Conditions of doctors in government hospitals under Covid-19 lockdown

MEL spoke to Dr. K. Senthil, President of Tamilnadu Government Doctors’ Association (TNGDA), on the prevailing Covid-19 situation and conditions of doctors in government hospitals.

MEL:  Dear Dr. Senthil, We want to know the current status of the Corona Virus in Tamilnadu.

Dr. Senthil : Among various diseases in the world, Covid-19 (Corona Virus) is one with very high infectivity, long incubation period  (of 15 days), and long infectivity period, viz. the time upto which it can spread to others, is 28 days. After TB and Leprosy, Corona virus is one with long infectivity. With these characteristics, it can very easily spread and can cause large scale community transmission.

We doctors have some doubt based on the current trends, if we are moving from Stage 2 (Individual Transmission) to stage 3(Community Transmission) of the disease. Stage 2 to 3 need not be extensive all over the state but can be regional. With lockdown and other necessary steps, we are trying to see if we can prevent going into stage 3.

We have reached over 1600 Corona Virus infected positive cases in Tamilnadu and recently some patients are becoming positive due to unknown sources. Under such situation, when lockdown is lifted, unknown sources particularly those patients without any symptoms have the possibility of spreading the disease to the public. At the same time, we know that the lockdown cannot be continued for a long time. Hence we the government doctors feel that we should lift lockdown only in a phased manner. Otherwise there is possibility of the disease spreading to dangerous levels.

MEL - How do we prevent its spread?

Dr. Senthil: Death percentage from those infected has been at 12% in Italy and 7% in US. World average death rate of Covid19 is being 7%. Although the death rate is high in aged people, the number of aged people getting infected is less as they don’t go out much and hence are not exposed to the Virus too much. Infection is high in the younger age group, but death rate is higher in aged group.

Mortality rate of Sars-Cov2 infected patients In TN is 1.25%, whereas in whole of India it is about 3%. Given the high death rate of this virus, we should not let it spread. We must aim to contain it by ‘’breaking-the-chain’’ that is by containment methods and lock the virus from infecting others, as they have done in China, South Korea, etc. Even though cure has not been found, by complete lockdown, isolating the infected persons and their contacts, we can prevent its further spread.

MEL - What are the treatment options for the infected people ?

Dr. Senthil: We are trying to make the patient recover as soon as possible by all available means. Medicines suggested by the Government of India and Tamil Nadu such as Hydroxychloroquine and others, are used for supportive and adjuvant treatment, but they are not of specific help to patients. In seriously ill cases, other aggressive protocol is followed. We are also waiting to start convalescent plasma therapy shortly.  

Toculizumab is an expensive drug (about Rs 50,000) which may be needed for patients whose condition is fast deteriorating. Selective usage of steroids and anticoagulants also help in some difficult cases.

Apart from the medicines, using Ventilators and Oxygen are main aspects of treatment. Giving Oxygen yields excellent results. Even if we give Oxygen for 3-4 days, the disease gets cured in 20% of cases. So we should ensure adequate Oxygen supply at all hospitals.

We need more laying of oxygen pipelines, points, regulators, Oxygen cylinders and Oxygen generators. We may require 15-20 times the normal Oxygen requirements, to treat the large number of Covid19 patients. With new modes of supportive treatment, the requirements of ventilators has come down to 5% of patients. But we still require lot of ventilators.  

Convalescent Plasma therapy is another suggested line of treatment.

As a permanent remedy we in India also must try to find a medicine or a vaccine for the virus.

MEL - Are the Doctors treating Covid-19 patients protected well?

Dr. Senthil: As far as the protective gear is concerned, Personal Protective Equipment (PPE) is being given by government. But its quality is somewhat doubtful. Sometimes, its model, size etc. do not fit properly. Hopefully the quality of these protective equipment and accessories will be ensured. Protective gears are the most important aspect of our efforts in treating Covid-19 patients. Any compromise on that will seriously put our healthcare workers and thereby the entire healthcare services of our country to a very serious risk. Our Association has requested the Government to ensure the quality, before distributing them to our healthcare workers.

World records show that fatalities from Covid-19 for medical personnel are about twice those for the general public. This is because of exposure and high viral load for medical professionals as they are directly exposed to the infected patients.  

MEL - Has government provided PPE to all medical professionals who are likely to meet Corona Virus infected patients?

Dr. Senthil  :I think for those who do Corona Duty, PPEs have been supplied. But as mentioned earlier, the design and the quality of it cannot be said with certainty.

For Non-Covid duty, which is looking after regular patients, etc. we have asked the government that they should also be provided with proper PPE such as masks, etc. within the next few days. Government has accepted it. That becomes very crucial, if the community spread happens.

MEL - What type of masks are recommended to be used?

Dr. Senthil: ICMR has recommended N95 masks for Covid duty and fever wards. For ICU and emergency type of non-covid cases also use of N95 masks is recommended. Most delivery cases are coming to Government hospitals, as almost all private hospitals are now closed. Emergency cases and delivery cases form the key services in non-covid cases in all government hospitals. For other Out Patient areas, normal surgical masks are sufficient. However, if community spread starts, then we need PPE to attend all cases. Before Lockdown is lifted, government has to ensure PPE for all doctors.

Anything which requires physical examination and touching of patient, need to be done only with PPE. Until an effective medicine or vaccine is found for Corona virus, we may have to minimize physical examination of patients. Doctors have to stand 1 meter away and treat patients whenever possible. This will be the practice throughout India.

MEL - Can you please elaborate on the working conditions of Covid-19 duty doctors?

Dr. Senthil: Considering that there is elaborate preparations needed by doctors before and after duty, doctors are posted for 6 hour duty shifts. Once doctors complete 7 days of duty then they are kept in isolation for another 7 to 14 days. Doctors are given accommodation in hotels as they cannot go back to their homes or hostels and have to be isolated. During this entire duty and isolation period of 21 days, they cannot meet any one including their family members and total isolation has to be observed. Even food and water is being provided in their place of stay as they cannot go out. Doctors are given supplementary medicines such as Hydroxychloroquine, Vitamin C, D, etc. In some places they are also given immunizations for H1N1. Doctors are regularly tested for Virus on the 7th day of their isolation stay. Given all this support and prevention, doctors are working confidently in fighting against the Virus, although the risks are multiple times high from multiple sources.

MEL - What are the social issues doctors face at this time?

Dr. Senthil: In general we isolate ourselves from the society, in order to prevent infecting others. Due to lack of knowledge people are afraid of coming in contact with doctors and nurses. You are aware of how some people reacted towards the burial of a doctor who had died of Covid-19. We took serious objection to this and asked the government to provide necessary protection for such cases. Central government has issued an ordinance to protect medical professionals. State government has also promised to provide state protection for funerals, etc.

In spite of the very high risks to lives of medical professionals, no doctor or nurse so far has refused to take up the Covid duty.

MEL - What are the other demands of government doctors?

Dr. Senthil: All over Tamilnadu, about 18,000 doctors are working in government hospitals. We have certain important demands on pay structure and allowances of doctors. We were in the final stages of discussions with the Government on these issues when the Sars-cov2 virus struck our country. We have presently set those demands aside and are engaged in Covid work.

MEL - Do you get adequate support from your health care support staff in the hospitals?

Dr. Senthil: Our Nurses provide excellent support in our fight against Covid-19. They are also very committed, take responsibility and work with dedication without hesitation, along with doctors. We are working on training the other support staff such as nursing assistants, sanitary workers, etc. about the precautions to be observed during the pandemic.

MEL - What are the lessons we can take from the Corona virus pandemic for the health care of our country?

Dr. Senthil  : Health is an important sector. The state has to ensure good quality and adequate health care at affordable rates, to all the population.  Health care must include preventive medicine, research for newer drugs, vaccines, etc. Hence quite a considerable share has to be allotted to healthcare in our country's budget.

MEL - What are your suggestions to the people of TN?

Dr. Senthil: People of Tamilnadu fully understand the risks involved due to this pandemic. Vast sections of our people have lost their livelihood and do not have adequate support during this lockdown. In spite of this, they are doing their best and co-operating with the public authorities against heavy odds. Lives are very precious and we all must work together to protect them.

We the Doctors, Nurses and other healthcare staff will continue to provide our best services to overcome this crisis.

MEL - We thank you for sharing your valuable thoughts and experiences.

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