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PAKISTAN is in a crisis of global, unpredictable proportions. The unprecedented Covid-19 pandemic has shocked some of the world’s most developed countries, causing widespread panic and confusion. We have been trying to keep up with global guidelines to minimise losses, but the worst is yet to come.
Pakistan, however, is at a certain advantage. We already have some research and guidelines on best practices from other countries’ experiences. We have adopted policies of quarantine, thermal scanning and social distancing. But there is one key problem we have missed, something that is likely to be pivotal in the war against Covid-19: what happens when our healthcare providers get infected? What do we do when they need to be isolated? And worse, what if they unwittingly transmit the virus to people who were not hitherto infected? These questions need urgent answers.
The Chinese and Italian experiences tell us that many of our healthcare professionals will contract Covid-19. Coupled with the limited supplies of personal protective equipment (PPE) in Pakistan, the number will certainly be higher than in those countries. I cannot overstate how dangerous that would be, and how critical it is to avoid such a situation at all costs. The consequences would be disastrous: not only will our healthcare system lose capacity as doctors and nurses get infected, but our providers and caregivers may also spread the virus to many more people. A single infected doctor can potentially turn the tide against us before he or she even begins to show symptoms and can be isolated.
In that situation, hospitals will become hotspots of viral transmission, and our most vulnerable people would be at even higher risk. We need to find effective ways to make sure, first that our doctors don’t become the very source of spread and, second, that a lack of doctors doesn’t cause high mortality rates.
As our most precious resource, medical staff must be protected.
My experience on the front lines of our response to the dengue outbreak has led to a few suggestions. For a start, we should divide healthcare staff at each facility in two batches. Each batch should consist of senior and junior doctors as well as students. While one batch works in the hospitals, the other can serve as a reserve force — in self-quarantine, away from patients infected with the virus, and keeping an eye on their own health. As doctors, nurses and other staff from the active team are relieved or isolated over suspicions of having contracted the virus, our facilities can call on this reserve pool to maintain baseline availability of essential staff.
However, this means we will effectively cut our human resource in half, even as we face a surge in patients. I would suggest a few adjustments to mitigate the impact. All doctors currently enrolled in house jobs must continue serving, perhaps with temporary contracts as medical officers, at the same facilities after their designated house job periods end. Furthermore, students of ex-final year (new house officers) should be recruited in hospitals as soon as possible so that they may add to the workforce. And, like Italy has done, current final year medical students may also be allotted rotations in wards so that they may help out as well as they can.
To ensure our healthcare resources are available for those who most need it amidst this pandemic, we must supplement these steps with a suspension of all day-to-day, non-emergency OPD and non-critical/elective surgical procedures.
These drastic actions may create temporary hiccups in the system, but no healthcare system in the world can respond to a pandemic with such a high attack rate. It is critical to improvise, and in doing so, important to ensure that what little resources we do have are not immobilised due to our own carelessness. It worries me no end that unprotected medical professionals will contract the virus, which will then make hospitals hotspots for new infections.
By rationing our human resource, we can use PPE more efficiently, and also make a good-faith effort to make sure all staff working on the front line have access to all the equipment they need. We must not take the WHO-reported three per cent mortality rate lightly, for it is highly dependent on quality of healthcare available to those who contract Covid-19.
We must protect our medical staff, who will offer their sweat, blood and lives as the crisis worsens. We must also maintain a reserve healthcare force, which should kick in as and when the need arises. We cannot, after all, afford to have hospitals out of commission because all their staff contracted Covid-19, nor can we afford to have healthcare professionals spreading the virus wherever they go and to all other patients just because of a lack of PPE. It is only a matter of days until our system witnesses the full brunt of this pandemic. The time to prepare was yesterday; we have no time left to waste.
The writer is a doctor.
Published in Dawn, March 22nd, 2020
