The Viral Test
THE WEEK|November 29, 2020
Covid-19 exposed the many chinks in our armour. And even as our overburdened health system is learning on the go, it is bracing itself for the after-effects of Covid-19
Namita Kohli

Dr Priyadarshini Singh, head, accident and emergency department at Delhi’s Indraprastha Apollo Hospitals says this is simply “unprecedented”. Comparisons with other viruses seem unfair. “With swine flu, recovery was a consolation. People got cured and went home,” she says. With Covid-19 though, even recovery does not seem to guarantee much. Since the early days of the pandemic, the Union health ministry has been projecting high recovery rates for Covid-19—93.52 per cent as of November 18. Doctors, however, say they are bracing for the next big challenge—among those who recovered from a severe bout of Covid-19, some end up coming back to the hospital.

Hospitals struggling to cope with the deluge of Covid-19 patients are also trying to handle the additional challenge of post-Covid issues with special clinics. At Indraprastha Apollo Hospitals, for instance, doctors are baffled by a small percentage of post-Covid cases where the patient reported no co-morbidities, implying that even the ‘healthier’ among us are not particularly insulated from the serious effects of what experts term ‘long Covid’. The pulmonology team has treated four such cases in people with no co-morbidities in September. One of them, as Singh recalls, proved to be particularly challenging.

“This patient is 64 years old, and reported no history of major co-morbidities such as high blood pressure or diabetes,” she recalls. Two weeks after his hospital admission, he tested negative, but his lung function started to deteriorate. Lung fibrosis and infection in the blood meant that he could not maintain oxygen saturation in his body, and hence had to be put on the ECMO machine. “Post-Covid lung fibrosis meant that he needed lung transplant, which was challenging since the transplant had to be done at Hyderabad where the patient’s family chose to have the procedure done,” says Singh. “Airlifting him from Delhi to Hyderabad had to be done while ensuring that the ECMO circuit was not disturbed and the supply was not interrupted at any point.” Though such a procedure has been done in the country and at the hospital previously, Singh and her team held dry runs to ensure that the transition was smooth and error-free.

The doctors at Apollo may have surmounted this challenge, but the onslaught of the virus —and now its after-effects—have been relentless for health systems in India, and across the world. Hospitals have had brief spells of relief before getting overwhelmed, again. “In Delhi, the Covid-19 surge is back. In the hospital, it is a war-like situation every day,” says Dr Sandeep Budhiraja, group medical director, Max Healthcare. Since March-April, the challenges have been tremendous—getting health care workers trained in infection control pratices, designing clinical standard operating procedures (SOPs) for a new disease where not much was known, ensuring that the staff had enough PPE and auditing the new processes. The early days were particularly difficult in that respect, recalls Budhiraja. “Initially even the stigma faced by health care workers was demoralising,” he says. “I recall how our doctors were turned away by residents of a south Delhi colony when they arrived at the accommodation that had been arranged for them since they could not go home after Covid duty.”

Not that the health systems in India had not had a definite advantage. “It is true that this is a new disease, and though we do not know much about it, we did have a relative advantage in that we had some time to prepare ourselves. We could work on our clinical SOPs and infection control practices, since we had some information streaming in from our European counterparts,” says Budhiraja.

Critical care experts agree. The use of steroids and blood thinners to prevent clotting, for instance, immensely helped doctors manning the ICUs, and consequently, helped save lives, says Dr Sumit Ray, head, critical care, Holy Family Hospital, Delhi.

Despite a few advantages, India’s health care infrastructure has been left wanting, says Budhiraja. “We are not geared up for pandemics,” he says. “There is a need to create segregated infrastructure to deal with infectious diseases. As of now, we do not have that,” he says.

INTERVIEW Dr Randeep Guleria, director, AIIMS

Managing post-Covid will be a huge challenge for hospitals

BY NAMITA KOHLI

Q/ How has AIIMS dealt with the Covid-19 challenge?

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