The good practice: Frontline fighters in the war on novel coronavirus

It was an image that spoke a million words — Italian nurse Elena Pagliarini, worn-out and slumped on a keyboard, the mask still on her face, body and head wrapped in protective gear. That picture, clicked by a co-worker, showed how a virus on the loose was stretching thin the best healthcare systems in the world.

Speaking to an Italian newspaper later, Pagliarini summed up the anxiety: “I can work for 24 hours straight if it’s necessary, but I won’t hide the fact that right now I’m anxious because I’m fighting an enemy that I don’t know.”

As in Italy, and elsewhere in the world, India is bracing for an all-out virus attack. The two-million Indian health workers are the country’s frontline fighters. Two doctors have already caught the highly infectious virus — which the World Health Organization classifies as a new strain — from their patients. Battling a bug with no case history is the new challenge.

“It is a new virus and nobody has immunity to it. So, there is apprehension,” admits Dr Ghanshyam Pangtey, professor of medicine at Lady Hardinge Medical College, New Delhi. Developed countries such as the US, Spain and Italy have struggled to check the outbreak. “We are a developing country in terms of health infrastructure. But we did a good job in identifying and quarantining people in the first stage,” he says.

The doctor explains that out of 100 infected, 15-20 require hospital admission. Of them, five may need ventilator support. “Hospital care workers tend to get infected through interactions with ventilator patients,” says Dr Pangtey, who also supervised the quarantine centre at the Indo Tibetan Border Police’s Chhawla Camp in Delhi.

Continuous duty in such critical care units (CCU) makes the healthcare worker vulnerable to virus exposure. Despite protective gear, critical care workers run the risk of infection and passing it to their families. “But we have to do our work; can’t run away from it,” Dr Pangtey says.

Sarojini Frank, senior nursing officer at the hospital, stresses that nurses are up to the task, pandemic or not. “We support each other and reassure one another that all will be well. The patient comes first,” Frank says.

As the hospital prepares for novel coronavirus patients, Frank, who is in charge of equipment in the CCU, is on her toes. “All electronically operated equipment are ready, as are ventilators, hand sanitisers, N-95 masks and personal protective equipment (PPE) for the six-bed Intensive Care Unit. I have placed orders for more,” she says.

While PPE is mandatory when dealing with infected patients, it is difficult to wear them for long hours, the health experts stress. “It is made of plastic and can only be removed in designated areas so that other places are not infected. The nursing staff ends up wearing them for long hours; if the PPE is removed in a washroom, the place gets infected. So they wear diapers. Such equipment have to be used judiciously,” Dr Pangtey explains.

At the Government Medical College, Ernakulam, emergency measures are in place. “In the event of a pandemic, the regular duty roster goes for a toss,” says Rohith Suresh, a house surgeon.

Staff across departments is pooled, given crash courses on the virus and placed on special duty. House surgeons, resident doctors and nurses become the foot soldiers.

“A few are on duty at the airport (to check incoming passengers), others in the quarantine room,” Suresh says. While those tending to quarantined patients wear PPE, healthcare workers attending to out-patients and passengers at airports manage with masks.

“There is a risk of exposure as the first screening happens here. But that is how it is. The patients didn’t will to be unwell, did they?” asks Suresh. It is common for healthcare workers to stay on in hostels to keep families out of danger. Suresh’s only grouse is that the food delivery personnel are no longer venturing into the hospital premises.

There are other problems, too. For instance, a drawback of centrally air-conditioned hospitals is the lack of ventilation, points out Twinkle Prabhakaran, Kottayam’s district tuberculosis officer.

“When an infected person coughs and sneezes, the viral load tends to hang in the air and might affect medical staff. We are encouraging the use of ventilated spaces to protect healthcare workers,” he says.

As the pandemic forces healthcare workers to balance their own safety with day-long patient care, Dr Jai Ranjan Ram, consultant psychiatrist at Apollo Gleneagles Hospital, Kolkata, stresses that these are exceptionally difficult times for medical personnel.

“The dilemma of worrying for one’s health and looking after those critically unwell adds an extra dimension to the stress. But it is part of the job, and doctors and nurses are trained for it,” he says.

The real test would be in the event of a spike in the number of infections, when the staff would have to work with limited resources. “It gets unpleasant when patients cannot be accommodated, when doctors are forced to choose whom to admit or give ventilator support to. It becomes stressful when doctors have to play god,” Dr Ram adds.

However, the psychiatrist hopes the medical community will come out of the crisis the way it always has — by supporting each other. “We are trained to handle the situation. But peer support is important, we work as a team.”

As hospitals turn into war zones, routine is often the first casualty. For Frank, however, one ritual is a must. “Before we enter the CCU, a moment is spent in prayer,” she says.

P Anima

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