Q3. Has COVID-19 been a boon for some of the industries?

Q5. What are these vulnerabilities? How do we make our industry resilient?

Q8. Can you give us some specific examples?

Interviewed by Dr. Debleena Bhattacharya, Associate Editor, InnoHEALTH interviewed him where he shared his insightful perspective about the recent pandemic situation and the way India can bounce back with speed, scale and sustainability.

Corona virus: A name much heard and facts lesser known

An ongoing epidemic, fifty affected nations, numerous health-anxious people across the globe, a major economic fallout, ample of online rumors and a TINY 27-34 Kb VIRUS. Yes! Here we are talking about the major viral outbreak that has taken a toll of almost 2,805 lives up till now; Corona Virus – A virus that doesn’t respect borders. This article intends to present a preliminary opinion about the viral outbreak, the associated myths, the fact check and current situation report.

Origin and the Outbreak

In December 2019, a cluster of viral pneumonia cases was officially announced due to an unknown cause detected in Wuhan City, Hubei Province of China. On 22 January 2020, origin of a novel virus was declared from wild bats and these viruses belonged to the family of beta-corona virus which contains Severe Acute Respiratory Syndrome Associated Corona virus (SARSCoV). Both CoV and SARS-CoV belong to same subgroup with only seventy percent similarity at genome levels, as the CoV-19 shows major genetic differences from SARS corona virus. The novel virus was given the interim name 2019-CoV by World Health Organization (WHO) and was later renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses. Third in the list of corona viruses which have emerged in the human population in the past two decades, 2019-nCoV has put all public health organizations globally on high alert.

The novel corona virus that is supposedly believed to have emerged from a local Chinese market has killed more than ~2000 people and rapidly spread around the globe. The latest situation reports released by WHO, state 77,780 confirmed cases, and 2666 deaths within China and has known to affect fifty countries across the globe with 2459 confirmed cases, and 34 deaths.

Knowing the Killer

Corona viruses are a large group of viruses surrounded by a core of genetic material surrounded by an envelope with protein spikes. This gives them the appearance of a crown. ‘Crown’ in Latin is called ‘Corona’ and hence, the name corona virus. These are known to cause several respiratory and sometimes gastrointestinal infections in animals and humans. Respiratory diseases can vary from common cold to pneumonia.

The respiratory infections may include Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). SARS was the cause for the 2002–2003 epidemics which first emerged in the Guangdong province, China. Both SARS and MERS corona viruses originated likely from bats and their direct transmission to humans has been reported. The initial epidemiological investigations on the pneumonia-like cases that occurred in Wuhan city clearly linked to seafood and animal markets. These point towards the zoonotic origin of the novel corona virus. On the grounds of environmental sanitation and disinfection, the Chinese government immediately had shut down the markets.

With the origination of first case, the infection was probably from animalto-human (zoonotic) but with the increase in number of infections within and across the borders of China, clearly implicated a second transmission from human-to-human. Since the day of official outbreak of the epidemic, China has been making continuous efforts to understand the epidemiology, identify the origin, clinical manifestation, possible transmission routes, development of diagnostic kits and global risk assessment. Reportedly, the possibility of human-to-human transmission was raised by the Wuhan Health Commission as infections of family members of the afflictedmarket workers and the healthcare workers suggested the occurrence of individual-to-individual spread.

Since the day of official outbreak of the epidemic, China has been making continuous efforts to understand the epidemiology, identify the origin, clinical manifestation, possible transmission routes, development of diagnostic kits and global risk assessment.

Sources and Modes of Transmission

The secondary cases of infection began to be reported approximately 8−10 days after the first official outbreak. The patients who were newly diagnosed had never been to the allegedly culprit marketplace but had a history of contact with the people working there. The confirmed reports of several infected healthcare workers from Wuhan city indicated the occurrence of human-tohuman transmission. The first case of infection outside China was reported on 13 January 2020 from Thailand. Other cases from countries across Chinese borders such as the USA, France, Japan and South Korea have also been reported. Human-to-human disease transmission often happens due to close contact. Like most respiratory viruses, 2019-CoV is also considered very contagious. Its transmission occurs primarily through respiratory droplets which spread when an infected person sneezes or coughs. Ongoing investigations on the spread and severity of disease still are unable to explain whether a person can be infected by coming in contact with an infected surface or object. We lack sufficient data on the infectiousness and severity of the disease and extensive research is ongoing.

Treatment, Prevention and Protection

Although research is ongoing but yet there is no proven cure for novel corona virus to-date. No vaccine or antiviral treatment currently exists. Ongoing efforts by the healthcare providers majorly aim at managing the symptoms, and supportive and preventive therapy. Regularly washing hands, maintaining safe distance from those who are infected, wearing masks and avoidance of touching one’s own face is highly recommended to prevent the disease.

Clinically, the infected people majorly show initial flu-like symptoms such as fever, cough, difficulty in breathing, and fatigue. Development of the disease can further lead to severe pneumonia, acute respiratory distress syndrome, septic shock and even death. Few of the infected may be asymptomatic, i.e. showing positive test results confirming infection but showing no clinical symptoms. Health agencies have advised that individuals who are in close contact to infected patients should be monitored and examined in real time to rule out infection.

Governments have advised against all the unessential travels to countries with reported infected individuals and country with epicenter of the outbreak. Though efforts are underway all across the globe, till date there are no specific medications for 2019-nCoV or SARSCoV-2. Supportive therapies that can provide relief to the symptoms include self-isolation, intake of plenty of fluids and regular flu medications.

As on 27 February 2020, no details were available on the spread of SARS-CoV-2 (previously 2019-nCoV) however, it is known that the droplets of other corona viruses can stay suspended in the air only for a short time. As stated by WHO, they have shown uncertainty on how long the virus can survive on various surfaces.

The drug, Favipiravir which has previously been approved for treatment of influenza, showed early efficacy against SARS-CoV-2 in human trials in China. The Chinese National Medical Products Association, in February 2020, approved it as antiviral treatment for SARS-CoV-2. Another antiviral drug, Remdesivir which has been used in the first case reported from the USA, is the only one drug to-date which might have real efficacy. The drug supposedly terminates the viral transcription at early stages.

Myths and Fact Check – Spread of E-Misinformation

Social media and other online sources have spread a lot of rumors amongst the highly health conscious people across the globe which pose to suggest various miracle cures for corona virus. Let’s have a quick check on the myths and facts related to the deadly 2019-nCoV.

Strategic Preparedness and Future Projections

Corona virus is on the edge of spreading across the world. There have been reports of large clusters of cases outside Chinese boundaries. It has posed new global challenges with its widespread aggressiveness. Complicating matters, the unease and cost of its early detection, prevention and supportive therapies have alarmed the global public health agencies. Since the vaccines cannot be developed so early and manufacturers working on its vaccines cannot make them available to the public at least before a year. Meanwhile, when the virus is on a rapid spread, the best measure is to prevent and slow the spread of infection from symptomatic individuals. Strategic measures like social distancing and self isolation can be implemented community-wide to slowdown the aggressiveness of the pandemic. China has been practicing these strategies by land lockdown of Wuhan city, immediately after the announcement of outbreak. Next in the list is Italy, where Codogno is being now called the “Wuhan of Italy” and currently is in lockdown.

The need of the hour is testing of the virus at early stages and at broader and global levels. A handful of laboratories and few specialized equipment cannot cope up with the current condition. We need rapid and cheaper diagnostic kits at everybody’s doorsteps and vigilant public healthcare agencies. Since, there is a lack of standard methodology to evaluate the pandemic’s existence and severity, superpowers such as the USA who are financially competent must take lead and create a task force to fast-track the development of new diagnostic kits.

Developing a widely affordable and accessible point-of care diagnostic kit requires significant budget, decisive health-driven execution, reliable scientific tools and protocols which would help in determining whom and when to test, how to interpret and how to attend to the infected, and cooperative nations. With this approach, we can not only control the current novel pandemic; it can also help in creating an infrastructure to deal with future epidemics

Composed by Dr. Jasmeet Kaur Chhabra, Doctorate

Dr. Jasmeet Kaur Chhabra is a Doctorate in Immunology and whenever she gets free time from her full-time job, she loves to read and write about imperative issues in healthcare.

Supporting nurses and midwives in a pandemic situation like covid-19

The year 2020 marks the 72nd anniversary of the World Health Organisation, and with it, came the World Health Day slated on 7 April 2020, themed “Support nurses and midwives”. Though unprecedented, this year, the theme became very relevant with the adversity of COVID-19. This situation exponentially elevated the service and efforts these healthcare workers put in to keep the world from destabilizing.

We at InnovatioCuris Foundation of Healthcare & Excellence (ICFHE), had the privilege to hold a virtual panel discussion through a webinar, with some top healthcare workers from around the globe on 7 April 2020, to commemorate the nurse and midwife community.

The response to the webinar was quite overwhelming. The initial number of registrations stood at 1248. Due to this, we broadcasted the webinar, live on YouTube, to the rest of the audience who wished to watch the event. Since then, the webinar video garnered more than 1100 views in 12 hours and the number has been rising steadily. This response reinforced our belief of the newfound love in supporting the real fighters who have been battling COVID-19 with their selfless efforts.

The discussion was initiated by Surgeon Rear Admiral Dr. V K Singh, Managing Director of InnovatioCuris. He briefly introduced the panelists and lauded the efforts of the healthcare workers. He then handed over the stage to the moderator Prof. Manju Chhugani, who is the Dean of School of Nursing Sciences and Allied Health at Jamia Hamdard in New Delhi. She introduced the following panelists of the webinar and their accomplishments in detail:

Prof. (Dr.) Roy K George, National President, Trained Nurses Association of India (TNAI) & Academic Director at Baby Memorial Hospital Kozhikode, India

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this – devoted and obedient” – Florence Nightingale

•  Dr. Della Sherratt, an independent midwifery consultant from United Kingdom
•  Dr. Thankam Gomez, President, Clinical Services, Aarohan Healthcare Services, India

The webinar steered with many aspects, primarily on the challenges being faced by the nursing communities in the COVID-19 pandemic. Also, many revered solutions that each panelist’s circles were following, were discussed in greater detail.

Prof. (Dr.) Roy K George mentioned that COVID-19 is the greatest challenge for the nursing fraternity in 150+ years of modern nursing history. Adding to this, Prof. Manju Chhugani emphasized that swift, strong, skilled and sustained efforts of all healthcare providers will lead to success in winning the battle against Corona. Dr. Thankam Gomez quoted news from WHO and also starkly pointed out the nursing deficit of 2 million in India and 6 million globally as per the 2018 statistics. Dr. Della Sherratt’s statement of nurse workload overburden clearly supports the statement made by Dr. Gomez. Dr. Sherratt also mentions the solidarity the people in UK are showing towards National Health Service (NHS) by their applause standing by the windows every Thursday at 8 o’clock, UK time for their constant efforts.

Many more experiences like the above were shared in the webinar and it circled down to the consolidation of the efforts that the world and in particular the healthcare workers are putting in fighting COVID-19.

Social media

Fun has been a deficit too in these tough times. So, in the form of solidarity, we tried to showcase their support to the healthcare workers by sharing their SMILING selfies. Many from the 1000+ attendees did not lose a second in sharing their photographs. We put the photographs together in the form of a collage mentioned below and shared it on our social media portals.

Consolidation

With so much support to the Nurses and Midwives, we would like to re-establish more webinars on topics related to nursing and midwifery to provide the visibility that these communities deserve. We all salute you again for the devotion, obedience, patience, and love towards humanity. Thank you!

#SupportNursesAndMidwives

Composed by  InnoHEALTH Magazine Digital Team

There is need to practice regularly tabletop exercises, mock drills to update our system and make all functionaries aware of their role and responsibilities. The guidelines and mock drills conducted by NDMA to find gaps revealed many startling facts like Gurgaon did not have blood bank in 2007 and on investigations it was revealed that 27 districts in India do not have such facilities, similarly Gurgaon did not have ladder with fire brigade to extinguish fire in high rise buildings. Gautam Budh Nagar (NOIDA) did not have district hospital. We had Japanese encephalitis cases in UP killing many children, did we learn and took actions to update system except knee jerk reactions on occurrence and blame each other.

In case we have to handle mass causalities our day to-day system should be perfect with enough reserves. We must rely on govt hospitals to deliver quality healthcare and to handle mass causalities at optimum cost. Health leadership must be updated on management issues and should be made accountable and answerable. Health is state subject hence more is to be done by states. There is need to revamp primary healthcare and public health. We should investigate all aspects of disaster because it can strike anytime anywhere to create human and economic miseries. In case it is not planned well we would execute solutions which are half baked, costly and people are not aware as what is expected of them. Planning is most important part of management to develop system to execute seamlessly with speed and less cost. Analyze what is happening in present disaster ad-hocism, imports at breakneck speed which were easily avoidable if system was developed in place

We have many challenges: a population of 1.3 billion, high density of population, 27.5% is below poverty line, literacy rate is still 74.4% despite so much efforts. The large population still feels it is a catastrophe created beyond human endeavours as act of God over which we have no control. Though we have come long way and push of present government is laudable for many initiatives on self-reliance and to lift socio economic status. We are still in stage of bullock cart and landing on moon. We have capability of becoming developed nation with in one decade. We as community and policy makers must seriously consider check on pollution, safe environment and check climatic changes, all these impact disease pattern and our life. We must embark a big movement of good quality of life for citizens to make next generation a big asset to country.

Composed by Dr. V K Singh, Editor-in-Chief & MD, InnovatioCuris

What it takes to organise India’s largest Covid-19 Ideathon

Estonia started with a 48 hr online hack on 15 March to respond to COVID-19, then a few days later Germany and Finland followed. 42000+ people participated in the German edition ending up crashing Slack! We also wanted to respond to the crisis in a meaningful way by doing an online hackathon in India, called an IDEAthon! The event started at 6:00 PM on 26 March and concluded at 6:00 PM on 29 March. The original plan was 48 hours and it stretched to 72 hrs because of the overwhelming response.

The three themes of the proposals solicited were, Saving Lives, Saving Communities and Saving Businesses. Through a rigorous process, we could shortlist the top 20 out of the 5000+ applications. Seven entries in the student track, six entries in the educator track and seven in the startup track, each faced an international jury. Eighteen out of twenty received a cash prize and are now being considered for various government grants to further accelerations to their solutions.

Outreach – Reach more people through partnerships!

When you are in a crisis, traditional models of outreach don’t work. Best way is to work through partners who already have your stakeholders. In our case, we started with the Ministry of Human Resources, Innovation Cell run under AICTE. Every year they organise the world’s largest hackathon. Along with them, we partnered with an incubator based out of Coimbatore, called FORGE. Then we onboarded various national and international agencies like iHub Gujarat, UN Technology Lab to World Startup in the Netherlands.

The few days we had (four days to be precise) to do outreach we had 5400+ teams and 350+ mentors applying for the IDEAthon.

Technologies to Collaborate

We used a variety of tools. Depending on your need you may use the same or alternate.

Curating Challenges We reached out to many experts for articulating challenges through video messages. Below is a list of compiled video messages on Youtube. It enabled a quick understanding of the context to participants.

https://www.youtube.com/ watch?v=8JN_vnSE2eE&list= PLdKuvvCBPEpjRaPmju HI3msRj5PU tKu4i

Mentor Dynamics

Mentors are the soul of any such program. People genuinely wanted to help, and if you can map their expertise efficiently they can be utilised better by the participating teams. Also, for mentors to stay online without being utilised is not good.

Innovation for hospitals during COVID-19

In India, the healthcare industry is one of the fastest growing sectors in terms of investments, employment, etc. It comprises many sectors under it such as the hospitals (public, private), public health, wellness centres, medical devices, medical tourism, clinical trials, medical devices, health insurance, health IT, telemedicine, medical equipment and much more. The sectors expand all over the country and covers both the rural as well the urban areas with the help of primary, secondary, tertiary and quaternary healthcare institutions and hospitals.

The Covid-19 pandemic which started in China in December 2019 and hit India in late January 2020 has made the whole world come to a standstill, harming literally everything ranging from the economy to every individual’s life. It has locked almost one-third of the population indoors. The sector which is facing a major damage due to the pandemic is hospitals, both public as well as private. The number of Covid-19 cases continue to grow worldwide and many hospitals are struggling to deal with the situation of treating patients and other aspects of running the hospitals. The three main challenges faced by the hospitals are: finding additional beds, ventilators, creating new spaces for the increased number of patients. Apart from this, there are several others on the list as follows.

Some of the major challenges faced by the hospitals:

• One of the major challenges faced by hospitals due to this pandemic is the lack of infrastructure. Although private hospitals make up the majority of the healthcare system in India, still they lack the preparedness to handle a sudden outbreak of a pandemic like this and provide for the health needs for every individual of the large population such as ours. Many of the hospitals especially in states like Bihar, Odisha, etc. are not well-equipped to cover their population and detect cases efficiently. Many hospitals lack testing kits and supplies which brings down their efficiency in covering the population for testing.
• There is also a shortage of beds and ventilators for new patients to admit because of the burden of the existing patients which are already admitted for treatment. Expanding capacity and creating space for new patients has therefore become a major challenge.
• Hospitals have also reported a shortage of personal protective equipment (PPE) for their staff. Due to a sudden increase in the demand of the testing kits and PPEs in this outbreak, the supply chains have faced many issues which has also depleted the reserves of the PPEs of the hospitals.
• Apart from the shortage of beds and doctors, hospitals are also facing the shortage of medical equipment like ventilators due to which many of them are not able to treat patients efficiently.
• Another main issue faced by the hospitals is difficulty in maintaining adequate staff (both medical and para-medical as well as administrative staff). Most of the hospital staff specially those of managerial and administrative background are preferring to not actively get involved in handling the hospital systems mainly due to fear and concern. Therefore, there is a sudden rise in the requirement of manpower specially during this crisis because these are the people who are required to take the charge of running and managing the hospitals while the doctors and the nurses take up the forefront role of treating the patients.
• Also, along with testing and treating the patients for COVID-19, it is essential to keep the hospital staff safe from contracting the virus and getting infected which might lead to the shortage of staff even more. This is a challenge too for the hospitals.
• There also exists a major challenge of high run for revenues and cost control. If we see hospitals as a business, the patients are its customers. Due to the pandemic, there is a decrease in the patient visits to the hospitals because people try to avoid going to hospitals due to the fear of contracting the virus. This has led to a downfall in the revenue generation for the hospitals and hence, difficulty in operations. This has also led to many people losing their jobs or salary cuts in some cases because hospitals are not able to pay them their salaries.
• Hospitals like AIIMS and many others had to cancel or postpone the surgeries of their previous patients because they are under the pressure to free up bed space for COVID-19 patients. They are unable to handle the unmanageable patient load due to the pandemic. Every other department of the hospitals are experiencing reduction in patient visits due to reduced admissions.
• Patient safety and hazardous waste management are the other two major issues faced by hospitals as this may lead to other concerns like hospital acquired infections, rise and spread of other diseases, etc. Also, an obvious downfall in the quality of services is also seen.

Possible innovative solutions for hospitals:

A large number of hospitals and the whole healthcare sector are moving towards the machines and trying to incorporate technology into their working and systems in order to deal with the emergency situation that is prevalent right now. They plan to use automated tools to help them manage the Covid-19 pandemic. In the light of the need at this time, many innovations are happening around the world to come up with solutions to create tools and technologies so as to help us combat the virus and increase efficiency of the existing healthcare system at the same time.

Around 25-30 startups were studied and their innovations and tools related to Covid-19 were identified. The ones which concerned healthcare and hospitals were selected and a database was prepared. The products that can be deployed in hospitals to deal with the pandemic were studied and were categorized using various criterias under categories like Artificial Intelligence, telemedicine services, screening, diagnostics, monitoring, tracing and tracking.

The study shows the percentage of the innovations made in specific areas. The selection was made restricted to India to understand the progress and scope of innovations happening in the country to assist us fight the pandemic.

Many start-ups like RIoT solutions, Practo and Thyrocare are helping with the testing and care of the coronavirus patients. Leveraging Artificial Intelligence (AI) to build highly accurate respiration monitoring systems that will work as a mini ICU monitoring unit to allow doctors and other health professionals to track multiple patients and at the same time ensure safety of health workers.

Some of the big hospitals like Apollo hospitals have tied up with Zomato, OYO hotels and homes and many other organizations to provide isolation and virtual care.

DaytoDay Health which is an MIT-incubated start-up, has started a virtual healthcare system for patients who tested positive for coronavirus. The company helps people manage complex health issues, manage their medicine schedule, record their progress data, tracking, etc. These activities are done with the help of an app which has been designed to have live chats, calls, consultations. Working with few hospitals in different parts of India, they are helping in early containment of the coronavirus with the help of IT by managing asymptomatic and non-critical coronavirus patients.

Another Indian based IoT startup called HELYXON uses AI-enabled devices for better management of the pandemic by constantly monitoring the vital parameters of patients or suspects. 98.6 Fever Watch is another innovation which is useful particularly for unwell children in whom continuous monitoring of temperature is a vital parameter in disease management. It connects to hospitals systems or personal systems and keeps transferring patient information to a central dashboard.

Some of the health-tech start-ups including Dozee, Qure.ai, Log 9, MyLab and Biodesign Innovation Labs are providing solutions which range from prevention mechanisms and testing to monitoring and manufacturing medical equipment. For example, Dozee’s device is used for medical-grade remote monitoring of vital parameters including heart rate and respiratory rate to monitor vulnerable patients in their homes, or in hospitals that are facing manpower shortages.

Qure.ai has partnered with Italian San Raffaele University Hospital to deploy new solutions that automatically read and interpret chest X-Ray scans for COVID-19 in seconds. This tool quantifies how much of the patient’s lungs have been affected, enabling the clinicians to monitor disease progression more effectively.

Another start-up Log 9 claims that its device can completely neutralize Covid-19 and other pathogens on surfaces of masks, hospital PPE and groceries in less than 10 minutes.

Pune based company MyLabs has come up with Covid-19 diagnostic test kits which are priced at around 1200 rupees which saves the testing cost by many times as compared to the present cost of 4500 rupees.

Medtech startup Docturnal has proposed a solution-based product called the ‘COVID-19 Innovation’ which screens the sound of a person’s cough from home with the help of an app and identifies the suspected lung diseases.

AI Highway provides pre-screening and triage tools that are based on risk-assessment scores for Covid-19, linked to symptoms, contact history and more.

Biodesign Innovation Labs has developed ‘RespirAID’, an automated respiratory assist device, which is an alternative for prolonged manual ventilation of AMBU bags or BVM used during hospital transit of patients or transit in ambulances, and operation theatres.

Bengaluru start-up Predible Health is using AI-based radiology solutions to pre-screen COVID-19 patients with the help of a tool LungIQ, which can measure percentage of lung damage in patients through CT scans & help doctors understand how badly a patient is affected and if he needs a ventilator or not.

Cardiac Design Labs has come up with a ‘Telemetric Patient Monitoring System’. It is a centralised vitals monitoring system, which allows frontline workers to monitor multiple patients simultaneously from a central location. The system has wearable devices, which are put onto the chest of the patient. The data collected is then shared with the nursing station, which can be located out of the COVID-19 wards. It also has algorithms to alert the healthcare professionals if something goes wrong with any particular patient.

Many companies like Invento, Asimov Robotics have been building humanoid robots which can help in lessening the exposure between Covid-19 patients and the caregivers. The robots can carry food, medical or clinical consumables for the patients and navigate freely within the hospitals decreasing the burden on the healthcare staff. These are also capable of collecting patients’ information and monitoring them. Others like Diagnostic.AI, PerSapien have developed robots that can help in the sanitation of the areas in hospitals or even in the public using ultraviolet rays.

Companies like AgVa solutions, Big Band Boom Solutions, Aerobiosys, etc. are building cost-effective portable ventilators. They are also lending a helping hand in ramping up the production and supply of ventilators to the hospitals.

Clearly, most of the innovations and solutions coming up are based on technology or are related to it in some way or the other. This shows that the IT sector is incorporating itself into healthcare and is proving to provide immense help with regards to ideas and solutions to deal with the pandemic and restore the world. Telemedicine is going to be a major field in the future on which literally every sector will depend and operate.

“Care is shifting from the hospital to the clinic, from the clinic to the home and from the home to a 24/7, ubiquitous access to care, driven by the mobile phone.”

–Sangita Reddy, joint managing director of Apollo Hospitals

The remote screening solution supports healthcare institutes to diagnose and treat patients at alternative points of care and is helping to safeguard the scarce critical care capacity. AI systems that have been trained via machine learning to offer clinical decision support may play an important role in the COVID-19 crisis, helping to keep hospitals functional and patients alive.

Composed by Anamika Gandhi, InnovatioCuris

The detrimental effect of the outbreak of COVID-19[the disease caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-COV-2)] was evident not only on global healthcare systems but also on other aspects of human life.

The World Health Organisation (WHO) declared the COVID-19 outbreak as a global emergency on 30th January 2020. According to various scientific literatures, and a response to ‘flatten the curve’ governments have enforced border shutdowns, travel restrictions and quarantine in countries which constitute the world’s largest economies.All these factors have anticipated the fears of an impending economic crisis and recession.

The COVID-19 pandemic has caused an unprecedented challenge for healthcare systems worldwide with healthcare workers as the frontline warriors .
In upcoming times there may be a higher surge in cases reporting critical situations or may be even fatalities due to previously existing illnesses like Chronic Heart Failure, Chronic Renal Failure, COPD, etc. getting complicated because of improper or not adequately managed.

Several reports have shown the predicamemt of patients having chronic diseases and those require proper medical maneuvering other than COVID-19 infected patients.The overall revenue generation for hospitals and healthcare sectors were greatly affected e.g an official data from a 350 bedded hospital in NCR reports more than 50 % reduction in bed occupancy rate and more than 60 % reduction in routine elective procedures thus making the system very fragile.

Maharashtra Govt. has undertaken 80 percent of private hospital beds with capping of treatment costs Another such step has been taken by the Delhi Govt which has directed the private hospitals with capacity of 50 beds or more to provide 20 % of its total capacity for COVID-19 patients.

With the prevalence of such regulations, adequate measures are taken to safeguard the workforce of the organization. With such regulations, it becomes foremost important to take adequate measures to protect our workforce amid this health crisis as they are the only weapons all through this fight. For enabling life towards getting near to normal , first thing that has to be made sustainable is the healthcare system.

THE PROBLEM STATEMENT

• Patients with similar symptoms (influenza like symptoms) with pre-existing conditions like cardiac ailments and respiratory issues, are facing lot of trouble in getting routine management as well as emergency management because of projected COVID 19 stigma
• Upcoming conditions with similar presentation like Dengue, Malaria in South East Asian countries will make situation more complicated thus pose further challenges in healthcare system
• Healthcare workers (HCWs) has to embrace the the Quarantine in masses because of accidental exposure from a patient tested positive after routine admission
• Collapse of health system in terms of providing adequate health services and revenue to sustain hospitals viability

In short our health system includes both public sector and corporate sector are facing issue at every step whether it is:

1. Containment of disease
2. Proper handling to emergencies due to non COVID-19 chronic illnesses
3. Protection of HCWS (almost 321 HCWs has been tested positive across DELHI)
4. Sustainability

OBJECTIVES

• Combat ongoing crisis in best possible and efficient mannerto minimise the incidence of COVID-19 infection among HCWs
• Proper redressal of Patients suffering from chronic illnesses and impending life threatening emergencies related to such illnesses
• Anticipate upcoming seasonal illness like Dengue and Malaria and take optimum measures to reduce chances of further crisis with these upcoming health threats
• Develop a sustainable system where both the public health sector and private sector collaborate to fight this Pandemic crisis
• Develop a system where the corporate health system reaches their maximum capacity in terms of services and also the revenue

POLICY SUGGESTIONS

• Every center starts functioning in a ZONED MANNER i.e they get divided into zones viz. Red, Yellow and Green
• Functioning of Non-COVID Zoned Hospital (may have reserved bed for COVID-19)

INTRAHOSPITAL ZONING

Non-COVID ZONED HOSPITAL gets divided in the following:

• RED zone: Consists of Emergency Room , RED ICU and RED Ward
  • Every HCW working in Red Zone works with all precautions including PPEs. (LEVEL 4)
  • Patient treated as per his condition with all necessary monitoring and investigations thereby making things more clear
  • First COVID-19 testing done at Red zone
  • If patient is tested positive for COVID-19 then the patient is shifted to COVID center and if report comes out negative then patient is transferred to Yellow zone
• ORANGE or YELLOW zone: Consists of another ORANGE ICU and an ORANGE WARD
  • Only patient once tested negative for COVID Negative gets entry to Yellow / Orange zone
  • Health care workers use at least level 2 PPE adjunct with an antiviral kit
    Patient are treated as per the symptoms with all necessary monitoring.
  • Clinical follow up of patient done with investigations like CBC to look for lymphopenia, coagulation profile to look for any derangement, LDH levels and serial Chest X-rays to look for radiological evidences .
  • Also any suspected patient to be kept in isolation or cabin with Negative pressure if available
  • Second COVID-19 testing done at Orange/ Yellow zone in case of any suspect either clinically or derangement in any of the significant investigations
  • If patient is unfortunately tested Positive , patient is referred to COVID Unit
  • If Second report also comes out Negative , then patient is transferred to Green zone
• GREEN zone: consists of GREEN ICU and GREEN Ward
  • Patient that has been tested as COVID-19 negative twice is admitted in Green Zone
  • HCWs use N95 and Gloves only
  • Patients are treated as per his condition including all necessary monitoring and investigations
  • Patients gets discharged from Green zone

ANTICIPATED CHALLENGES

• ZONING of the hospital itself may be a challenge as common AHUs . But this can be managed with little extra efforts and adequate planning and therefore allowing areas into a particular zone so that areas sharing common AHU comprise of either RED zone or Orange zone only
• Reallocation of healthcare workers in respective areas
• Rotational duty rosters and Post duty Quarantine followed by Covid testing before rejoining
• Additional cost of the PPE kits and additional Covid 19 test , this can sum up to around 8k- 10k per patient
• Adjunct Formulations

ANTICIPATED ADVANTAGES

1. Protection of healthcare workers – with double testing and proper zoning of hospitals depending upon the risk associated, can achieve a system where minimize of the infection among HCWs by using proper PPEs depending upon the zones
2. We will be able to cater to life-saving emergencies efficiently, also the routine services can be escalated with such kind of strategies
3. The hospitals can achieve a system where they can provide their services near to normal (pre-covid times) thereby reaching a sustainable system both in terms of services and revenue generation

The current article mentions the zoning of a hospital for handling the emergency admissions, likewise for routine health services as well such zoning can be formulated and adopted. E.g. an elective surgery can be performed by performing a pre-admission COVID-19 test and then admitting the patient in ORANGE zone ward isolation rooms and then performing another test if required.

Recently there has been guidelines by Delhi govt suggesting a division of NonCovid hospitals into Risk Zones ( i.e mild , moderate, and severe ) addressing the issue of infection among HCWs and thereby suggesting the use of a different level of PPEs in different zones depending upon the risk associated . Also the advisory states formation of Holding area (corresponds to Red zone) for patients with influenza like illness (ILI ) in Non-Covid hospitals.

We appreciate the authorities for addressing the problem and taking such suggestions into consideration while forming the advisories and formulating the guidelines . Though there can be much more that can be done to achieve a more sustainable system which helps us fight the current pandemic in much more efficient manner as in our consideration achieving a SUSTAINABLE HEALTH SYSTEM ( HEALTH 2.0 ) is the only weapon amidst this crisis that can help us reach a safe bank.

Authored by Dr. Kulsaurabh & Dr. Yachika

Dr. Kulsaurabh is working as Intensivist at Fortis Escorts , New Delhi. Has done his MBBS and MD from PGIMS , Rohtak. Loves to be a part of an ecosystem working for any sought of development to overcome ongoing challenges. Presently holding a position as Joint Secretary, Federation of Resident Doctor association , FORDA.

Dr. Yachika completed MBBS from PGIMS Rohtak and has secured a respectable rank at NEET PG and will be joining a PG course.