In an exclusive conversation with NewsX, Dr Mukul Chandra Kapoor, Director Anesthesia in Saket’s Max Smart Super Speciality Hospital in Delhi said Covid-19 is a Gen-Next virus that has managed to get a global footprint in a couple of months. The current epidemic of the virus infection has thrown unique challenges, as the epidemiological performance of the virus is very different from the behavior of contemporary infectious diseases. The rapid spread of Covid-19 disease is also a reflection of the adverse effects of globalization. Although Covid-19 is not very virulent, its spread is stormy. India has been fortunate to contain its ingress. Timely political and administrative actions have slowed the progress of the epidemic in our country. It’s time to consolidate our gains and develop a plan of managing this threat in the coming days and weeks, as the pandemic enters the inevitable third phase.
Multiple strategies have been tried internationally to curb the disease. The pitfalls/positives of the strategies used by different countries need to be analyzed to derive a protocol for its management. Some countries like Singapore, South Korea, and China managed to contain its proliferation despite an initial explosive spread. Other countries like the USA, UK, Italy, and Spain failed to control its mushrooming despite boasting of excellent healthcare facilities. The primary lesson learned from all these strategies is that the only way to control its spread right now by isolating the infected from the non-infected.
No country in the world has enough intensive care beds or mechanical ventilators to manage the expected load of critical Covid-19 patients. It’s a guesstimate that we have 40000 ventilators in our country. This number is highly inadequate to handle the expected critically ill cases. There is no way to overcome this shortfall, as new ventilators are impossible to procure, considering the limited production and the high current international demand. It is, however, feasible to have makeshift intensive care beds. The government has asked various public/private hospitals to earmark and furnish beds to cater for overflow from the designated hospitals currently treating positive Covid-19 cases.
The designated Covid-19 hospitals are loaded with work of all specialties. Though elective surgery is restricted in them, the emergency surgery and medical therapy load continue to be tremendous. There is a need to totally stop patients of other specialities from entering these hospitals. Despite the best isolation and sanitation measures, a hospital with a mixed population offers considerable chances of cross-infection. These hospitals should be designated Covid-19 hospitals and be relieved of all other duties. The workload of the balance specialties may be distributed to other public/private hospitals. Stand-alone Covid-19 hospitals will not only geographically restrict the infected population but also help reduce waste of resources.
Personal protective equipment (PPE) is an invaluable resource that is currently in massive demand. Imagine all hospitals having positive Covid-19 cases (a mistake Italy made); there will be enormous cross-infection and hardly any PPE available. There will be no need to provide PPE to all hospitals in the country, and so the medical staff in these hospitals will be provided all PPE. The medical staff of this hospital will exclusively treat Covid-19 patients. The medical staff of hospitals with less number of Covid-19 patients will be required to treat other patients and thus spread the infection to all patients and staff.
The medical staff managing the cases can be rostered into three batches, to work at a stretch for 5-6 days on 8-hour shifts. Another set of 3 batches will take over from them on completion of their tenure. The personnel managing cases can be quarantined for 14 days after such duties. Such duties will be less taxing on the staff and would offer the incentive of rest after a tiring 5-6 days tenure. The teams tasked must be lodged in suitable accommodation during their duty days to prevent transmission of infection. Trained staff can be pooled from different hospitals.