Covid-19: We must prepare for the worst, say experts

Are we prepared for a Covid surge? Is our medical equipment functional? These questions have bothered the masses and healthcare experts, especially with the shutting down of civic-run jumbo Covid care centres and special wards in hospitals.

mid-day had cautioned against the dismantling of these centres in reports ‘Closure of jumbo centres amid global Covid surge is worrying' (October 19) and ‘Don't let medical equipment fall into disuse, say experts' (October 22). Experts are of the view that the most important part of the preparedness is to keep the public informed.

Worrisome numbers

"Assume that 2 lakh people are tested via RT-PCR in each metro. A Covid positivity rate of 20 per cent - 40,000 new cases - daily in each city. While 23 per cent of Covid-positive patients will need hospitalisation for oxygen, 30 per cent of those testing positive will need hospitalisation, ie 12,000 hospital beds, daily in each metro city, added cumulatively for three to 10 days," said Dr Subhash Hira, professor of global health at the University of Washington-Seattle and advisor to WHO-TDR-Geneva.

"The problem staring at health officials now is that several quarantine and treatment centres have been dismantled. For example, the BKC Covid jumbo centre, with a bed capacity of 2,000 and an oxygen plant with piped connections to beds, hundreds of ventilators, paediatric beds and an ICU, was dismantled a few months ago. Those familiar with its design are disappointed about wasted resources," Dr Hira added.

Also read: Mumbai: All Covid samples to undergo genome test, says BMC

State preparedness

According to Dr Hira, to avoid panic, the state health departments should ensure that the public is informed well in advance of preparedness about treatment centres, nearest Covid testing centres and their timings, hospitals with oxygen plants and medical supplies through Pradhan Mantri Jan Aushadhi Kendra to avoid black-marketing, and helpline numbers. "The main change will be that the droplet transmissibility of BF.7 will be reduced to a quarter by using nasal vaccines, i.e. to infect fewer than four persons," Dr Hira said.

Dismantled centres' status

Dr Wiqar Shaikh, professor of medicine, Grant Medical College and Sir JJ Group of Hospitals, said he was seriously concerned about the global Covid-19 situation. "The spike in several countries and the emergence of new, resistant variants are worrisome and in India, we just cannot afford to be complacent," he said.

Dr Shaikh added that mid-day had earlier warned about a possible Covid surge during the winter and said that a bigger worry was the dismantling of coronavirus facilities all over the country. He stated that in Mumbai in particular, all jumbo Covid-19 centres had been dismantled and what remains in the city for Covid-19 patients are the Seven Hills Hospital and Kasturba Hospital. "If there is indeed a surge, where will patients get hospitalized," he asked.

Dr Shaikh also said that he was concerned about the state of critical care equipment, which was dismantled and has now been put in storage. "A surge during the coming weeks could put a serious strain on facilities in Mumbai. If jumbo centres have to be opened at short notice, will all this equipment be in working condition, particularly ventilators, cardiac monitors, BIPAP/CPAP machines and pulse oximeters, etc," he asked.

RT-PCR kits for testing

Dr Shaikh voiced another cause for concern: the virtual abandonment of Covid testing, particularly the RT-PCR swab test. He added that RT-PCR kits are just not available in several laboratories and hospitals across Mumbai and the same is possibly true for the rest of the country. Ramping up facilities for Covid-19 testing is, he said, a critical part of our war against the virus.

Dr Shaikh said that it is now time, as is being done in other countries, to restart Covid jumbo centres, check the functioning of all critical care equipment and begin to employ extra medical and nursing personnel, as well as supporting staff. Dr Shaikh added that in view of the looming threat, the government must do its homework on a war footing and every Covid-19 facility must be kept ready for every eventuality.

Learn from the past

"It is high time we start learning from past mistakes to avoid any last-minute panic. The fact that the Central government directed all states to prepare themselves for any oxygen supply shortage is indicative that we need to prepare ourselves for something that is unseen at this moment," said Dr Shaikh, reiterating the need for the Central and state governments to make wearing masks and following social distancing norms mandatory.

Way out to fight virus

Dr Ketan Vagholkar, professor of surgery at DY Patil Medical College, said, "The recent surge of infections due to newer Covid variants in China should serve as a warning to us. All major health facilities that are experienced in managing Covid cases should keep part of the facility well-equipped and ready to meet any unprecedented challenge posed by variants. These facilities should also take into consideration that all supportive facilities, including oxygen supply, are adequate. An online video consultation facility should be offered by every state, civic and private-run hospital managing such cases so that citizens have access to immediate healthcare advice."

Prepare to face the worst

Dr Santosh Bansode, head of department, Emergency Medicine, Wockhardt Hospital, Mumbai Central, said, "The whole world is on alert since Covid cases have started increasing. We need to be more alert, considering our huge population. When Covid initially started spreading in India, people did not have any idea about where to do tests, where to admit positive cases, etc. Since jumbo centres are closed and private hospitals are dealing with non-Covid patients, people don't have any idea what to do if a family member has Covid symptoms."

SOP needs to be in place

Dr Bansode added, "We must have a clear idea about protocols and places that we can go to for investigations and treatment. The government has alerted us but we still don't have a clear idea about Covid patients' admissions. Initially, the government developed a helpline for Covid patients. This helpline will be needed again for spreading information. The state health department should educate people about test centres, admission facilities and availability of oxygen and ICU beds for Covid patients so that if cases increase, we are completely informed."

According to Dr Bansode, the government must use the media to circulate information about area-specific Covid facilities. "Our backup plan should be ready so that we won't face difficulties. All doctors should also be made aware of where they should refer patients for admissions and treatment. We should learn from our past and act promptly so that people won't suffer in actual situations. Drugs that are used for treating Covid should be made available at affordable rates to prevent black-marketing. We have to be ready, keeping in mind the worst scenario," he concluded.