Adapting To A ‘pandemic’ Way Of Life

Despite India’s Covid-19 count crossing the 60 lakh-mark, the latest recovery rate has been a harbinger of hope. The total number of recoveries from Covid-19 surged to 48, 49,584 on September 26, 2020, as per the Union Health Ministry data, which translates to a recovery rate of 82.14%, topping the total number of recoveries with high successive single-day numbers globally. While the current scenario of low mortality rate and the anticipated vaccine pipeline is reassuring, Dr Devi Prasad Shetty, Chairman and Founder of Narayana Health, Bengaluru, offers more clarity on managing healthcare during the pandemic in a recent webinar hosted by the Ladies Study Group (Kolkata). Dr Shetty lauded the government’s long-hauled initial lockdown decision, well before most other countries and other pro-active steps, which although was rife with hardships has set the stage for a ‘new normal’ way of coping with the coronavirus

"If we did not go for a lockdown, then within the initial one and a half months, we would have had at least few hundred thousand Covid-19 patients flooding the hospitals, which are most ill-prepared to manage Covid-19 pandemic. We had just one or two companies making PPE’s and if the patients started flooding the hospitals without PPEs, in no time, half the country’s doctors, nurses and paramedics would have been infected, and that would have been a disaster”, said Dr Devi Prasad Shetty, Chairman and Founder of Narayana Health, Bengaluru.

The Silver Lining

Before the onslaught of the Covid-19, India had less than 40,000 ventilators, for a country with a population of 1.3 billion. India also faced the humiliating experience of refusal from every country in the world to import PPE’s and ventilators in the initial days but within two months (of the breakout) and now, India has hundreds of companies making PPEs. “We have companies which can manufacture thousands of ventilators on a daily basis. I am very proud to say that we are in a position to export PPEs, ventilators, medicines and whatever is required for Covid-19. This country has become independent, not only independent but it is also supporting other countries. All this wouldn’t have happened but for the initial lockdown” said Dr Shetty.

The latest Union Health Ministry data recorded, indicates an accelerating total death count of 95,542 but a promising revival of recoveries at 50,16,520 too. The active cases registered in the same data was 9,62,640, but does the scenario demand another lockdown?

“If you ask me whether with the increasing number, you need another lockdown, the answer is no! We have to get back to work now. Lockdown has served the purpose”, said Dr Shetty. The next step forward is in being responsible for managing the spread of the virus. The doctor asked, “Is it the government or is it the people”? His reply was, “The ball is in our court. It is entirely left to the people of the country to prevent the spread and protect themselves. Government has done the job, now it is up to you,” he said.

And The Lockdowns

He introspected on people finding faults in the way the government is managing the outbreak, restricting Covid-19 testing, quarantining them against their wish. “One must realise that Covid-19 is a six-month old disease and no one knows how to treat it. After treating thousands of patients. We know how it behaves. Which medicine works and which that don’t. Therefore, quarantining an infected person is the best way to prevent the spread. But who’s infected? Most people who are infected, they look normal. If you’re waiting for symptoms so that you can go for the test, it is too late,” he said.

Rx For Prevention And Protection

Avoid Panic Buttons

• Do not worry about the increasing numbers. Numbers are increasing but it doesn’t mean that more people are getting infected. People getting infected as before and they will get infected
• Over 1.2 million tests are conducted daily and as with more tests, more people will be detected with problems. So, there is no point in worrying
• Try and get as many people tested at least once in two weeks, and quarantine whoever is infected in a safe place, making sure they do not infect others

The Do’s:

• Get employees tested at regular intervals
• Get staffers at home and office tested regularly such as drivers, maids and other associates Rx Warning: “If these essential service providers are tested positive, they go home and give the infection to their loved ones. We are in a position to get them tested, after all how much does it costs? Over a period of time, the cost of the test will also come down.”

"Over 1.2 million tests are conducted daily and as with more tests, more people will be detected with problems. So, there is no point in worrying"

Masks For Survival

As a surgeon, in the initial days of the outbreak, Dr Shetty would be annoyed at people wearing surgeons’ mask. “I believe that mask can never prevent from getting anything or giving any (infection) to somebody else. We as surgeons wear the mask only to prevent the splashing of the blood into our face and when we cough, we don’t want the spit to enter the patient’s chest. That’s the only purpose I thought,” he said.

However, this personal notion on masks has since altered and he prescribes wearing masks and regular screening (testing for Covid-19) as essentials.

“It’s not very complicated at all. I am not an epidemiologist, I might not have all the data to justify my statements. But I’ve been in this business of healthcare for over few decades. My observation is that if every citizen of the country wears a mask when he is interacting with other people at home or outside the house, I strongly believe that this incidence of Covid-19 in India will come down significantly”, said Dr Shetty.

He emphasised on the scientific evidence of wearing masks while talking, communicating, sneezing and coughing which can help prevent the spread of the virus to others. “When you continuously wear mask, and suppose you are exposed to somebody who is coughing with Covid-19, the quantum of the virus which will enter your respiratory passage is too small for you to get the infection. But, it is big enough to induce immunization. So, continuously wearing the mask in public places is as good as getting a vaccination done over a period of time,” he said.

Rx Warning : “The tendency is to pull off the mask while talking which defeats the whole purpose of wearing it. My request is that wear a mask always inside and outside the house. Make sure everyone else in your house wears a mask. It may not be an N95 or a surgical mask, it can be a cloth mask and if you do that, you not only protect yourself but everyone else.”

Regular Screening

As a surgeon operating and consulting large number of patients, Dr Shetty has to deal with the fact that the majority of the people with Covid-19 in India are asymptomatic carriers. So, they have the policy to screen anyone who comes in close contact with Dr Shetty because of his age including his immediate staffers secretaries, drivers and everyone.

“I was shocked that two of my secretaries who are constantly standing beside me, didn’t even cough a single day. They had no symptoms but both tested positive. One of our drivers was positive. In another incidence, we got two of our family friends to get the test and they were positive and are so grateful to us because both of them have 80-year-old mothers at home. If they didn’t get tested, they would have given the Covid-19 infection to their mothers, there is a strong possibility that the consequences would have been disastrous,” he said.

Social Distancing Norms

While it is advisable to avoid large gathering, make sure that it is arranged in the open. “There is enough scientific evidence to prove that if you have any social engagement in an open air-space, and everyone is wearing a mask and keeping a safe distance, the chances of anyone giving or getting an infection from other person is extremely small,” he said.

Washing Hands

Washing hands and not touching the face can make a huge difference. “You should wash your hands at least for 20 seconds and do not wipe your hands with a towel after washing. Keep disposable papers to dry your skin.”

"If we remove the pen and paper from the hands of doctors, nurses and technicians and give them the digital tool where all the data is entered on software, healthcare will become safer, accessible and it will become affordable"

Testing For Covid-19?

“Covid-19 test is not like an injection. They just put the stick with a swab inside the throat and the nose. I test myself every week, sometimes twice a week, and after a few times you get used to it. My son is studying in MIT, they open their university for the students to attend classes with one condition. Every student must go for Covid-19 testing twice a week. There the band is activated in a manner that only the ones who had a Covid-19 test negative are allowed to go inside,” said Dr Shetty.

He debunked the idea that the precautions laid down may seem like a lot of hassle and said, “Believe me, you have no choice. Covid-19 is not going to go away for at least one more year. Because the last Spanish Flu lasted for nearly a year and a half.”

On the anticipation surrounding the vaccination pipelines in progress in India and abroad, Dr Shetty is realistic about the vaccine reaching wider communities. “I understand all of you are waiting for the vaccination to happen. And you all think we can protect ourselves. That is wishful thinking. I have no doubt that we will be successful in producing a vaccine to prevent Covid-19. The question is when? Is it going to be in two months? Or one year?”

Juxtaposing With Business And Economics

Dr Shetty strongly advocates on opening up the economy as a year-long wait or more in anticipation of the pandemic to subside could be detrimental to the world economy. “The entire global economy will fall apart. So, the only way to revive the country’s economy is that all of you go out, go for shopping, go out and eat in restaurants. Thousands of restaurants are getting closed. But when you’re there, please follow very strict social distancing. That is very important,” he said.

Rx Warning : He said that by staying at home, we run the risk of ruining the Indian economy. “Whatever I’m saying maybe contrary to all the teachings you have heard so far, but the economy must start. People must start to sell, people must start buying and the only way this can happen is if we go out. But, just because we go out and indulge in these activities, are we going to increase the spread? No.”

On Travel Restrictions : “If you ask me whether there is 100% guarantee, it is a ‘no’. But people without co-morbid conditions can go for a short flight if you are protected with all the mask and devices and everything, it can be reasonably safe. But, whenever using the restroom, you have to be very careful to not touch any of the wet surfaces. Take as much precaution as possible.”

On retrenchments : “There is a downturn and a company is doing badly but I can never reduce the workforce unless I file frivolous complaints against him and making him as a criminal or incompetent person and then get rid of him. It’s such a humiliating experience. While a lot of bad things have occurred because of the Covid-19, a lot of good things also have happened.”

Greater Good

• Companies are investing heavily in technology and software. “If we remove the pen and paper from the hands of doctors, nurses and technicians and give them the digital tool where all the data is entered on software, healthcare will become safer, accessible and it will become affordable,” he said.
• Telemedicine becomes legal. “For 17 years, telemedicine was illegal. No doctor could see a patient online and advice on medications or other health aspects. Since it was illegal, if the patient sues me, I will lose the case in the court of law. Came Covid-19, regulations changed within a week and today I see 30 patients every day, sitting in my OPD or from home-patients in remote location sitting in their bedrooms. Believe me, this will dramatically change the way heart patients are managed, the way diabetes and cancer are managed, essentially, we will be in your pocket whenever you want.”

"I understand all of you are waiting for the vaccination to happen. And you all think we can protect ourselves. That is wishful thinking. I have no doubt that we will be successful in producing a vaccine to prevent Covid-19. The question is, when? Is it going to be in two months? Or one year?"

Medical Interventions

Since Covid-19 is ruthless to elderly people, especially those with co-morbidities, Dr Shetty requested that the elderly and people with co-morbidities be extremely cautious. He noted that at any given time, people who are dying are those who knew they have Covid-19 but they didn’t bother checking their oxygen saturation.

He requested everyone to buy an Oximeter for the house to check oxygen saturation as many times as possible. It is an important parameter which is monitored in other diseases too. “But unfortunately, in Covid-19, even when the oxygen level goes down to certain low levels, you have to put them on a ventilator. They are calm and composed, and a good number of them are even talking to their loved ones on the mobile phone. And, the next minute they are on a ventilator,” he said.

The other greater problem is that people come to the hospital very late. “It’s not their fault, it just that they didn’t know what oxygen saturation is. If the oxygen saturation comes to less than 94 please ask for medical attention. You’re better off in a hospital than at home. That is very important, doesn’t matter how fit you are.”

DO’S

People with co-morbid conditions should be restricted as much as possible. “But, if they want to go to temple early morning, when there is nobody, they can go, or go to a restaurant when there is hardly anybody there, with their family members. There are ways and means of going out of the house, than staying constantly at home, which is one of the strongest reason for people getting depression”, he said.

Manpower Challenges

Dr Shetty categorically said that it is not the ICU beds that are in short supply but the availability of trained medical staff. “Beds do not treat the patients. It is doctors, nurses and technicians who treat you and they are in short supply. In the last six months, 170 doctors, nurses and technicians of our hospital are infected with Covid-19. They are so motivated that as soon as they got better in 15 days, they joined back, working full time. Therefore, we should be eternally grateful to these passionate doctors, the young nurses and technicians who were willing to sacrifice their lives to save unfamiliar persons.”

Liberating Medical Education

In India, there are less than 40,000 anaesthetists and half of them might have crossed 50 years, and may not want to ventilate a Covid-19 patient. Also, we have nearly 70-80,000 under graduation seats and there are hardly 20,000 postgraduate seats (Post Graduate Certifications) which is the reverse trend when compared with that in the U.S. “Post Covid-19, higher medical education has been liberated by the government allowing a good medical faculty with good patient out-flow to transform into a specialist centre and train medical experts in eight of the important medical specialities enabling any hospital with over 100 beds to do so,” he said.

“What we see is a gloomy picture right now but will overcome the difficulties and this also shall pass. It the end, the new world will be much stronger than what we are.”