Spain has the unfortunate distinction of having the highest number of health care workers affected by COVID-19 infection and having an unacceptably high mortality rate among doctors. Approximately 50,000 health care workers (20% of all recorded cases) were infected, and 70 of them have died.
Health care workers are the most valuable asset and the backbone in the fight to contain any pandemic. The focus of a state should be to preserve this resource and use it with extreme caution. In a conventional war, medical officers are never sent along with forwarding companies but instead stationed at the unit headquarters. The aim is to protect them from enemy fire and keep the resource safe.
The safety of health care workers is the responsibility of the administration and state. It was most astounding to find that the Ministry of Health and Family Welfare stated in the Supreme Court that the onus of doctors remaining Corona Negative is on the doctors themselves. It is bewildering to see the Dean of a Medical College passing an order that the internship of Medical Interns will be extended if they test positive or are quarantined. Instead of showing sympathy and gratitude to the COVID warriors, the administration is deterring and discouraging these young doctors. Similarly, the state government lodging FIR against a hospital for an inconsequential error is unthinkable, that too, when the nation is in the midst of a medical crisis.
In a letter to the British Medical Journal, Professor Javier Crespo has cited five structural issues for the unusually high infection rate and mortality in Spain. The reasons are:
1. Health system fragmented into 17 health regions;
2. Inadequate government structure, due to this transfer;
3. Insufficient investment in health care;
4. No proactive strategy for tracing of potential cases; epidemiologists working advisers rather than in the field;
5. Inadequate response from the industry; insufficient investment in research; and limited innovation adaptation.
Almost all these issues apply to us. Despite not having an optimal state health administration setup, every state of the country is deciding its own health policy. The investment of governments in the health care sector is abysmal. Budgetary allocations, both in the center and the states, are always on a downward trend. Policies are framed by eminent doctors, nominated by the politicians, and not by specialist Epidemiologists. The expert opinion is taken from Cardiac Surgeons, Nephrologists, Pediatricians, and many such specialists who have no experience in containing epidemics. The response of the government and the media is knee-jerk, and policy letters are regularly amended. Panels of doctors, who are neither involved in the treatment or the prevention of infectious diseases, influence the change.
The availability of personal protective equipment for health care personnel remains restricted or sub-standard. The diagnostic kit availability is limited. Government diktat determines who can get tested, rather than professional doctors. The importance of surveillance screening for asymptomatic carriers is not permitted. Hospitals are hotbeds for transmission of infection. Almost every hospital is facing staff depletion due to staff picking up the virus from asymptomatic patients and their attendants. In Delhi alone, it is estimated that more than 1000 health care workers have been infected by the virus, despite taking precautions. More than 20 doctors have already succumbed to COVID-19 in the country.
Unfortunately, doctors are being blamed for not taking due precautions and thus becoming victims of the virus. No sensible person would invite death on himself/herself. Doctors are also human and value their lives. The civic society, media, and the administration have, of late, started accusing the medical profession of the misery faced during these COVID times. It is time to stop doctors from being made a scapegoat and instead try to fight the menace together. Let’s not make the mistake of placing political and economic interests before health and the nation. Let’s learn from the Spanish debacle and prevent our country from going the same way.
The writer is Director Anesthesia at Max Smart Hospital, Saket, Delhi.