Sitting in an eerily empty Outdoor clinic, I watch a video shared by New York Times incredulously. A tearful, exhausted chief ER physician shows around a New York hospital ER swamped with COVID 19 patients, some on ventilators while others gasping for breath. She is making a desperate plea for more ventilators and medical equipment. I cannot believe my eyes. This is America, regarded widely as an epitome of excellence in medical education and provision of quality health care, yet here it is struggling to cope against the contagion. As such images from first world countries flash on my screen, a chill runs down my spine. Myself, a resident training in internal medicine, I can only imagine the terrifying times that lie ahead.
The deadly corona virus is wreaking havoc all across the globe, making no distinction between the privileged and disadvantaged, mighty and frail. Governments, policy makers and health authorities all scramble their resources in a desperate bid to keep themselves ahead of this scourge. But reports pouring in from across the globe paint a grim picture: humanity finds itself on the losing side of a battle that it was never prepared for.
Things at home don’t seem to be any rosier. Pakistan’s first case emerged on 26th feb 2020, that was almost two months after disease reared its evil head in China. Long before it was declared a pandemic by WHO, it was evident that Pakistan won’t be spared by the virus as the first two major hotspots were our immediate neighbors. With extensive cross border movement, religious pilgrimages and trade, we were constantly at risk. The considerable leeway we were lent by nature was unfortunately wasted away. We should have designed and implemented a national emergency plan, stocked up on vital personal protective equipment, created special triage and isolation areas for patients with suspected COVID 19 and rigorously trained our health care providers in handling patients while exercising infection control measures and in techniques of doffing and donning PPE. That this was not done is highly regrettable.
Unfortunately in stark contrast what actually is happening that our health care providers are working with inadequate protection all across the country, placing themselves and communities at large at huge peril. Doctors and nurses increasingly feel that they have been left to fend off for themselves in this grueling ordeal. Higher authorities, in a cruel display of bureaucratic apathy, are turning a deaf ear to their demands. There is failure of recognition at the highest level of importance of provision of adequate PPE and appropriate training to medical personnel. Several doctors have been infected and many of their colleagues have been placed in quarantine as a consequence. A few have unfortunately lost their lives in the line of duty. This places an enormous strain on an already stretched workforce. Appalling reports of doctors subjected to baton charge and rough handedness at hands of law enforcement agencies in Quetta for demanding PPE shatter the morale of a healthcare workforce already serving in very trying circumstances. This all is taking a heavy toll on their mental and emotional well being as they not only are running the risk of infecting themselves but also their loved ones.
We need to act as quickly as possible to avert the looming crisis that has been spurred on by our apparent inaction and lack of insight. We need to understand the gravity of situation fully and rush to action immediately as time is the key. Health experts from areas hit hard by COVID19 have been urging on authorities all over the world to take precautionary measures and implement on the lessons learnt by them during the course of the disease. In an article published in leading medical journal NEJM, frontline Italian doctors have dished some useful advice with regards to protecting the workforce and preventing hospitals from becoming breeding grounds of deadly virus. https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080 This includes the following:
- The disaster can be averted only by massive deployment of outreach services. Home care and mobile clinics should be used to avoid unnecessary movements and release pressure from hospital
- In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available.
- Measures to prevent infection must be implemented massively, in all locations and including vehicles.
- Dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas. This is one of the most important means to prevent spread of infection
- Special training programs for educating them on infection control measures and management of COVID 19 should be organized for the frontline health care workers
In Pakistan, we need to take heed to this advice as soon as possible. This is to serve as a key tool in our fight against the infection.
What we need to realize is this is a war and our health care personnel are our frontline soldiers. An unarmed and ill equipped army up against a covert enemy is always headed for disaster. The need of the hour is that both public and private sector should join hands to provide adequate PPE and arrange supervised, organized training of healthcare workers on an emergency footing to tackle the menace head on. As Nino Cartabellotta, an Italian public health expert and director of Gruppo Italiano per la Medicina Basata sulle Evidenze or GIMBE – Italy’s Group for Evidence-based Medicine that published staggering figures of casualties of Italian HCPs in the line of work, rightly states
“If we don’t provide them with adequate protection, it will end up like in a war where soldiers don’t die while fighting on the battlefield, but because of lack of equipment. The more medical personnel are infected, the weaker the responsiveness of the healthcare system.”
The writer is a doctor, graduate of King Edward Medical University, currently pursuing a residency in internal medicine