Bengaluru: Dr Devi Prasad Shetty, one of India’s top cardiac surgeons, has a word of caution as preparations for a potential third wave of Covid gets underway. Doctors and nurses working the Covid wards have been hard at work for nearly 18 months and counting, and they are tired. State governments, he told ThePrint in an interview, need to get cracking to get a fresh workforce ready for deployment on India’s pandemic frontlines.
“We can’t keep on flogging the same horses, which (we) have been flogging for the last one-and-a-half years in the Covid ICU. They are tired, a good number of them are infected, we need a fresh workforce,” said Dr Shetty. Founder and chairman of Narayana Health, a Bengaluru-headquartered chain of multi-speciality hospitals, Shetty is currently leading a committee of experts set up by the Karnataka government to tackle the third wave.
Talking about ways the staff strength can be enhanced, Shetty said state governments should document the workforce available and come up with a clear road map to train more doctors and nurses.
To this end, he added, states could tap the pool of aspiring doctors who didn’t make the cut in the NEET postgraduate exam, and those who got their medical degrees abroad and are now awaiting certification in India (those who pursue their MBBS in countries other than the US, the UK, Australia, New Zealand, and Canada, are required to appear for an exam to get a licence to practise in India).
Also read: Traumatised, burnt out & depressed — the silent crisis of Indian doctors in the second wave
Health infrastructure ahead of 3rd wave
According to figures reported by the 15th Finance Commission earlier this year, one doctor in India caters to 1,511 people — significantly above the World Health Organization-set norm of one doctor for every 1,000 people.
The second Covid-19 wave, which hit the country in March and only subsided last month, has exacted a devastating toll on the country. At its peak in May, the Covid wave saw the number of new cases per day jump over 4 lakh, while the official Covid death toll hovered between 3,000 and 5,000 a day.
The surge in hospitalisations meant severe stress for doctors and nurses — stress compounded by the limitations of India’s healthcare framework. Looking to optimise the resources available, doctors often had to make difficult decisions and prioritise treatment for patients with a better shot at survival. The oxygen crisis that erupted as cases surged also took a toll on doctors — a viral news report in April detailed how a Delhi doctor broke down as he discussed the oxygen shortage at his hospital.
Tending to dozens of patients day after day, for hours on end, in PPE kits that even make washroom breaks a long chore, and still watching some people die on your watch, doctors and nurses had a nightmarish run through the second wave, and their burnout and stress has been widely reported in the media.
“Unfortunately, you know, we are not even aware of how many doctors are working or how many nurses are working… My suggestion to everyone is that every state government should have a document stating how many doctors are working in their state,” Shetty said, noting that health is a state subject.
“State governments have taken the stand that if there’s a manpower problem, the central government should be blamed when in reality it is not the central government that is controlling the state medical manpower,” he added.
State governments, Shetty said, should “create their own curriculum” and build more nursing colleges to mitigate the challenge.
To address the current shortage, Shetty said the state governments should look to expand the workforce by recruiting among those who do not get a NEET PG seat (1.4 lakh-1.5 lakh doctors) or those who qualified from overseas universities (80,000-1 lakh doctors) and are waiting to be certified in India.
“It is very, very important that we must make our government hospitals vibrant… Every state government should have a checklist, which every government hospital should publish on a daily basis on a mobile phone app that includes data like how many surgeries were done, how many patients came to their OPD etc.”
Shetty said he had a “gut feeling” that “the third wave won’t be as bad as the second wave”. “But I keep saying in all our meetings that we should be prepared for the Covid third wave to be at least 30 per cent worse than the second wave.”
Also read: ICU for 70yr man or 30yr woman? Doctors, nurses are turning to psychiatrists in 2nd wave
Impact on children?
There has been speculation that the third wave will predominantly impact children, but Shetty rejected it, joining other experts — including AIIMS Director Randeep Guleria and WHO chief scientist Soumya Swaminathan, in questioning this theory.
Last month, a serological study by AIIMS found that the number of children with virus-fighting antibodies was comparable to the figure for adults.
Shetty said it is not true that a third wave will primarily attack children. But, he added, since children are not immunised and thus not protected, “they are a vulnerable population”.
“Unlike for adults, scaling up paediatric hospital services and critical care services [for children] is very difficult,” he said.
For instance, he added, there are only an estimated 1,000 ventilators in the entire country for children weighing less than five kg.
In June, the Devi Shetty-led panel recommended the setting up of an “exclusive children’s hospital” and upgrading existing paediatric units. In their interim report, the committee also advocated for the phased reopening of schools and colleges.
Shetty, however, clarified that while the decision was taken, the committee never specified when educational institutions should reopen.
“It is a very, very complex decision, which has a massive impact on thousands of children and families. So, I don’t think any expert committee has the knowledge to clearly say that you could start school or a college at this time,” he said.
Long Covid symptoms
For many patients who have had Covid, the disease appears to be having an impact that far outlasts infection.
Post-Covid ailments and complications are becoming a significant cause for concern among many doctors. These conditions include blood clots, heart and respiratory ailments, and pulmonary complications among many others. Shetty described these long Covid symptoms as a “great challenge in the next few years for healthcare”.
“We have seen a different set of diseases that can affect your brain, your heart, and the rest of the body… This is going to be a huge burden on the already overburdened health system of the country… we have no idea what will emerge after one year or two years,” he said. He wouldn’t be surprised, Shetty added, if Covid specialist emerged as a separate specialty.
(Edited by Sunanda Ranjan)
Also read: India’s healthcare workers are the most vulnerable, but there is no framework for their health