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Focus on the health system to tackle covid

  • Given the large number of asymptomatic patients who could unknowingly spread the virus, it is vital that we increase testing and not rely solely on lockdowns.
  • A preventive healthcare governance model needs to be pursued so that the testing, tracing and treatment of patients is ramped up.

In this rapidly changing situation of the covid-19 pandemic, we are experiencing the unforeseen. If even the most severe lockdown doesn’t help, how do we prepare for the long haul? Given the hotspots of infection spread we are currently facing, not being aggressive with testing while performing routine services in hospitals can have catastrophic consequences. The hospitals providing routine services during the pandemic are becoming culture media for the growth and spread of the virus. Our non-covid healthcare workers are getting infected by the minute and unknowingly carrying the virus into society. With the number of asymptomatic carriers on the rise, the only bailout in the fight against coronavirus is to test like never before. Never have laboratories engaged in testing of such magnitude as now. Policy discourse like “Make in India" must give attention to the manufacturing of good quality Personal Protective Equipment (PPE) at affordable costs, so that there isn’t doubt in their minds when healthcare workers use these equipment.

Going by a study published by Lauer et al in March 2020, symptoms mostly appeared 11 or 12 days after exposure, Fewer than 2.5% were symptomatic within 2.2 days and the vast majority were symptomatic within 14 days. However, it is known that patients who remain asymptomatic (30% of exposed cases) or mildly symptomatic (56% of exposed cases) can transmit the infection. Taking these facts into consideration, patients who are scheduled for a procedure should always be assumed to be potential carriers of the virus, even if they pass the pre-assessment triage, including normal temperature, no history of exposure or travel, and no respiratory symptoms. Patients should be “screened" with the standard tests, 24 hours before any routine procedure and then isolated in their rooms, with no visitors allowed.

Patients who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the covid-19 disease, have higher perioperative morbidity and mortality. Unexpected progression to acute respiratory distress syndrome, cardiac injury, kidney failure and even deaths have been observed in patients infected by SARS-CoV-2 who have undergone surgical procedures. Are we ready to risk lives of patients just because we didn’t care to find out their covid status? Evidence in data-driven countries such as the US, UK and Australia, help plug policy gaps in carrying out robust pre-operative and pre-procedure testing in asymptomatic patients. Emulating policies of this nature will complement the lockdowns, yet balance the free fall of the economy that will protect health workers across all tiers of health systems.

Primary healthcare centres, front-line non-government organizations (NGOs) engaging with urban and rural populations for relief and rehabilitation work, and government officials in district offices can all possibly be potential sources of asymptomatic carriers of the viral load. State governments have not aggressively engaged in the testing of the front-line workers, police officials, NGO workers and district administrations. Village health and sanitation committees do not have a policy in place on what to do to mitigate the risk of the virus. There are myths prevailing across India’s heartlands relating to covid-19, which continue to stymie prevention efforts.

District administrations must be proactive in supporting developmental work and in evolving models with NGOs holding domain expertise in shaping health systems. Combating the covid-19 pandemic cannot possibly be effective if people work in silos. The effort needs to be structured and implemented in partnership and with teamwork.

It is important to move food from farm-to-fork to meet civilian needs given the kharif season is underway. Nevertheless, from a health perspective, food security also needs to be addressed to mitigate the burden of malnutrition. With a national lockdown of such an extent, daily wage earners are left to starve. Malnutrition resulting from a lack of resources by itself will cause multiple co-morbid conditions over time, and will end up becoming a major life-threat. Safeguarding communities from a health perspective also assumes center stage, by testing coronavirus suspects and supplying PPEs to health workers in all cadres.

In many instances, panchayat and local government officials across states ask for masks, disinfectants, hand sanitizers and gloves.

India as a country cannot afford the lockdown model of governance and we have to invest in a preventive healthcare model of governance by testing, tracing and treating as a way forward. India must work towards establishing a resilient policy for the sovereignty of her people.

The authors are, respectively, a gynaecologic oncologist at Max Hospital, Saket, New Delhi and a community health physician with CHD Group.

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