COVID19 has emerged as the single most impactful adversary that humanity has faced. Deceptively small, embarrassingly simple to dissolve yet destroying without pause. It’s not like we do not have a mechanism to avoid or even tolerate when infected. It’s not like we don’t know how to diminish its effects. We even know that millions can be saved by the simplest of no cost social measures including hand washing and social distancing . Despite all these efforts if the virus infects a small subset of Indians the health system will be overwhelmed. This is not because of any lack of effort on the part of the government or even the private sector. It is a question of numbers and having well designed infrastructure to tackle this scourge.
India has been a leader in the provision of basic healthcare for various diseases. Even the WHO has acknowledged success in eliminating polio and small pox. India’s health apparatus is made for public health measures-from management of tuberculosis or malaria to tracking and treating various social determinants of health . However if the implored, begged, requested, therapeutic distancing is not done completely we will be sitting on the cusp of a toll unlike that seen in recent memory. The public and even the private health network is not geared for mass critical care at this scale. No nation has been prepared for this pandemic. Modeling and simulated gaming has been reputed to give ideas and plans but the rapidity of this onslaught has created the need for on the spot strategic thinking. We need to take this opportunity to also ask ourselves if this is a nature given window to clean house. Not literally as many of us are probably doing now during our time at home but for our health systems.
We currently have the dream situation of a laser focus on health, a US $2 billion fund as well as empty streets and hospitals. Health care teams will have less work till and if the surge occurs. We must now use this as a sabbatical for our doctors , nurses, paramedics, lab teams, health administrators, patient helpers and everyone who is a healthcare industry stakeholder. We must rapidly, vigorously and thoroughly educate and change our approach to health. Alter it from a casual laissez faire “chalta hai” attitude to a compassionate, science based and outcomes enabled system of care. We must integrate wellness and exercise, mindfulness and stress relief along with the potions and options that modern medicine offers. We must rapidly assemble existing teams to enhance, connect and integrate our critical care infrastructure. Using India’s remote technology and internet based telemedicine strengths we should connect every ICU with a hub and spoke model to ensure uniformity of protocols and a guarantee of quality. We must tackle our biggest problems: cardiac disease and cardiac death, malaria and dengue as well as organophosphate poisoning that ruins lives daily. We must tackle our trauma and burns as well as the immense need for managing sepsis.
India can show the world that it has the ability to conquer adversity with magical ingenuity. India can show the globe how to care for its elderly, infirm and voiceless. It can show once again that this nation is the embodiment of vasudeva kutumbakam with truly universal citizens. The innovation and low cost creativity that will rapidly change how we live and treat the sick will create waves of opportunity to transform countries in Africa, Asia and South America who are living sometimes worse lives. We must use all our resources to partner the public and private sectors to take a fresh approach for our lives are truly at stake. We must ensure that government systems catch up to well functioning private models and private healthcare lives up to its commitment to public health. Hospitals have no doors and people move from one to the other, often shopping for cost effectiveness and convenience. Let us give them the best.
If all healthcare personnel commit that in these three weeks we learn about managing critical illness, learn the basic principles of safe care and give our careers a fresh start we will truly move mountains. When Hanuman brought the Sanjivani herb by lifting the Dronagiri mountain to cure Lakshmana it was deemed a monumental task. We have a similar challenge ahead of us. We need to lift Indian healthcare up, high above the inefficiency, apathy, disrepair and despair that it often finds itself victim to. We need to find the healing herb within this system for it’s in there-we may have to shake the mountain a bit and perhaps move some rocks around .
Under the leadership of the Government of India and the support of all those , who may distance themselves from or support various political ideologies , we must speak as one voice for the enemy ahead is staring us squarely in the face. Every breath could be fatal if viral particles are shared. Every whiff of air inhaled will be devastatingly hard to take if lung damage sets in. We have the resources, the need, the opportunity to change how hospitals are structured, how infection control is practiced and how cleanliness can be truly instilled. This is our moment to shine: cough etiquette diminishing tuberculosis, controlled traffic by tele-commuting lowering our AQI to Himalayan quality, home bound families rediscovering the joy of togetherness, tobacco use disappearing as knowledge of the vital nature of the lungs is remembered and of course living through this imminent hell and thanking all with gratitude for the gift of life.
Philosophical and wistful thoughts aside, is there a practical way to get this done ? Here is a blueprint that must get edited and executed by the end of the day by the smartest minds in India’s varied planning apparatus – doctors, scientists, engineers, public health experts, politicians, business owners and the lay public. Can this be done we may ask? A nation that can share information with the touch of a button with no correlation to literacy, a nation that can manage the finances and the shopping of billions around the world, a nation that can roll up their sleeves and clap over a trillion times will do this.
1 Organize Zoom meetings of the MCI, AIIMS deans , private hospital CEO’s and the insurance authority to prioritize emergency, critical care and post critical illness management in all health institutions over the next five days
2 Begin daily education of all nurses and doctors as well as paramedics in managing critical illness and specifically respiratory failure, infection control and ventilator use
3 Place a call to technology leaders to develop a fully functional ventilator in five days
4 Hospital project teams to rapidly review modular ICU creation , use hub and spoke models as well as virtual technology to create a seamless patient journey from a basic to a tertiary center – complete in 5 days
5 Standardize lab processes and reeducate lab teams on best practices as per the NABL
6 Ensure financial models available to guarantee private enterprise profits along with public hospital sustainability . One size will not be enough – we need a plethora of ideas for healthcare structures to cater to 1.3 billion Indians.
7 We must research this endeavor and share lessons for the world . Delegate this task to our highest published institutions
8 Doctors who are leaders in critical care, pulmonology, internal medicine , cardiology as well as public health must confirm the guidelines to be followed nationally for all critical care
9 Pharmacies must enforce standard best practices of safe prescribing and dispensing using the help of thousands of pharmacy and PharmD graduates
10 Patient education must begin in earnest with the participation of the large number of medical , dental and allied field trainees and graduates. This is a multimedia friendly country and loves its song and dance . Innovate in education and remind everyone about the life saving hand wash, don’t touch your face aphorism . Digitise medical records that already exist and begin a paperless medical interaction for the future.
All this in 21 days ? No – all this in 5 days to plan and then you only have 16 days to execute. Well that’s not a long time in a normal year. This is far from normal-our existence is threatened . This is not a movie – pinch yourself – you are awake and the risk is real . However with over 400 million Indians who can help by learning and planning and doing we will really have over 100,800,000,000 man/woman/child hours to get this done by just committing 12 hours a day to this effort.
This involves sacrifice. This involves community. This invokes our sense of humanity. We must set aside our ego, our need for family connection, our desire to meet our friends . We need to have an earnest and committed effort not unlike various apocalyptical movies where the Earth is saved by the daring hero. We must all step up and find our inner hero and work towards our common future. Let us begin the 21 day miracle: Transforming Indian Healthcare : for everyone, everywhere , forever. The planet awaits.
© Dr Sai Praveen Haranath
MBBS, AB, MPH, FCCP
Senior Pulmonologist and Intensivist
Apollo Hospitals, Jubilee Hills, Hyderabad, India
This article is a personal opinion.