Indian doctors and healthcare staff have been trained to work in difficult situations. Dr Prabal Deb, Director Lab Operations and Chief Histopathologist, SRL Diagnostics shares his views on how in terms of fighting in a medical warzone, the healthcare community largely stands sans experience
Since COVID-19 has stuck the world, doctors and healthcare workers have led the charge against an invisible enemy that’s highly artful in disguising its presence, and at the same time, it has been highly successful in impacting mankind unlike any other crisis in the modern history.
Major and much evolved healthcare systems in the world are reeling under pressure and doctors are at the line of control, keeping a brave front. Going by the population size, India has a gigantic challenge to overcome in the coming months. India already has over five lakh cases, and the burden on healthcare ecosystem is increasing with the passage of time.
Doctors at the frontline
Amidst the crises, the doctors, the healthcare professionals, and all those having to work closely with the healthcare system are at high exposure risk and have to sacrifice immensely to protect themselves and their loved ones. Furthermore, there have been several casualties reported, and every casualty in this crucial fight is a great loss, especially in a country like ours which sees acute shortage of healthcare professionals.
Indian doctors and healthcare staff have been trained to work in difficult situations. However, in terms of fighting in a medical warzone, the healthcare community largely stands sans experience. The COVID-19 pandemic is a medical warzone.
In the fight against the disease which has no treatment, vaccine or cure, the fight is being fought at the diagnostic level. Testing, testing, testing is what the World Health Organization Director General Dr Tedros Adhanomhas called for. And rightly so! At the centre of the every effective COVID-19 response strategy that the world has seen, there is diagnostics. For, it’s only when you know who all, and how many infected can the healthcare practitioners undertake the right treatment or initiate public health strategy.
Working closest to virus: The doctors at diagnostic centres
Within the healthcare ecosystem, there’s another fleet of doctors and laboratory staff, who are perhaps living closest to the virus. Everyone at ground zero is at high risk of exposure. Everyone would include doctors, pathologists, scientists, lab technicians, administrators, phlebotomists and complete diagnostics and logistics team at work, bringing the patients samples to labs for testing. Along the way, these COVID warriors have several challenges to face. Every step has to be carefully monitored because any error can lead to severe exposure.
Although the novel coronavirus has not yet proven to be air-borne, but it has been associated with forming aerosols on strong movement of contaminated surface. Aerosols are formed when small solid or liquid particles are suspended in air due to high pressure or strong movement. For instance, deodorant sprays work on the aerosol concept. Studies suggest the coronavirus is expected to form aerosols and can stay in the air for few hours, especially in high-exposure zones such as hospitals and labs. The possibility of COVID aerosol formation puts doctors, pathologists and other laboratory staff at high risk.
The common challenges begin from the point of taking the swab test. The phlebotomists on the front collect the samples by following all biosafety precautions and using personal protective equipment.
A long swab is inserted deep in the nasal cavity for around 10 seconds and rotated slowly few times. The swab sample has to be taken out with extreme care without much movement. The samples have to be properly sealed and transported to the lab. These are collected in a viral transport medium (VTM) to maintain the stability of the sample and get transported in a cold chain.
In the labs, doctors, scientists, and researchers are either conducting study or reverse transcription-polymerase chain reaction (RT-PCR) tests that have to come really close to the sample for isolating the viral genetic material. With the pace at which testing is conducted and samples are flooding labs, doctors and staff at COVID diagnostic labs are under tremendous pressure to deliver rapidly and accurately. The team is working tirelessly towards the goals. A large section of the team is to have made arrangements keeping away from family. The whole environment is highly demanding for the doctors and diagnostic staff.
For a controlled environment, the diagnostic industry is employing biosafety level two or three or equivalent practices for COVID testing. Biosafety level-two practices are expected to safeguard people from potentially viral infectious materials such as body fluids in a laboratory setting. The entire staff diligently practice standard precautions including hand hygiene.
The personal protective equipment (PPE), including gowns, gloves, face protection and masks are used as per the exposure risk. For instance, a pathologist or doctor would be wearing the full PPE gear while an admin staff member will have the essentials like gloves, masks, etc, put on. It’s highly difficult to be working in PPE gear which doctors are braving with a smile. This is for the reason that once a person has donned a complete PPE suit, he or she has to work in the suit without food, water, or attending to nature’s call for as long as possible, sometimes upto six hours. The taking off of PPE gear is also highly tedious. It cannot be done in a rush. It has to be done in a very systematic and slow manner without creating aerosols around and sanitising oneself several times during the whole process.
The life of these frontline COVID warriors have transformed tremendously. Most of them haven’t gone home or met their families and friends for months now. This is beacuse distancing themselves from their families is supposedly the best way they can prevent spreading infection. Most of them satisfy themselves with occasional video calls. On the other hand, due to high levels of testing done, the pressure to conduct beyond capacity is extremely high on the COVID-19 labs across diagnostic industry. In national service, the doctors have been working for long hours daily almost without leaves or weekly offs. The personal sacrifice made by the doctors on ground zero is tremendous and emotionally heart-wrenching.
Leading the initiatives
Being a leader in the diagnostics space, SRL, its doctors and staff are honoured to be playing a significant role in national service. Working hand-in-hand, shoulder to shoulder with the government machinery across regions in the battle against the virus, SRL has already exceeded 1, 00, 000 tests mark.
Various initiatives to speed up testing, like drive-through specimen collection sites, mobile van testing in containment areas were adopted in partnership with the government and local authorities across cities. Furthermore, understanding the risks at the ground level, all employees handling infectious samples were given an additional medical insurance cover that not just covers the employee, but also includes their spouse, dependent parents and children, and so forth.
In this time of national crisis, SRL salutes not only its doctors and staff but of the whole healthcare, diagnostic, and medical research industry for their immeasurable sacrifices and relentless efforts in the fight against the pandemic. It’s through these united efforts that India will overcome this unprecedented crisis. The Doctor’s Day of 2020 will be a testimony of the lakhs of stories of these brave hearts and corona warriors fighting at the frontline.