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Putting aside pathy wars

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Divisive causes will merely divert attention and prolong our tussle with the real foe: SARS-CoV2

As  India’s  second  wave  of  COVID-19 ebbs and flows across various states, doctors and hospital administrations are coping with rising cases of fungal infections. Cases of mucormycosis are being  reported  in  a  disproportionate  number  of COVID-19 recovered patients, most often seen in immunocompromised patients, as well as diabetics.

While the black fungus variant has been observed to mainly affect tissues in the nostrils, sinuses, retinal vessels, and brain, white fungus infects the oral mucosa, tongue, mouth, and food pipe. The third variant observed so far,  yellow fungus, affects internal organs like the small and large intestines.

Theories abound that these fungal infections could be linked to the overuse of steroids, lack of adequate ventilation, and poor infection control and prevention protocols, especially of intubated patients. Thus hospital administration will need to ramp  up  the focus on  cleaning, disinfection and sanitation of hospital premises and staff hygiene practices, especially related to ICUs. A notification from the health ministry on May 21 cautioned that infection prevention and control practices needs to be enhanced in ICUs using a bundle-approach to prevent device associated infections such as ventilator associated pneumonia or catheter-associated blood stream, urinary infections etc.

One learning from the first year of the pandemic is that we can never let down our guard, even when cases  seem  to  be stabilising. Thus, doctors and hospitals are already preparing for the third wave. Various hospital associations are conducting CMEs on the safe use of medical oxygen, as very often, due to rising infection rates among senior doctors, junior resident doctors and nurses have to handle complex ventilation  equipment,   with   little   or   no   prior   training. Other CMEs aim to upskill doctors and nurses to remotely manage ICUs, in anticipation of hospitals having to scale up the number of ICU beds during the third wave.

Experts are also predicting that since children will  remain  unvaccinated  for  some  time,  due  to  vaccine shortages, the third wave might see more infections in this age group. Thus hospitals will have to be re-designed for treating children rather than only  adults. For  example,  this  means  sourcing  equipment like ventilators, etc sized for children. As well as having more paediatricians available and trained for ICU duties.

Midst the battle with SARS-CoV2, divisive forces seem hell-bent on dividing healthcare practitioners. The pathy war has once again flared up, this time triggered by comments from Baba Ramdev decrying the use of allopathy during the pandemic. The Indian Medical Association (IMA) has pushed back and is threatening legal action.

There is no doubt that this is a turf war driven by hard economics. Baba Ramdev’s Patanjali range of products compete with allopathic products and now COVID-19 vaccines, for the hard-earned out-of-pocket healthcare spends of India’s households. For instance, rising pharma and vaccine stocks during the first year of the pandemic has thrown up newly minted billionaires while substantially increasing the wealth of existing ones. The People’s Vaccine Alliance analysed the annual Forbes Rich List, as published this April 6. There are nine new vaccine billionaires. Two of the eight vaccine billionaires who saw their wealth increase during the pandemic are from India: Cyrus Poonawala, founder of Serum Institute of India and Cadila Healthcare’s Pankaj Patel. Without getting into the debate on reasonable profits being necessary incentives  to  fund  cures  for  future  pandemics, there is no doubt that this is a battle for market share.

But with a virus raging, there is a lot more at stake than market share. As of June 1, IMA has lost 594 doctors just during the second wave of COVID-19, with the highest number being in Delhi (107). The toll among other frontline healthcare professionals like nurses and lab technicians, etc as well as doctors not affiliated to the IMA, would take this number   even higher. India’s daily new cases reported might be reaching a plateau in some states, but it is much higher than the first wave. We have long crossed Brazil in terms of global COVID cases. Our national vaccination campaign has lagged due to dearth of supplies. And hospitals and staff are racing against time to gear up and skill up before the third wave.

Divisive causes will merely divert attention and prolong our tussle with the real foe: SARS-CoV2. And  future  threats  to human health. Allopathy, AYUSH, and all streams of medicines, and their practitioners need to bury their differences, find common ground and evolve an integrated approach to disease management. Rather than disintegrating the dwindling trust of hapless patients in all pathies and their practitioners.

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