Dr H Sudarshan Ballal, Chairman – MHEPL, Manipal Hospital

What is happening in the health care sector during the second wave of COVID-19?

High number of infections and deaths are observed in the second wave. This unexpected surge caused a great paucity of beds, oxygen, ICU and medicines. A few months prior, countries like USA and UK also experienced this deadly second wave, but soon the situation was contained. Hence, this example should be used to be hopeful that the second wave will eventually subside in India as well. That being said, we need to be fully prepared of third wave.

Working in ICU creates stressful environment for frontline workers as every case is unpredictable. How can frontline workers cope with such pressure and stress?

Stress is produced on both mental and physical levels, when unavailability of resources leads to avoidable deaths, something that was observed during the second wave. Physical stress due to long working hours was something the frontline workers already witnessed in the first wave, but the mental stress during second wave is a slightly newer phenomenon.

In order to combat physical stress, a shift system must be devised by all hospitals, which would help the frontline workers to take some time off from work and spend time on things such as family. Due to higher caseloads, workers were unable to devote time to things such as normal eating habits, routine, exercise, and personal time. A shift system would allow them to focus on these aspects which would in turn also help with their mental well-being.

In order to combat the mental stress, constant counselling sessions must be provided to the health care workers so that they have an outlet to release their pressure and stress.

Are there any drugs or therapeutics which will help fortify the infection in frontline workers?

Opinions have changed regarding zinc, hydroxychloroquine, vitamin c and D, as they have not yielded any scientific proof of being effective in treatment of COVID 19. The only way to battle and overcome this pandemic is through COVID appropriate protocols such as mask, social distancing and avoiding crowded spaces. This, combined with vaccination would prove extremely beneficial in bring down the number of cases.

Where is this virus headed?

As is the case with most viruses, they mutate as they replicate. Hence, emerges the need for a booster dose. The best-known example of this is influenza. So, we can expect that vaccine for COVID-19 will have to be administered every year. The frequency would depend on the type of mutations and the immunity period provided by the vaccine.

How can hospital staff manage non-covid patients during a time like this?

This is perhaps the biggest concern during this time as there is now place where patients of cancer, diabetes, kidney, heart attacks, lug diseases can go to seek treatment. Non-covid diseases have also got worse with time as centers for treatments such as dialysis centers have to be shut down due to lockdowns and also due to the patient’s inability to travel. Planners must keep in mind for the future that both COVID care and non-COVID care must be made available in the hospitals.

How can transfer of skills and infrastructure to rural areas be done, in order to battle the disease better?

• As an emergency measure, people who have just finished MBBS and nursing students should be taken in
• They should be provided with incentives and placed in COVID hospitals under supervision
• Foreign students who are here in India to finish their qualifications can also be brought into the fold by providing them with quick training
• ICU care should be thrown open to health care workers who were previously involved in anesthetic and orthopedic departments
• Retired medical workers and armed forces should also be allowed to contribute in COVID care

Government of Karnataka and Manipal Hospitals, in a joint venture appointed respiratory physicians for e consultation/ICU in hospitals across Karnataka. This led to the decrease in mortality to 50%. In addition to these measures, nurse practitioners must also be provided with the opportunity to work in the primary health care.

How do frontline workers manage the expectation of angry patients?

Government should come down heavily on violence against healthcare workers. Measures such as heavy penalty (jail) must be taken. Violence against healthcare workers must be seen as cognizable offence. Special insurance must be provided to health care workers, which would cover areas such as succumbing to illness and enduring such violence.

How to deal with the guilt of not being able to help some patients?

Unfortunately, we as health care workers must adapt to these current circumstances. We can only do our best. It is of course, not possible to cure all ailments in India and elsewhere. This is where talking and counselling play an important role. Take frequent breaks between work this would help with dealing with depression and despondence.