Dr P K Singh, Director, AIIMS, Patna talks how Vaccination and community ownership of Covid Appropriate Behaviour will not only break the chain of viral transmission but it will also offload the system from huge cost and current vaccine availability to vaccinate the whole population of India.
Question: How has the second wave of Covid-19 affected Bihar? How is the situation now?
Dr P K Singh: The second wave of Covid-19 was severe. During the first wave, most of the patients came to us from the urban areas, but this time, we had patients from the rural regions too.
This wave penetrated to the remote villages which were not affected earlier. Take for example, last year there were hardly any cases from Katihar, or Raxol, Purnia, which are at the Nepal border but this time we got a lot of patients from these places. However, places such as Bhojpur, Bhagalpur, Patna, Gaya, Navada, Begusarai, Shekhpura were affected in the last wave as well as in this wave.
But thankfully, now we have less than 90 positive cases per day. The recovery rate, too, has improved to 96.4 percent.
Question: Do you think lack of non-compliance of Covid-Appropriate behaviour among people was the major reason for this sudden upsurge. How do you think we can help the community adapt to this change?
Dr P K Singh: I agree that people are not very particular when it comes to following Covid-Appropriate Behaviour. Unfortunately, most of the people, more so in the villages, are still in denial mode; they feel that Covid-19 is nothing and they will not get affected. People need to understand and be aware of COVID-19 and should follow required precautions so as to avoid getting infected and prevent spread of vaccination.
Question: So, do you counsel the patients who are coming to the institute about importance of Covid Appropriate Behaviour?
Dr P K Singh: Yes, we do counsel patients on CAB. We tell them about the precautions they should take post-Covid-19 infection. We also educate them about how the disease spread and can affect them and their loved ones if they do not follow Covid Appropriate protocols.
I strongly feel that it is important to study their post-Covid behavior. Right now, we assume that they must be behaving responsibly after having to suffer so much because of COVID. But Covid Appropriate Behavior should be checked and ensured as we can’t rely on assumptions.
Question: What was the biggest challenge that you faced during the second wave of Covid-19. How did the institute overcome that?
Dr P K Singh: Last year, we prepared our faculty, resident doctors, nursing cadre support staff and facilities to tackle the highly contagious virus. We developed our clinical and administrative protocols to effectively handle the crisis. We conducted more than 80 training sessions to orient more than 2000 staff members on institutional protocols and clinical management, safety and precautions. We increased our bed strength, we re-arranged our entry and exits for Covid-19 patients so that regular health services can go on unaffected. For our para-medical and other staff, we also designed short online courses on Covid-19 management. We devised testing and admission policies, treatment protocols, discharge policies which we have been regularly updating. We gave training on how to manage hospital consumables. We set up protocols on how to handle the dead bodies of Covid-19 patients. All these measures boost the morale and confidence of the staff and ensure standards of care in the hospital.
To ensure standards and quality of care we ensured that all the wards are all-time covered by in-house doctors with adequate nursing staff in wards and proper nurse-patient ratio in ICUs. At the same time, to avoid fatigue and exhaustion in the healthcare workers, we designed our duty roster in such a way that doctors, nurses and supporting staff get equitable roles according to their capacity and have enough time to rejuvenate between their shift covid duties.
We anticipated and took cognizance of mental agony, the patients admitted in isolation were likely to go through, and ensured psychological support for patients and particularly parents of young children. We ensured that they could talk with their families on their phones through audio or video calls. We tried to make their stay in the hospital as natural as possible by providing newspapers, televisions and home-made food. These small but targeted steps were appreciated a lot by patients and their families to serve the natural needs at the time of agony.
If we look at the epidemiology of the virus, the second wave generally is more severe than the first and affects more people. It happened during the Spanish flu pandemic also. But thankfully, we could manage the patients during the surge. We feel that clinically coronavirus behaved differently during the second wave. For example, this time the disease was progressing faster and so patient’s’ condition was deteriorating faster, at times within 1 or 2 days only, which we didn’t see during the first wave. This phase affected young adults as well.
The delayed presentation was also a major challenge as many patients kept waiting at home till they were already deteriorated. Those who reached hospital in severe degrees of illness, many could not be saved despite all our best efforts.
Then, the injudicious use of steroids without proper monitoring of blood sugar made the matter worse for secondary infections such as mucormycosis.
Question: Why is vaccine so important in our fight against Covid-19?
Dr P K Singh: Vaccine is the most effective weapon in our fight against covid but it has a limited supply so we need to use it efficiently. Newer mutations in the virus can lead to the third wave of pandemic. Mutations occur when the virus goes from one host to another but, by ensuring effective vaccination we can break this chain and not only protect people from existing viral genotypes but can check further mutations as well. The most reliable way to avoid further waves of the pandemic is to vaccinate maximum people quickly.
Those who have already been infected by the virus have developed a certain degree of immunity against it (naturally vaccinated to a certain extent). With seroprevalence studies, we understand that a significant number of people already have antibodies against the virus although they never developed the symptoms of the disease (asymptomatic infection). We can prioritize vaccination for people who have not got the infection yet. If we can develop a cost-effective, easy-to-do, kit-based antibody test with instant results to detect an immune response in the population, it can be effectively utilized to prioritize vaccines for those who have not developed an immune response yet. As per the estimates based on seroprevalence studies, we can achieve herd immunity for 80 to 90 percent of people, by smartly vaccinating the remaining vulnerable group that should be as less as 30-40 percent of the population (those who do not mount antibody response).
Vaccination and community ownership of Covid Appropriate Behaviour will not only break the chain of viral transmission but it will also offload the system from huge cost and limited vaccine availability at present to vaccinate the whole population of India.
