Thursday, April 15, 2021

Get organized

Hospitals play a critical role in the healthcare system in providing essential medical care to the community, particularly in a state of crisis. Prolonged outbreaks with progressive spread of disease, with rapidly increasing service demands can potentially overwhelm the capacity of hospitals and the health system at large. Almost all the government hospitals in our State under normal working conditions operate at near-surge capacity. Consequently, even a modest rise in admission volume overwhelms our hospitals beyond their functional reserve. The overwhelming nature of COVID-19 pandemic requires innovative approaches to tackle this problem. Without proactive capacity building, the healthcare infrastructure will collapse with the large number of infected individuals who need hospitalization. Without a doubt, the COVID-19 pandemic by now is well established in the community here, although authorities might differ and continue to deny community spread. But we are now witness to some new cases coming to medical attention that do not have any history of travel, or high risk exposure to a confirmed COVID-19 case, which reflects community spread. With cases coming from every district (except Kiphire), the virus is now omnipresent. This virus is not going to disappear in near future and we have to face it likely for a prolonged time. Hence we expect the daily increment in number of COVID-19 cases will be much higher than the current scenario. As the worse is yet to come, here is the most important question: Are we prepared for the battle and how good are our hospitals to deal with the crisis? Healthcare policy makers have to see the approaching time in advance and gear up in advance. Epidemiologically we are seeing only the tip of an iceberg as more than 99% of infected persons are asymptomatic and these unaware cases are continuing their routine like visiting markets, worship places, family functions and gatherings – many without adhering to social distancing rules and preventive norms and measures. But the enemy although invisible is deadly. As the virus is spreading exponentially there seems no escape from it. A steep rise in the number of cases detected, admitted to hospitals and dying due to COVID-19 illness in the near future is certain. When it comes to containment of the virus spread, the most difficult task is restriction of an asymptomatic person who moves freely into community and keeps on infecting close contacts. Contracting viral pneumonia by a novel strain is not easy for a previously healthy person but a fragile patient will be thrown off balance. While the Spanish flu was a brave virus attacking only young and pregnant, this virus is opportunistic and has a predilection for elderly, frail, sick, patients with co-morbid illnesses like diabetes, hypertension, heart, kidney and liver ailments and immuno-compromised persons. It throws them off balance with high chances of death. These fragile individuals are present in every single home of our communities. Today it is apparent that our hospitals are witnessing the worst times. Hospitals are complex and vulnerable institutions, dependent on crucial external support and supply lines. During the current outbreak of COVID-19, an interruption of critical support services and supplies would potentially disrupt the provision of acute health care by an unprepared health-care facility. In addition, a high rate of staff absenteeism can be expected as healthcare workers need to take off to quarantine themselves from the community; as they may themselves get infected. Patients admitted to the hospital with COVID-19 infection have an average hospital stay of 10 days. This issue is compounded by the exposure of physicians and other healthcare workers, which may lead to up to 20% of healthcare staff being unable to work for periods of time from being ill or self-isolated from high-risk exposure. Any shortage of critical equipment and supplies can limit access to needed care and have a direct impact on healthcare delivery. Even for a well-prepared hospital, coping with the health consequences of a COVID-19 outbreak is a complex challenge. A proactive and systematic implementation of key generic and specific actions can facilitate effective hospital-based management during a rapidly evolving outbreak. Our policy makers have to come to ground level in order to frame an effective policy and plan. They need to be given continuous feedback from health care workers and should be receptive to suggestions given from time to time. Any loopholes in the system will allow the virus to continue to spread.