Dr Priya Sampathkumar is an infectious disease specialist at the highly-regarded Mayo Clinic in Rochester, Minnesota, USA. In an interview with The New Indian Express, she talks of the missteps most countries have made, the steps needed to prevent a potential third wave from turning as destructive as the second and how 'Covid treatment is not that complex'. Excerpts...
What are your thoughts on the massive healthcare crisis that has arisen due the second Covid-19 wave in India? What implications could this crisis in India have for other countries?
The second wave in India is stressing the system to an incredible extent and in so many ways. Patients have been unable to access care because hospitals have been overwhelmed. Outcomes in hospitals have been poor because doctors and nurses are overwhelmed and there is inadequate supply to treat these huge numbers of patients. There has been a lack of medicines, lack of equipment, lack of ventilators and even hospital beds. Finally, the most critical crisis has been the lack of oxygen. You don't have time to acquire oxygen when a patient is critically ill. In the long term, there is going to be an issue of burnout of healthcare workers and mental health issues, as they are losing patients with potentially preventable deaths. Also, India does not exist in a vacuum. Its borders are fairly porous. The surge in India is definitely going to spread to other countries. And in neighbouring countries, the healthcare system is not even as good as in India. What is happening in India will have a huge impact on other countries.
How do you see the administration's role in handling the crisis in India? What could the governments have done better but didn't?
Covid took the entire world by surprise and all over the world, governments were not prepared for this, neither was the public. Therefore, there were missteps in most countries. These included, one, underestimating the problem and two, in not messaging the problem adequately. This has not been unique to India but all over the world.
At one point, the US, too, was reporting a high number of daily infections and deaths. How do you compare the crisis management by these two countries, even though there are vast differences in terms of resources?
This time last year, when the US was having its surges, we had the same sort of situation in New York. There were a huge number of cases, the health system was completely overwhelmed and the death rate was very high because healthcare workers could not take care of patients adequately.
The difference between India and the US was one of scale. The initial surge in the US was confined to New York, so it was possible to shift resources from other parts of the country to help New York deal with the situation. Then there was a time in the US with lockdowns and universal masking policies, and all the regions and states were able to prepare and none of the other surges were ever as bad as New York because of preparations that medical institutions and state governments took to get ready for this.
In India, everything is on a much larger scale because of the huge population and far lesser per capita hospital beds as compared to the US. It is very hard to scale up medical preparation and really prepare for dealing with Covid when over 1.3 billion are potentially at risk of infection.
Do you have any advice for policymakers in India for the country's vaccination drive? How crucial do you think vaccination is in the world's fight against the pandemic?
Vaccination is very important in the fight against the pandemic and the current crisis in India is not just one country's problem, as cases will spread around the world if it's not controlled in India. Vaccination may not have an immediate impact, but in order not to have a third surge and not to have ongoing lockdowns, vaccination is very important.
I think for a country as large as India, we need a different model of vaccination from the one used in the US. Registrations and appointments are not feasible to rapidly get a very large number of people vaccinated. We need door-to-door vaccinations. And of course, we need the international community to step up and deliver vaccines to India because although the country has the capacity, it might take a few months and vaccines are needed now.
Do you see a third wave of this pandemic as a possibility? If yes, what do you think can be done to prepare for it?
If we appropriately carry out public health messaging on how pandemics behave and send out the right messages, which are fairly simple, and on top of that carry out an aggressive vaccination programme, it will go a long way in preventing a third wave. But while we need to work on prevention, we also need to prepare as people's behaviour is unpredictable and cannot be fully relied upon. So, you do need to prepare and raise medical capacity and train healthcare workers to recognise cases early and instituting measures at population level to prevent spread. Finally, make sure you have enough supplies including lifesaving things like steroids and oxygen. That way even if there is a third wave, mortalities can be reduced.
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Will you offer any advice to healthcare workers who are trying hard to save lives despite a severe resource crunch?
What I would say to them is, it is easy to get overwhelmed and say that you need high tech things to treat and prevent Covid. But people just need to step back and look at the tools they have on hand. If you treat people early, you can prevent the disease from progressing to a stage when a patient needs ICU care. Covid treatment is not that complex and I will lay it out here.
Most of the people with Covid will recover fully without any treatment, with just symptomatic treatment, with things like paracetamol. A small proportion of people will progress to needing oxygen and it's important to reach to healthcare providers quickly and get the oxygen and get the medication that is lifesaving - dexamethasone - and if it's not available, there are other steroids that will work. In addition, just good hospital care, proning (lying on stomach) are lifesaving measures. Beyond that, there are very few medicines that you need and a very limited role for these medications.
Certain treatments that are widely used currently are definitely not useful at all. Ivermectin, hydroxychloroquine, fabiflu, azithromycin, doxycycline do not help at all and potentially can be harmful. There are other categories of medications such as vitamins and zinc that again are not going to make a big impact but are at least not harmful.
There is also a question of timing of medicine. So steroids are very useful when a patient has low oxygen levels but that does not mean that steroids taken early in the course of illness will help. Also, steroids taken for a prolonged period are harmful.
For doctors, I would suggest using a reliable source of information and one such source is covidindiatreatment.com. Treatment of Covid does not need to be resource-intensive if you treat early. So good public health, telling patients to stay home when they don't need to go to hospitals and then having a plan on how you will approach patients in hospitals is what you need. You don't need fancy equipment and training and anybody with basic training can take care of Covid-19 patients, provided they have the right information at their fingertips.
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