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Beyond any wave, preparing for the future

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HSD Srinivas, Director-Health, Tata Trusts talks about the learnings from the disruptive impact of COVID-19 and highlights that the need of the hour is to collectively augment India’s healthcare sector and be equipped for challenges

COVID-19 has disrupted health, and livelihoods of billions across the globe, claiming millions of lives and shattering economies. However, the adversity of the pandemic catalysed a collective response with every stakeholder pooling resources to cope with the calamity. From public institutions, healthcare professionals, and organisations to multilateral agencies, pharmaceutical companies and common citizens, everyone joined hands with the Government to tackle the difficult situation. Importantly, the learnings from the healthcare crisis have given us insights into how we can prepare for the future.

Pandemic waves and the learning curve

The pandemic has taught us many lessons, serving as a wake-up call and highlighting the need for self-reliant healthcare and a self-reliant (local/ hyperlocal) economy. The much under-appreciated front line health workers of the Indian public health system formed the bulwark of a massive community based response to ‘Test, Isolate and Treat’ lakhs of potential COVID-19 carriers during the (comparatively milder) first wave, while the Secondary and Tertiary care hospitals quickly repurposed their existing systems to reduce the mortality among those with severe symptoms.  Industry and Corporates pooled their resources to address the national emergency while also standing up to the challenges of maintaining a productive environment and balancing their resources.

With each wave of the pandemic in the country, the health system experimented and exercised various clinical, technomangerial options emerging in continuing interactions.

The first wave was a jerk to the community as well as the healthcare system with a lack of hand wash practices, social distancing among population leading to spread of the disease compounded with lack of Infection control practices, lack of triaging & ICU management skills among the staff of health facilities.

These gaps in the first wave were filled up with a focus on behaviour change communication among the mass population for COVID-19 appropriate behaviour coupled with facility-level improvements like ensuring availability of PPE (Personal Protective equipment), capacity building of health staff on ICU management and appropriate triaging of patients in home isolation, isolation centres and COVID-19 hospitals.

The second wave, though expected was not merciful to allow time for recovering from the first wave leading to more life-threatening situations like shortage of medical oxygen, lack of critical case transportation, lack of medicines.

Ensuring the timely supply of oxygen by establishing oxygen plants, efficient system of oxygen transportation as well as critical case transportation, focus on virtual consultations to avoid physical exposure were key learnings from the second wave.

The pharma industry and skilled work-force balance

It may be relevant to acknowledge that, of the seven billion people living on earth, an overwhelming majority of 6.2 billion live in the emerging and developing world and India is home to nearly 20% of this. The challenge in India, like in most parts of the world, is to provide affordable essential drugs and timely vaccines.

The speed and accuracy in developing vaccines for COVID-19 has been unprecedented in human history. India has been at the forefront of production of these live-saving vaccines and drugs. India supplies 30% of the generic drugs, globally, and 50% of India’s pharma production is exported to over 150 countries. The need of the hour is to further leverage this strength and encourage businesses to adopt a humanitarian outlook for the larger good.

Another aspect is the training of ICU physicians and intensivists, specialised in critical care management of infectious diseases, including COVID-19, TB, etc. This will require support of a wider cohort of doctors, nurses and paramedical staff.  These specialised training programmes are to meet the need of a skilled work-force, by acquainting non-ICU professionals with the fundamental principles and practices of critical care and management of infectious diseases for any future waves.

The training should ideally include essential interventions and procedures in ICUs, orientation of critical care skills, like airway management and ventilator management, and how to triage a criticality as mild, moderate or severe and refer cases to appropriate facilities. The programmes should also cover essentials of managing variegated facilities for infectious diseases management, such as isolation and quarantine centres, and management of service areas and patients with mild illness.

The key stakeholders of the healthcare sector-hospitals, pharma and medical diagnostics industry, insurance companies, and governments should collectively strive to provide access to medicines and medical facilities at affordable prices, and facilitate training of healthcare workers to handle any potential threat.

Actions to be prioritised before future wave hits include

With the WHO pronouncing that India may be entering an endemic stage and experts warning about the future waves affecting children, now is the time to regroup for the eventuality. The challenge is to adopt a compassionate approach to healthcare and keep moving ahead more effectively with lessons of the first two waves. This preparedness is also an opportunity to augment the country’s healthcare resources for a healthier future.

  1. Assessment of risk in paediatric age group and planning service delivery accordingly.
  2. Establishment & strengthening of critical care facilities for children i.e., paediatric intensive care units at sub district & district levels
  3. Capacity building of health staff for critical care management of paediatric patients along with cross-functional health teams across the care continuum.
  4. Leveraging technology for virtual consultations/ E-ICUs for effective virtual mentoring by experts to manage critical patients at lower facilities
  5. Strengthening Critical care transport to avoid deaths due to delay in timely care
  6. Sustained scientific knowledge mentorship by the centre of excellence (AIIMS, ICMR etc) and adherence by lower medical centres & overall medical fraternity. It needed to be coupled with capacity building, living guidelines which are well disseminated through CMEs.
  7. Adherence to protocols in schools & colleges and inclusion of COVID-19 appropriate behaviours / Good Health Practices in school teachings, Right Information on WASH (Water & Sanitation Hygiene), Nutrition etc.

The way forward

Even as the Government has redoubled its efforts to vaccinate the citizens at a record rate, it is equally important for all stakeholders to rebuild consensus for observing COVID-19-appropriate behaviour and maintaining the recommended protocols for the foreseeable future. There should be simultaneous capacity building of healthcare workers along with efforts to augment medical supplies as well as primary healthcare facilities in the country. While the immediate goal would be to ensure preparedness, in terms of medicines and infrastructure to deal with another potential wave, the long-term goal should be to go beyond medicines and vaccines towards healthcare management. The usage of appropriate technology tools has helped reduce wastage and closely monitor usage of essential drugs and vaccines and target the vulnerable population in a very frugal way compared to the costs borne by many in developed world.

This is an opportune time for India to build a robust healthcare system that would not only ensure preparedness for a pandemic-like emergency but also ensure the well-being and wellness of its people in regular times.

Even as the increasing healthcare expenditure will go a long way in providing accessible and affordable healthcare to all Indians, it will also ensure that the country is not overwhelmed ever again by any such crisis at any time in the future. On our part, stakeholders like Tata Trusts that are committed to the healthcare sector can actively partner with the government and local bodies in implementing forward-looking initiatives to fight the pandemic and actively contribute to the goal of a healthier India.

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