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Amid COVID pandemic entire infrastructure needs to be transformed

Healthcare across the world has been battling COVID-19 for over a year now. What started off as something that was not thought to be as big as it has turned out to be now; we are still nowhere near ending the pandemic either by means of vaccination or herd immunity, and in all forcible future this is going to go on for some more time and nobody can exactly predict how and when it will end. In the initial stages of the pandemic hospitals found themselves to be woefully inadequate as far as the facilities were concerned to treat patients of such an infectious disease on such a massive scale.

While we have been treating patients from across the world who were very infectious, for example H1N1 etc. but that used to be one or two patients at an instant, incomparable to the scale that now we are seeing. Almost 80 percent of ICUs are full of COVID-19 patients, 60 to 70 percent of novel patients in a hospital are COVID-19 infected cases.

COVID-19 is not just a highly infectious disease but also as the days are passing we are seeing new mutations coming in, which are seemingly more infectious. So as we were talking initially the hospitals found themselves inadequate as far as the infrastructure is concerned to keep patients in one area because of the mixing of airflow and very less number of isolation rooms etc. at hospitals. But as they say that innovation happens when humanity is faced with challenges and humans are extremely adept at innovating to be able to survive, and that’s what has been seen in the last year.

So what are those infrastructure changes that may hospitals talk about? Basically it was about isolating areas, both physical patient isolation and airflow isolation, because if you have an air conditioning system hospital a becomes like a citadel, and the complete air getting mixed up in the hospital from infective to non-infective areas is not a favorable situation, though future studies may be able to pinpoint how this disease transmits.

So two important barriers had to be created, one was the physical barrier which was created by using walls etc. which hospitals did very quickly, and by isolation area I meant having separate walls, separate knobs, lifts which only could take COVID patients, and separate corridors for COVID-19 patients. It also included the manpower, which was required to treat COVID-19 patients so that they are dedicated to work in rotation so that you have some people resting for some time and some people working for some time, but this manpower of course did not get mixed up with the non COVID-19 patients.

Then hospitals also very smartly looked at the files etc. which our hospitals were still using, and at that moment the files were also restricted in particular areas so that the files don’t move from infected to non-infective areas and carry that infection. Now this was from a physical standpoint which the hospitals did quite quickly.

The more difficult part was when you had to segregate the air conditioning systems as AFU and AHU etc. But since it was very much desirable and many of the hospitals either had new AFU, AHU being used or were able to segregate particular air conditioning ducts and air conditioning modules to specifically supply to a particular area, blanking off some areas, managing intake and air supply to and from COVID and non-COVID areas separately.

So there was a physical separation and there was a separation as far as the airflow is concerned, which most hospitals have learnt to adapt in the time we are dealing with this pandemic. In the near foreseeable future we foresee that this disease and pandemic is going to remain till the time it becomes endemic – the way most of the pandemics have gone because they move from being pandemic into endemic as it moves through its course or life cycle.

So after taking care of infrastructure, the next thing was to look at using digital and IT infrastructure to limit patient visits to the hospital only in critical health conditions-and online consultations, video consultations, home sample collections were started. The process of sending online reports, sending images through emails was also started. So basically those patients who could stay at home were made to stay at home. This was the new way of dealing with things. It was a hybrid kind of model – there were patients who could come to the hospital, who really required coming to the hospital and there were patients who were treated at home through online consultations. Along with this most of the hospitals started home services of sample collection to basically reduce the rush inside the hospital so that people don’t cross infect and don’t get infected.

I think the most important thing the Narayana Health addressed in the beginning itself was to have its staff adequately protected with PPEs, masks and that kept the entire staff motivated and we were first off the block to have proactively done this.

Our hospital in Katra which is very remotely located and was in fact given the first set of PPEs etc. to ensure staff is adequately protected and once they knew they were protected there was much more they could do at their work with less fear.

The COVID vaccination drive, which is also the largest vaccination drive in the world-has also received the government’s nod for two vaccines and recently news also refers to approval for Sputnik, which is a Russian vaccine.

The near future could have many more vaccines which will come up for emergency approvals and also, it is expected that the government will lower the age of the people who are expected to be vaccinated once the supply sees adequate levels.

So a complete ecosystem has now been developed, from infrastructure to protective gear, to consultants, to the government, and these combined efforts against the virus will enable us to win this battle. Complete coordination between societies, private healthcare, government along with the stakeholders like vaccine manufacturers, PPE manufacturers etc. will help us through this battle against the virus.


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