Doctors have always been at the forefront of peace and war. The nation still looks towards them whenever a calamity hits it. Doctors are continually battling diseases, death, and providing a soothing touch. Doctors are boosted to a demi-god status whenever a crisis hits humans. It was very encouraging and elating for doctors to be commended by the Prime Minister for their role in the present COVID epidemic and, after that, receiving the blessings of the entire country in the form of an organized celebration. Doctors, who have managed the wrath of the virus, were similarly cheered by citizens across continents.

There is a need to review the current role of medical practitioners. Currently, the vast majority of doctors are under-utilized. The panic and the restrictions placed has resulted in most doctors remaining at home. Small hospitals, nursing Homes, and clinics have shut down. Although the mohalla clinics are functional and doing a good job, the common man thus has inadequate access to primary care. Refusal to treat non COVID ailments is causing a public scare. Doctors are not running OPDs and citing non-availability of PPE (personal protective equipment)  as the reason. Are we shrugging off our responsibilities engrained in the Hippocrates Oath? We are frontline warriors and cannot abstain from performing our solemn duty to treat the sick. We need to find a solution to it.

There is undoubtedly a need to protect the medical community, as they are the backbone in the fight against the virus, but have doctors looked into solving this issue. There is an emergent need to provide PPE. Till PPE is freely available, we need to improvise and prepare for self-protection so that the show goes on. Not everybody needs a Hazmat suit protection! A logical recommendation, based on the exposure of the clinician, should be made to ensure the best utilization of the limited resources available. Undue insistence, on enhanced PPE, puts pressure on the supply chain and results in shortages in areas genuinely needing it.

The IMA need to frame self-protection guidelines:

The IMA (Indian Medical Association) has played a vital role in fighting this epidemic. IMA has been very active in the media and has ensured that the ordinary public is educated and informed of the latest developments. It has also extended an essential advisory role with the government. The IMA now need to frame self-protection guidelines for all levels of doctors while ensuring their safety. The IMA should also partner with the government to notify such instructions. We may not be able to meet the national quantitative requirement, unless we have graded PPE recommendations, as per the level of protection required. The government, on its part, has to freely permit all textile units to manufacture fabric suitable for PPE. Such manufacturing units must have unlimited access to resources, but their manufacture monitored to prevent black-marketing. Regulatory authorities must oversee the PPE production and distribution, to avoid corruption and wastage.

The IMA should shoulder the responsibility of disseminating the guidelines to the members and addressing the concerns of its members. The IMA should proactively ensure that the establishments, run by IMA members are safe. The public will benefit from the re-establishment of primary care. The IMA must also regularly interact with the authorities and be a mediator between the clinicians and the government.

Tertiary healthcare facilities are facing unique challenges. Tertiary care hospitals are treating very sick individuals with complex diseases in an uncertain COVID infection milieu. There are multiple non-COVID illnesses, many of them life-threatening, which have taken a backseat. The COVID epidemic and its aftermath will take months to settle. In the COVID panic, we can’t ignore and sideline other ailments as morbidity and mortality of not treating them on time will be cataclysmic.

A number of hospitals are continuing to treat non-COVID patients and also perform surgery. Multiple improvised techniques are streaming in social media describing these techniques. Most of them are flawed and hastily achieved without adequate diligence. Such uncontrolled improvisations will, unfortunately, adversely impact patient care and also the safety of the clinicians. Professional bodies across the world are issuing guidelines about patient care in this environment. IMA should make a national task force to frame care guidelines for such non-COVID severe cases.

A significant event to highlight is what happened at LNJP Hospital in Delhi. More than 500 patients were discharged in a day and referred for admission to other government hospitals without assessing the bed capacity of the hospitals or arranging suitable transport. One such discharged Dialysis patient is said to have died on the way, and the fate of many more may have gone unnoticed. Better planning could have averted this catastrophe. These patients should have been transferred to empaneled private hospitals for further management.

Doctors should reopen their clinics, attend to OPDs:

It is time, doctors reopened their clinics, attend to OPDs, and admit patients needing care. Let us diligently use our clinical skills to identify the suspected cases and order COVID-19 tests, if required. The supply of kits is currently limited, so let us order COVID tests judiciously. Let us restart treating our patients, who need acute and chronic care, with due compassion. However, we need to take protective measures to ensure our safety by following strict hygiene, distancing, and relevant precautions. Family Doctors are a vital part of the ‘patient’s family.’ Let us not abandon our family!

Dr Vinay Aggarwal-Past National President IMA 

Recipient of Dr B C Roy National Award

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By now everyone must have understood how the corona virus originated, spread in Wuhan then the rest of the world. I am here not to talk about the economic impact of it. I am here to talk about the doctors who are getting infected because of the disease and the treatment what we do to these people.

When a common man gets the disease it’s usually from the fomite transmission, where a patient touches the surface and another person comes in contact with that and that’s how a person gets the disease. But when a treating doctor get the disease he gets it directly from the COVID 19 person and the initial viral load is so much that the disease seriousness and the fatality rates are much higher in doctors than those among the general population.

If we look at the number of cases in Italy which is a classic example, and numbers are quite reliable. It is (as on 5/4/2020) 2061 cases per million. But more than 5000 health care professionals were affected because of this virus and more than 40 of them had died as on march 26, 2020.  They don’t represent a huge population despite that the number of cases and the fatalities tell the story.

Here is what we should be doing, get more and more of the personal protection kits to the health care professionals, may it be doctors, nurses,  lab technicians, housekeeping staff and even those who take the waste out of the hospital for disposal. We must understand one thing that doctors and nurses are not the front line workers. The onus is on you, the common man who helps himself and others by maintaining the safe distancing policies, sanitation and helping spread the virus to limited and stopped.

Health care professionals’ are the last line of defense. If any person gets affected with the disease he needs to be monitored till he tests negative for the disease. That means till that time work force gets depleted every time a staff gets affected. We cannot afford to do that. It is not that we are not ready to work again after the illness gets over. Unfortunately if a HCW continues to work, he may be a reason to spread to other people including the loved ones. If they happen to be an elderly person in the family death rates are really high among them.

If we happen to lose any HCW, there are no avenues to replace them. For instance an anesthetist and an intensivist is basically irreplaceable. As these are the people who can take the person out of the death bed. Even if there are ICU’s and ventilators and patients on them there will be no one to handle that. First of the all the HCW’s have high risk of death, on top of that if the family gets affected it cannot be a bad thing than that.

All that we as doctors would urge you, please do not take this as simple thing. It is a matter of grave concern to everyone on this earth. Please follow the practices  what are advised, don’t hide history and report to the nearest facility where a sick person can be handled.

Dr Manjunath Sharma
Chiguru children’s clinic
Bank colony, Hanumanthnagar
Bengaluru-560050
Email: drmanjusharma@gmail.com Mob:9342620484

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