Stories from the frontlines: 'We cannot lockdown hospital wards. Progressive planning is the way to go'
As Covid-19 infections surge in Pakistan and the death toll rises, healthcare workers are fast becoming its target. According to a recent report by the World Health Organisation, over 500 Pakistani healthcare workers have been infected by the virus, and among them, doctors are the most affected. Since the release of this report, several healthcare workers have tested positive for the virus at Islamabad’s Pakistan Institute of Medical Sciences (Pims), resulting in the closure of its maternal and child health ward. In another instance, the gynaecology ward of Peshawar's Lady Reading Hospital was sealed shut after a sizeable number of healthcare workers tested positive for coronavirus. While it's true that in the fight against Covid-19, healthcare workers are undeniably at the high-risk frontline, at the same time, going for long term ward closures is like putting up locks on the wrong doors.
It needs to be said that Pakistan’s countrywide lockdown, though haphazard and varied, did help in slowing down reported infections but new relaxations in rules are likely to precipitate chaos unless carefully executed and matched with strict testing as well as contact tracing protocols. More worryingly, we see that some hospital wards are closing down, and that is only adding to the risks when it comes to the health and safety of our citizens, particularly as the government is gearing towards easing lockdown measures. What we need in this time are progressive contingency plans to account for healthcare workers who fall ill, but at the same time, ensure that we are not shutting down hospital operations as they provide critical service delivery to the public.
What should instead be done is to make sure that rules and regulations with respect to infection control are made mandatory in our wards and our hospitals. The government should ensure the availability of personal protective equipment (PPE) for healthcare workers at all costs and hospitals should as a matter of routine have staff go through video tutorials and demonstrations on the donning and doffing of PPE.
At the same time, patients should be encouraged to wear masks and gloves and the one attendant per patient policy should be adopted and strictly implemented with zero zero tolerance for any gatherings. Large meetings of hospital staff and workers that used to be a norm before Covid-19 should now be held online and infection control healthcare provider guidelines of WHO should be adopted and abided by across the board.
This is the only way we can keep our hospitals open for service delivery to the general public and it is our duty to ensure that when someone needs to see a doctor, they aren't at a loss of options.
It is important that we also look at global comparisons when it comes to hospital operations during Covid-19. Countries such as Iran, Italy, the United States, UK and others have suffered far worse numbers, but there are fewer reports on closures of hospital wards. In Iran, by March, more than 37 doctors had died of Covid-19, but there were no reported closures of hospital wards. In Italy, where hospitals have not experienced such levels of stress since the World War II, many hospital staffers developed symptoms, but reports do not indicate that hospitals shutdown, wholly or partly. Similarly, in the UK, many members of the country's National Health Service (NHS) have been infected, and around 100 healthcare workers have died, but hospitals have remained open and as functional as possible. In the US, over 9,200 healthcare workers have been infected and while the true count remains unknown, hospitals are functioning to maximise service delivery for patients.
In some countries, such as New Zealand, which have a current tally around 1,488 Covid-19 cases across the country, a ward in Christchurch closed as a temporary precautionary measure after a staffer was identified as a probable case. But in our case, we have been closures of entire wards at major hospitals for unclear durations, and also for longer than what may be needed to carry out disinfection. With cases cropping up in wards, closing them temporarily in order to carry out disinfection is fine, but indefinite closures come in the way of public’s access to quality healthcare for time sensitive matters.
Prominent members of the healthcare community are opposed to extended closures. Vice Chancellor of Dow University of Health Sciences, Professor Saeed Qureshi, has expressed displeasure at the closure of hospital wards, especially those in the free-of-cost public sector.
"Units can be closed for 10-12 hours for fumigation and appropriate asepsis, but they should never be closed for longer durations," he says while expressing the need for training final year students, fresh graduates, and post-graduate medical students across specialties as the second line of defence. His university plans on increasing training on critical care for all doctors, nurses, and related staff.
Professor Tariq Rafi, Vice Chancellor of Jinnah Sindh Medical University, has expressed similar views. He says that while armies have reserved forces, the medical community does not have that sort of a contingency, adding that it is time to develop such plans which should include pooling in services from young doctors, family physicians, medical students, and retired doctors and nurses across the board. He feels that workshops and courses for intensive care should be started for all specialties.
Dr Shershah Syed, an obstetrician-gynecologist or obgyn, community fistula surgeon at large, and founder of Pakistan’s only fistula hospital, was similarly horrified by the indefinite closure of critical hospital wards, particularly the gynecology ward at the Lady Reading Hospital. Its closure is likely to adversely impact the poorest of our women who may be in need of urgent care. And while some patients can postpone elective procedures, most cases in the gynaecology ward that usually involve pregnant and delivering women cannot be postponed. Dr Syed, who along with his team has been training health workers on infectious disease protocols and critical care, says the best way to continue operations is to quickly isolate Covid-19 patients so hospital services are not indefinitely impacted.
In summation, I'd like to say that Pakistan and its healthcare community should ensure the following:
Hospital wards are not locked down beyond the period that is needed for disinfection and sanitisation
The wards and hospitals should be kept open and PPE for healthcare providers should be made available
Doctors should care for all patients while fully complying with infection protocols as every patient until otherwise proven should be considered Covid-19 positive
Heads of departments at hospitals should develop contingency plans for infections within their departments and hire and train accordingly
Healthcare workers should receive trainings on social distancing and emergency care protocols. These trainings should particularly focus on removing misconceptions and stigma around Covid-19 infections.
Header photo by Yumna Rafi/File