'Intensity of Covid-19 will decline soon'
Hyderabad: In the midst of Covid-19 pandemic that has challenged the collective wisdom and knowledge of public health officials across the country and has impacted lives of the every one, the Founder and Director of Continental Hospitals, Dr Guru N Reddy believes there is a ray of hope at the end of the tunnel.
The renowned gastroenterologist, who has practised medicine in the United States for three decades and was elected to serve as Chief of Staff of Houston Northwest Medical Center, Memorial Hermann Northeast Medical Centre Hospital, during an interaction with ' Telangana Today ' said a lot can be gained by learning from the experiences of western countries which dealt with the Covid-19.
Peak of the pandemic will come to an end in India
We have to learn from countries who have fought Covid-19 pandemic and are back to almost normal. Germany has a population of 70 million but they had just 9,000 deaths related to Covid-19. The country managed to arrest the pandemic in two to two and half months. What does that tell us? It tells us that there is hope.
The United Kingdom with a 63 million population witnessed 45,000 deaths due to Covid-19 but it has managed to control the infection, as did other European countries like Spain and Italy. So what we are learning from all these European countries, which were the first ones to get affected, that they were able to control the pandemic and come out of it. The moral of the story is, yes the peak of the pandemic will come to an end at some point of time in India.
What is projected for India by various experts is that by mid-September, the peak of the pandemic will show signs of coming down. Already, there are signs in Gujarat, Delhi and Maharashtra. There is tremendous hope that the intensity of the pandemic is going to decline as it has done in other western countries, except for America, which is seeing a more intense Covid-19 epidemic because the US defied everything. We are far better than the US in terms of what we have done from the starting including measures like lockdown and strictly following guidelines of MOHFW and WHO.
On the need to have infectious diseases department in every hospital
I had the fortune of spending more than 30 plus years in the US, where Infectious Diseases is a very big subject. Every hospital in the US and other western countries has an infectious diseases specialist, microbiologists to treat patients with flu, dengue, malaria, chikungunya, pneumonia and TB.
Every hospital especially tertiary care hospitals should make sure they have a solid infectious disease management programme. Such patients should be regarded as very special because it is not chronic disease management but acute disease management.
On the role of hospital management during a pandemic
Because Covid-19 is evolving, in terms of what symptoms it presents with, how long it's going to remain in the body, how effectively it can be treated, almost every day and every week, things are changing. In this background, hospital management should be very much in tune and has to create a solid committee, which will be responsible to tackle various aspects of disease and patients. In the middle of March, at Continental Hospital we found a Covid Task Force (CTF) and I was personally chairing it. In the CTF, we had a critical care specialist, pulmonologist, internal medicine, leadership from nursing, supply chain management and hospital executive management.
On role of hospital task force
The Covid Task Force in our hospital looked into all the guidelines of Centre and State and reviewed them regularly and then embraced and adopted those guidelines and made sure that we are implementing them. That itself was a big task because we wanted uniformity and we wanted hospital staff to understand them properly to successfully implement.
Every Thursday, we used to meet for two hours and review treatment modalities including medications, condition of individual patients, classification, taking care of our own health care workers, how many days they should be quarantined, isolated. After discussing all these factors, we created Standard Operating Procedures (SOPs) for our institution.
On the need to change infrastructure for Covid-19
Fortunately, Continental Hospitals is one of the largest in the country area wise, although we have not been able to increase our capacity in terms of adding more beds. This is for the first time that we were able to put that infrastructure to use.
For instance, we prepared three separate entries for the emergency, which helped us to segregate patients who were already positive, patients who were coming for Covid-19 testing and non-Covid patients. We managed to create physical barriers, which helped us tremendously in reducing infections among our health care workers and also for non-Covid patients who are coming to the hospital. Moreover, there was a significant reduction in fear among health care workers and patients too. Right from April itself, we had designated areas including ICU units. We now have close to 60 ICU units only for Covid patients and created isolation facilities on the same floor. Geographic isolation and creating space was extremely important in a hospital situation.
On human resources
We had some difficult time with manpower initially. Fortunately for us, people did not leave abruptly. Majority of nurses stuck with us because you are educating them and ensuring that they are strictly following PPE protocols, which helps nurses and other health care workers protect themselves. We had some initial difficulty in getting access to PPEs in the month of April but things improved.
Across the board, we hiked compensation from 20 per cent to 50 per cent for our health care workers and introduced a special Covid allowance, which encourages people to turn-up for work. We roped-in a fresh group of nurses from Kerala who joined us in batches of 20 to 25 each because we wanted to ensure there was a proper nurse to patient ratio.
On struggles with ventilators in India
Let us face some hard truths. Nurses in India are not well trained in management of ventilators and you need a respiratory therapist, critical care doctor, pulmonologist. But it's not possible to keep a specialist round the clock in the hospital premises, so, we have to constantly improvise and make sure there is adequate guidance to nurses when they need help and how to maintain the ventilators.
In India, people have this tendency of taking it casual when it comes to ventilators. They expect that putting patients on a ventilator is enough and they expect them to recover quickly. The ventilator management is basically for five per cent of the Covid positive patients who are the sickest. A typical ventilator has 14 different parts out of which there are at least 6 parts that we have to continuously change every 24 hours. There are filters, suction vacuums and back-end bags of ventilators, which need constant changing and maintenance.
If you don't do this, then patients will die of secondary bacterial infections. This is what is happening in India during Covid-19 pandemic. Critical Covid-19 patients are put on ventilators but they eventually develop bacterial infection. In India, bacterial infections are resistant to common antibiotics. There is a definite need for intense management and it is not just putting patients on a ventilator and hoping they improve. Complete management of ventilators is important for outcomes of the patients.
Constraint of beds
We have allocated 70 per cent of beds in Continental Hospitals to Covid patients and 30 per cent to non-Covid and everyday it is 100 percent occupancy. Now, this is only for those who need to be in the hospital. On a daily basis, we send away at least 70 patients for home isolation and quarantine. No mild cases are admitted and we are strictly going by the guidelines to ensure that only the sickest patient gets a bed.
On linking admitted patients with their family outside
We have introduced health bulletins every morning and evening so that relatives and attenders are informed about their patients. Every day there are three hours of video consultations and counselling for patients and their family members. For serious Covid-19 patients who are bedridden, nurses will take the phone and they will talk to the family. Some Covid patients will be in critical condition but based on CDC/ WHO guidelines, we can allow their relatives to visit such patients.
However, that will be possible only if the patients and relatives understand the risks involved. Relatives must wear full PPE and go inside and spend 15 minutes to 30 minutes.
The good news on the vaccines is that there are several pharma companies across the world involved in developing vaccines. Few companies including Oxford from the UK and Moderna and Pfizer from the US are in phase three clinical trials. Once they complete the phase three trials, then the vaccines can be administered to the general public, which is likely to happen sometime towards the end of this year.
To determine efficacy of vaccines two, three or six months is not an adequate time. So do we know that these vaccines are going to be effective? At present we don't know. Yes, the Covid-19 vaccines will produce antibodies and will protect the body. However, for how long the antibodies will last in the patient, we don't know. Should individuals be re-vaccinated? Is the re-vaccination at the end of four months, six months or at the end of one year? These questions do remain.