Help us to save the Indian Health System

Help us to prevent the collapse of the Indian Health system

Covid arrived in India in early 2020 as a new virus causing a strange disease.

We learned fast, from both the global and our own experience. It was a steep learning curve but it gave us knowledge, courage, and confidence.

From knowledge should have come wisdom, which is where humankind slipped up.

Animals do not, they learn from one hurt and avoid the next pitfall.

Two lessons we ought to learn from a pandemic or a natural or a man-made disaster, are how to prevent it in the future, and if it does recur, despite our best efforts, how to manage it better.

It is now very clear that it is not just us, the world slipped up, and we were all caught even more unprepared to meet the next wave.

 Fact is, the world created the right conditions for the next wave.So the reasons are to be found in human behavior and the answers also lie there.

W e have to look inwards, starting at least now, as Covid is not going away anywhere in the near future, and the world  is assiduously incubating future pandemics. The next bus will surely come around the bend soon.

The first lesson Wuhan taught us was that secrecy and inappropriate responses do not work. Had Covid pneumonia in Wuhan been recognized and the infection geographically contained, the world would not have seen and suffered immeasurably from a pandemic.A sound and basic public health principle were overlooked due to political expediency and human intransigence.

Covid, or for that matter, any past or future pandemic, can be managed, controlled, and extinguished only by Public Health Science and practice.That effectively contains the spread in the population.

Outbreaks, epidemics, and pandemics always choose a particularly vulnerable segment of population to cause severe disease and death. Invariably the most severely affected are the poor and vulnerable.All over the world Covid has disproportionally affected the vulnerable people- the poor and aged on one hand, and the people with uncontrolled non- communicable diseases.They are the people who become severely ill, and die from Covid.Each death in the former sinks their families even deeper into poverty and disease. 

The rich world and their welfare states softened the blow for their people who could not work to earn and support their families but most of the world left them to their fate.

The health sector, which I am a part of, can only speak of where we can succeed and where we can recognize potentials for failure and set them right.

The harbinger of distress and death in Covid is hypoxia, which can set in and get severe as the pneumonia worsens.

 We learned from the first wave that various modes of oxygen administration, appropriate to the severity, address the hypoxia quite well and also conserves oxygen, the most vital resource. We also learned, especially in India, that not many would need to be ventilated.

The sad fact that we forgot that basic and vital lesson so quickly, and are now facing a crisis of oxygen production and distribution, is an unforgivable and unacceptable failure of our collective responsibility and native intelligence.

What we can do immediately is avoiding oxygen wastage. Only those patients whose oxygen saturation are below 93 % need oxygen and only they need admission to hospitals. NHS, UK, for example, would not admit anybody else.

There are number of points at which oxygen is wasted in the system and mode of administration which are very well known to doctors, nurses, hospital technicians, and even patients, and these can be easily prevented.

Before we come on to other medications which need hospitalization, it is important to identify who does not need hospitalization. Almost 99 % do not.

Fevers, bodyaches, fatigue, loss of smell and taste, diarrhoea are all self- limiting. Fever , in this second wave, has been seen to last for a week and ten days. If you can afford to buy a pulse oxymeter, use it as per instructions, and if the reading is consistently above 93, you do not need hospitalization. 

Simple drugs like paracetamol that give symptomatic relief are all that you need. You do not need antibiotics like Azithromycin or Doxycycline, unproved drugs like Ivermectin, and you certainly do not need Remdesivir or Cortisones. 

So, what drugs do you really need, and when? The only two proven treatments for Covid that work, besides oxygen, are cortisone ( steroids) and blood thinners. If your condition needs them your doctor would prescribe them for you at the hospital.

Is any drug a magic bullet for Covid? The answer is - none.

The real magic bullets are the three methods of universal prevention- the correct use of masks, social distancing and hand sanitation. We know about them; let us practise them, through this year and beyond.

The fourth magic bullet is " appropriate personal protective equipment" for the healthworker and the front line worker. Let us not fail.in.providing them.

The fifth and last magic bullet is the vaccine. Any vaccine that is on offer to you shall prevent serious, critical and fatal illness.Let us take them.

So much for the bullets that can save us.

But why do we shoot ourselves with so much of misinformation, rumors and gossip? 

Why are we so irresponsible with social distancing, one of the most effective preventions? No meeting or marriage or social celebration or even elections are justifiable reasons to risk a confrontation with Covid , with unpredictable outcomes.

In public spaces, large gatherings are high risk 

In private spaces, with poor ventilation, even small gatherings are high risk.

In a nutshell, where ever a crowd is present, the virus is also present.

Have I oversimplified a complex problem?

The world's most complex problems have always had simple, practical, realistic, effective, efficient and economical solutions

But often, we can't see the woods for the trees! 

Dr,Manivannan