What doctors order
Ahead of the third wave, doctors voice out the biggest needs of the hour from better adherence to social
distancing to improved infrastructure for paediatric medicine
CHENNAI: While the second wave of the pandemic pretty much took the country by surprise, we seem to want to have none of that the next time around. Even before we’ve dug our way out of this nightmare, the government has us worried about the third wave one that has been promised to be far more devastating with a more severe strain than the delta variant. The consequences, we are told, could be crippling. Faced with this future, doctors across the board tell us exactly what it is they want from the government and the public to survive what’s to come.
Watching out for the children
With every study indicating that the third wave is likely to affect children, the medical community, too, finds itself bracing for the impact. “The first wave affected people above 60 years, the second hit people between 30 to 60. Now, studies say it’s going to affect people below 30 years of age. And we’re already starting to see it. In the last wave, seeing people below 25 years come in would be rare. Now, we get three to fours cases in a day at our primary health centre itself (on the city outskirts).
The number is sure to be bigger at hospitals,” surmises Dr Yuvan*, a general physician who has held every Covid-related duty since the start of the pandemic. With reports suggesting that the third wave may hit India in August and peak in September, there is the need to train all available personnel in paediatric medicine, advises Dr Sakthi Sreenivasan, general surgeon, Tiruvallur Medical College. “For one lakh kids, there are only around 100 paediatricians. So, we need to train everyone in paediatrics.
Paediatric physiology is very different from that of adults. In the case of adults, we’ve discharged patients with 85 and 90 per cent saturation; they may survive. For kids, if the saturation level goes below 95 per cent itself, health will sink immediately. We can’t play the same game in paediatric cases. So, the government should ensure adequate infrastructure and technical expertise.
Oxygen and ventilators should be made available; there are still very few paediatric ventilators — both in government and private centres. While Tamil Nadu has already started increasing capacity for paediatric care, Dr Subramanian Swaminathan, director, Infectious Diseases, Gleneagles Global Health City, Chennai, says that he would like to see this happen on warfooting across the country because this is going to be something that people are less likely to forgive in terms of slip-ups.
“We need to start increasing capacity in terms of nursing strength, critical care manpower. These are not people you can recruit at a moment’s notice; these are specialised skills that need to be learnt and taught. We need to start developing bandwidth in that,” he elaborates.
Bridging the basics
While it took the government a long while to put together the SOP for treatment protocol the first time around, Dr Subramanian hopes that the process would be made swifter this time. “Just like how the CDC (in the US) responds within a week’s time of any new development, we need to have a very responsive system like that which is guided by experts in the area and instructs on how to move forward.
There has to be training in hospitals and other health centres, and implementing it immediately instead of waiting for the next wave,” he says. While planning for all this, there is also the need to look at the disruption of training to the current workforce and address it at the earliest. “In the last year and a half, there has been no training of medical students or postgraduates. Their skills need to be updated and we need to focus on making sure that the next set of students (both who are in training and who ready to move out) develop their skills quickly; so that we don’t end up with a workforce that is sub-par,” he explains.
In vaccination we trust
If there’s one thing all doctors agree upon, it’s that complete vaccination of the population is a subject of no negotiation. Dr Subramanian has some pointers for the government’s effort. “I don’t think the system can take one more round of punishment — both from the public point of view and healthcare institutions’ side. Therefore, the vaccine is the key. What I would like to see is more innovative messaging and a better PR campaign to help the vaccine drive succeed better.
We saw that the drive was launched with a lot of fanfare. But, I don’t think enough PR spin went into it to popularise it. So, for a long time, people at vaccine centres were just waiting for the public to turn up. I’m worried that though we are ramping up the vaccine production and delivery it’d start stagnating again. The government should be a little smarter this time and improve their PR machinery to try and improve the acceptance of the vaccine and also go after people spreading misinformation,” he explains.
Dr Anantha Subramanian, pulmonologist, Kauvery Hospital, Chennai, says that people should get vaccinated, whatever the efficacy of the vaccine may be. “Even after the vaccination, you might still catch the infection. But it won’t be severe. That we saw drastically over the last wave. Those who were vaccinated twice, very few of them turned out to have a severe infection,” he notes. Dr Srikala Prasad, gynaecologist, can personally vouch for it.
She tested positive for Covid well after her two doses of vaccination. But, despite being diabetic and in the high-risk category, she had a mild case of it and she didn’t need hospital care, she reports. “If you take Chennai, it looks like a lot of people were infected and many got the vaccine. But, Indian statistics is still at single digits for vaccination percentage. And this is the only protection we have. Especially given that the number of deaths in relatively healthy people is drastically high,” she points out.
Lockdown still the answer?
As much as no one wants the lockdown to be extended further, there’s no denying the enormous results it has delivered; be it at the start of the first wave or the second. So, not surprisingly, doctors do feel that it might do us good in the third one too. “It’s lockdown that will protect us, social distancing that will save us. These days, I haven’t witnessed social distancing being followed anywhere.
And traffic on the road seems much higher than prepandemic times, what with people making use of the relaxations. Now that dining is open, cases will increase,” details Dr Yuvan. While he understands that our people and economy might not be able to bear the brunt of another total lockdown, he suggests that a partial one with controlled relaxations might still help. Dr Sakthi seconds that stand and offers that strict action to stopping mass gatherings is vital.
Mothers in mind
Over the past one and a half years, India is believed to have lost many pregnant women to Covid; as always, the situation is believed to be much worse in rural areas. They are also more likely to have complications or deliver prematurely. Studies show that Covid positive pregnant women are much more likely to die from the virus, are in greater need of critical care, and are more likely to need the ventilator.
But, there is no official data to look into this devastating trend and find solutions. That’s all the more reason for the people around them to be cautious, says Dr Srikala. “In the last wave, we lost a lot of pregnant women who were actually healthy otherwise. If you really care for your progeny, see that you vaccinate yourself. Now, pregnant women are also eligible for vaccination,” she advises.
Care for the care providers
Across the country, violent attacks on doctors have once again brought the subject of workplace safety to the fore. Despite everyone joining in on the outrage, it has not translated to tangible changes on the ground. Naturally, doctors want this to be addressed at the earliest. “I would like to see a lot more stringent laws being applied in terms of safety in the workplace. When we start having children getting Covid, violence in the workplace is going to be a severe issue.
And we don’t want the doctors and nurses saying they don’t want to work at the hospital. The government needs to start looking at workplace safety a mandatory issue. Make it a non-bailable offence, perhaps,” suggests. Dr Subramanian. Dr Yuvan has a suggestion. “We have railway hospitals, police hospitals, military hospitals; in all these places, our service is being provided. Similarly, why can the government not arrange for police stations in hospitals. It doesn’t have to be at every hospital; the largest hospital in every area/region can have a police booth for three-four personnel dedicated to it.
This kind of safety is what we need, especially in this situation. I can take a cop along for work (fieldwork) or I can reach out to him in case of trouble and have him show up immediately. If I were working at a police station, my job would be to attend to just the personnel. Likewise, his job would be to attend to just the medical staff. This is something the government can easily arrange for,” he elaborates.
While too many reports have been suggesting that the third wave is likely to affect children, Dr Rajesh Bhardwaj, an ENT specialist who also consults on Practo, wants to shut down this line of argument. “That the third wave will affect children and they will go to the ICU is extremely irresponsible (assumption). There is no international evidence to say that this disease affects children more than adults. In fact, by and large, all our research, data and understanding points to the fact that children get a very mild or asymptomatic form of the disease.
And they may not even be carriers. So, that part is not very well taken except for the fact that the first wave took the elderly and the second took the younger people. (Because by then the elderly had had at least one dose of the vaccine. So, a lot of them were spared.) So there is this natural progression — first, elderly, then younger and the third wave will be children. That is not scientifically true,” he explains.
But, there is more reason to believe that children will still not be in grave danger. Given that the virus attaches itself to the ACE2 (Angiotensin-converting enzyme 2) receptors and children have very less of those enzymes, they are less likely to catch the infection, he points out. Having said all that, we still need to be prepared as a country for an imminent third wave and there are two things to do: vaccination and continued responsible behaviour, he offers.
Wear masks even when vaccinated; double masking works even better.
N-95 (worn single) is recommended for when you are caring for a Covid patient or in places like the airplane (where the risk is higher).
Wash your hands with soap and water when you return home. Otherwise, use sanitiser with at least 70 per cent alcohol.
Go out only if you have to. When you do, choose outdoor, open spaces over indoor ones where the virus multiplies.
Social distancing is still necessary.
Avoid gathering in large numbers.