Hospitals: Firefighting Covid and taking guard against new crises

In just over 10 days, at least three hospitals in tony South Mumbai saw their operations come to a virtual standstill after staff there came in contact with patients infected with Covid-19.

Wockhardt Hospitals and Jaslok initially closed their outpatient departments (OPD), only to be followed by the complete containment process that involved quarantine and contract tracing of staff and others who interacted with the Covid patient, and sealing of the hospital premises.

Even as this happened, a third hospital, Saifee, recovered from this process of containment and shutdown to resume regular operations with the opening of a dedicated Covid facility.

In the days that followed, more hospitals began to see operations disrupted entirely or in parts for similar reasons, in the city and across the country. And as doctors, nurses and healthcare workers (HCWs) began to report exposure to the infection, the pressure was beginning to tell on the healthcare infrastructure.

To cope with this surge and prepare for a possible peak in infection in the coming weeks, State governments are bringing in additional spaces for quarantine, as they did with Mumbai sports club NSCI, located in the vicinity of the quarantined Wockhardt Hospitals. States like Rajasthan are enlisting a large number of private hospitals. And reports say that 51 military hospitals are also preparing facilities dedicated to tackling this highly transmissible virus.

The virus has been ruthless in its spread across institutions and, when the pandemic ebbs, hospitals will be forced to look at redesigning hospital infrastructure and protocols to be better prepared next time. But right now, there’s no such luxury, as they think on their feet and plunge headlong into firefighting.

It’s all hands on deck, with resources and people being directed to Covid, says Hinduja Hospital’s Chief Executive Officer, Gautam Khanna. Hospitals are staggering appointments, staff are on rotational duty and non-essential procedures have been stopped, he says. Having encountered early cases of Covid, the hospital has a triage system where patient entry is streamlined after they declare their travel history, symptoms, etc. This helps prevent inadvertent infection. Even infected people need to be segregated, by keeping mildly infected patients or an elderly person away from someone with severe symptoms, he says, outlining the complexity of the logistics involved. Supplying healthcare workers with protective gear and having sanitisers across the premises are critical in keeping staff and patients safe. But much more needs to be in place, he says, pointing to regulating the number of people that can travel in a lift, ensuring increased houskeeping and cleaning, ferrying of staff in dedicated buses, etc. Medical staff dealing with Covid patients stay long hours in their protective suits, they could be scared; patients need to be told why they need to stay away from hospitals for routine tests, he says. Communicating to all of them is critical at all times.

More isolation wards

“This is no longer a Mumbai phenomenon,”says Vishal Bali, Executive Chairman with Asia Healthcare Holdings, pointing to increasing Covid cases from Tamil Nadu, Delhi and so on. Most hospitals were set up in the era of infectious diseases where the virus was not like this one that emerges “without announcing its arrival”, says Bali. Unlike, say, Tuberculosis, that has symptoms, Covid patients can be asymptomatic. So doctors will now have to see patients expecting that everyone has the infection, he says, indicating that HCWs cannot afford to drop their guard.

Bali earlier headed Wockhardt and Fortis Hospitals, and “having lived that life”, he points to the “mayhem” in the emergency room when patients are brought in. A patient treated for an injury may show Covid symptoms later and this leads to doctors and healthcare workers getting exposed to the virus, he explains.

With infectious diseases surfacing every other year, be it SARS, Avian flu, HINI, etc, hospitals will need to plan for more isolation beds, negative pressure rooms to control the infection, stockpile protective gear and have standard guidelines on how to respond to such crises, say several front line healthcare workers.

Stubborn virus

Karan Thakur, a doctor and administrator with the Apollo Hospitals Group, says that hospitals will need to look at turning around non-critical hospital areas to deal with such emergencies. This needs to be in the design, so the turnaround is quick and the non-critical areas are not close to the maternity or cancer wards, for instance, he says.

Despite precautions, HCWs get infected because sometimes patients don’t reveal their travel history for reasons of stigma, lack of knowledge or sheer carelessness. But for every one patient, many staff get quarantined and at some point more HCWs could end up at home, says Thakur, on the challenge in keeping this “stubborn and very infectious virus” under control. Clearly, a moving target that hospital administrators can ill afford to take lightly.