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Where the Mind is With Fear…

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Even though recovery is the rule rather than the exception in the case of this pandemic, irrational fears among healthcare workers have affected the treatment of these patients

By Dr KK Aggarwal

A small experiment by China—declaring a lockdown—created so much fear in the minds of people all over the world that every country started following it. India too declared a nationwide lockdown for over 40 days. Remember, China had a lockdown only in Wuhan with a population of around five crore. The virus made the whole world behave like a zoo with people living in their homes as if in a cage.

The media showed high mortality in various countries and had such a frightening effect in the minds of the common people and healthcare workers that everybody thought that with Covid-19 death is the rule, and recovery the exception. Everybody started fearing that their elderly and co-morbid relatives would not survive if they caught the infection.

Today, India is learning from its own experiences in cities like Delhi, Mumbai, Ahmedabad and Chennai and Indians are behaving differently from the West. In fact, the whole of Asia is different from Europe and North America. Even in Asia, four different patterns are seen. New Zealand and Australia have done the best. Middle East countries have higher mortality. Singapore, South Korea, Hong Kong, China and Taiwan have lower mortality. And we have India, Pakistan, Bangladesh, Thailand, Sri Lanka, Nepal, Malaysia and Indonesia with decreased mortality—less than 3 percent. The mortality in Kerala is six per million which is comparable to that of Sri Lanka which is five per million. This mortality is much lower than from other communicable diseases in India.

Today, we know that with Covid-19, recovery is the rule and not the exception. Extra-pulmonary Covid-19, which is seen in 40 to 50 percent of cases, is not serious. Also, respiratory lung Covid-19 which is detected at the time of silent hypoxia can be treated with minimal mortality. We also know that in women, the mortality is very low and so also in those less than 21 years. Also, we know that in co-morbid conditions if we start low molecular weight heparin when we suspect Covid-19, mortality can be reduced to a minimum.

This fear of Covid-19 has especially taken hold of the healthcare community. They must shed their fears first. One of the reasons for the fear was the government policy of not allowing the private sector to deal with these patients. However, its management is like any other disease’s management.

Another policy of the government of not allowing antibodies is also wrong. In a city like Delhi, Mumbai, Ahmedabad and Chennai, the prevalence of the disease ranges between 10 and 30 percent. I will not be surprised if 20 to 30 percent of healthcare workers are already Covid-19 antibodies positive. If all healthcare workers are provided with the antibodies test and if they are antibodies positive, the fear among them will go away.

The virus cannot be replicated after nine days, so why quarantine for 14 or 17 days? Why follow China in this regard? We know that the virus can become negative as early as three to seven days, then why not do the test among healthcare workers who acquired the infection every third day? Also, when we know that Covid-19 patients who have diarrhoea are the superspreaders, why not concentrate only on them for isolation? When we know that those with a loss of smell and taste do not become serious, why insist on their admission to hospital? Also, why are the policies different in different states? In Delhi, home isolation is allowed, while in UP, it isn’t.

Doctors and nurses all over the country are fearful of this disease. They are resigning from their posts and senior doctors are passing on the job of looking after these patients to their juniors. This is not an adversity but an opportunity for nurses to come forward and take the lead and become nurse-practitioners. This is also an opportunity for AYUSH doctors to come forward and take the lead, but they too live in fear.

This was and is an opportunity for young female doctors to become real Covid-19 warriors. Remember, young women have practically zero mortality. This was done by Italy where the main treatment was done by nurses aged 40 and less with no mortality. But in hospitals across Delhi, nurses are resigning over fear of the virus and lack of enough Personal Protective Equipment (PPE), compounding the healthcare crisis. Nurses have been working long and difficult hours without adequate support from the authorities.

Why can’t the government supply PPE to all doctors and nurses? Why can’t their prices be capped like those of stents? Why do we have to follow PPE designs of the West? Why can’t we have a kurta-pyjama made of PPE material which is simple to handle, easy to wear and non-suffocating? Why can’t the government mandate air purifiers in every emergency and isolation room?

India should lead the way and show that we can normalise life at the earliest. The medical profession can do this and start treating all patients with potential positives, take precautions and save themselves and the country.

But whether the government will  listen to these suggestions only time will tell.

—The writer is President, Confederation of Medical Associations in Asia and Oceania, and former National President, IMA

Lead picture: UNI

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