the spread of the coronavirus and our local health system is no exception. India has been fortunate to have had a headstart over countries such as China, Italy, Spain and the United Kingdom. This gave us an opportunity to learn from the examples of these countries to frame our own policy response. It also gave us the opportunity to get our hospitals and healthcare systems ready to fight this virus. However, it seems that this opportunity has either not been seized optimally or been squandered completely.

Consider the example of the tricity, comprising Chandigarh, Mohali and Panchkula. This hub of specialised medical care is home to renowned institutes such as PGIMER, GMCH-32, Fortis, Max etc. These hospitals will no doubt be expected to play a leading role in this fight that we have on our hands.

Only a fraction of the Covid cases in the tricity require hospitalisation as most of the patients experience mild symptoms. However, any patient can spread the disease to numerous other patients, leading to the number of corona cases snowballing. Since patients are present at hospitals, the hospitals have become major sites of the spread of the disease worldwide. The most worrying aspect of the disease has been the spread of the infection among the healthcare professionals.

Let’s consider the experience of dealing with a modest number of cases by our healthcare facilities in this region. In Mohali, a private hospital reportedly suffered an infection scare after a doctor contracted the disease from a patient at a hospital. A similar incident has been reported from Panchkula after two patients with respiratory problems died during treatment.

The number of healthcare workers in quarantine is reportedly more than twice the number of corona-positive cases.

The Prime Minister recently likened healthcare workers to our soldiers. So, just as the morale of the soldier at the battlefront is crucial in dictating the outcome of the war, so is the morale of the healthcare workers important in this war against the invisible virus. If the doctors, nurses, auxiliary staff do not feel confident and protected against the disease, we will see the unfortunate spectacle of desertion among the ranks. Already, some of the staff have started getting calls from their families to come back home. In Delhi, some doctors have tendered their resignations in the face of rising infections. Some other doctors are learnt to have procured certificates of pre-existing medical conditions to prove that the risk of infection could be lethal, akin to people trying to avoid conscription during wartime. In some other cities, nurses have gone on strike as they feel they are being pushed in front while their legitimate concerns are not being addressed. Moreover, everyone knows about the acute shortage of basic protective equipment.

If the healthcare worker is a soldier in this battle, the importance of his/her morale cannot be understated. A healthcare cadre with a high morale will fight more cohesively and withstand greater adversity. A unit with a low morale will buckle, desert or surrender. The morale is directly dependent on the health, comfort, safety of the healthcare workers. A system with good supply lines, assured access to essential equipment and clear protocols will typically have a better morale than one without. It does not appear that the healthcare system is even remotely prepared to handle the expected rise in number of cases. Each day, we are seeing videos of healthcare workers complaining of either the absence or the poor quality of basic equipment to deal with the crisis. Every nurse in quarantine, every death of a sanitation worker chips away at the morale of the cadre as a whole.

This is a time for us to ponder about the lessons from this early experience and bring about systemic changes in the local healthcare system. We must also learn from the experience of other countries. For instance, there is a need to designate certain hospitals where all respiratory emergencies are presented or referred to. This would require the establishment of a dedicated Covid-19 stream of care at these designated hospitals, separate from general patient population. The staff in the Covid-19 stream needs to be equipped with proper PPE for their safety and protection. Moreover, all respiratory cases must be dealt with on a presumption of being corona positive. This will ensure that proper precautions are taken early on and panic about infection spread is avoided when the test comes out positive. Currently, there are not enough measures in place to prevent the mixing of suspected patients with others in the hospitals.

There is also a need for hospitals to step out of their campuses and concentrate on community and home care. Testing can be done at the home of the patient, this obviates the need for the patient to present at the hospital and can control the spread of the disease among healthcare workers. Our ability to test needs to be scaled up considerably and needs to be proactive and not reactive.

Most importantly, the response so far has been top-down in nature. The directions come from Central bodies such as the Health Ministry and the ICMR and are implemented at the local level. Instead, the local healthcare community itself should be able to formulate a response based on the prevailing conditions. The role of the Central agencies should be to support the local community and shore up its capacity. This can only be achieved through a regular dialogue between the doctors so that lessons can be learnt and timely course correction can be undertaken. We must not forget that the virus travels faster than our bureaucracy and the decentralised system has proven to be more effective than a centralised one in dealing with Covid-19.

What we have learnt from the experience of other nations is that corona gives very little room for mistakes. The best time to take strong action is when the threat appears to be small. The large number of healthcare workers in quarantine compared to the modest number of positive cases should serve as a wakeup call that a rethink is required to get the system in fighting shape.