Forty doctors from across various hospitals in Telangana have written to Chief Minister K Chandrasekhar Rao highlighting their concerns about the second wave of the COVID-19 pandemic. The letter written by doctors highlights the challenges and the policy responses in emergency healthcare across all departments of the government. Among some of their key suggestions are having a transparent health bulletin, expediting RT-PCR testing, and passing an ordinance to take control over all the oxygen plants in the state.
Dr Lakshmi Lavanya Alapati, Consultant Endocrinologist, Diabetologist and Managing Director of American Institute of Diabetes and Endocrinology in Hyderabad took the initiative to bring all forty doctors together. Speaking to TNM, Dr Lakshmi Lavanya said, “We saw how the second wave surged suddenly and affected so many people. The health infrastructure was totally exposed. The panic was visible all around. This is not only with respect to Telangana but holds true for the entire country. All the doctors who came together are presently based out of Telangana and hence we had certain points regarding issues in the state.”
“Telangana is docile in bringing out the real numbers and that is where we all have a real problem. Because we are from Telangana, we are writing to bring to the notice of the Telangana CM and the Health Minister but so many points raised are valid for places across the country”, added Dr Lakshmi Lavanya.
An online meeting was organized and doctors also individually put forward their concerns and takeaways regarding the handling of the COVID-19 pandemic. Following the deliberations, a list of takeaways was made and the same has now been sent to CM KCR for consideration.
From suggesting government intervention and regulatory mechanisms, several important points have been highlighted in the letter. The doctors hope that the suggestions put forward will be considered by the government as it will help in a more resilient management of the crisis. Several senior doctors, from the various specializations, working in hospitals in Hyderabad and also from across the state were part of the deliberations and meetings.
1) Invoke emergency provisions and full implementation of ‘disaster management act’ to combat a war-like rescue zone to provide all needed facilities such as N-95 masks, PPE kits, ventilators, medical oxygen, essential medications, by the manufacturers as a priority to provide for the needful.
2) Emphasis on well-fitting masks. Manufacture, sale and use of sub-optimal masks should be discouraged. Government should provide masks to poor people in the lower socio-economic strata.
3) Need for government intervention to make available emergency medications such as Remdesevir etc. in a fair and quick way to the hospital facilities to avoid price gouging by various players with vested interests. Remdesivir and Tocilizumab are injectables given only in hospitals, so should be completely available in “in-patient pharmacies” of hospitals under prescription by treating doctors, no other route should be available for people to scramble about. The same is the case with medical oxygen.
4) Ordinance to take control over all the oxygen plants in the hands of the government and channelize the distribution through one window.
5) Consider using a hospital preparedness checklist and the COVID-19 surge spreadsheet to estimate and respond to the surge in demand for hospital-based services. Consider setting up an Emergency Operations Center (EOC) for hospitals if not already in place and ensure the EOC has enough staff for an extended response.
6) Expedition of RT-PCR testing and the turn-around time of conveying test results in the public health sector by keeping the availability of test analyzers and lab technicians at multiple nearby spots of testing facilities. RT-PCR/RAT testing centers should avail 24 hours service in the public health sector to cover the needs of the emergency.
7) Having a transparent health bulletin to display the test positivity, and daily active cases, deaths and discharges; also an active dashboard of bed availability of isolation beds with oxygen facility, ICU/ non ICU beds in both public and private health sector for patients to easily choose their care based on their budget, location, and bed availability.
8) Procurement of vaccines from the manufacturers as pre-orders at the earliest to reach our demands as the new guidelines decentralized the vaccination drive. There should be strict price caps and strict vigilance to not slip vaccines into third-party middlemen with high prices.
9) Provisions of incentives, compensation, and adequate rest/ break time to the COVID care doctors, nurses, and paramedic teams to ensure commitment and endurance in the public health sector during these difficult times of pandemic fatigue.
10) Private hospitals charging beyond the norms should be checked by peer review and legal committees to have a cap on the price.
11) Dead body disposal protocols should be standardized across to all private and public hospitals and the enforcement should be guided by law and enforcement
12) Pushing for more genomic sequencing of RT-PCR samples to understand the new variants and this will help to understand rediscovering newer second generation vaccines to prevent the third wave.
13) Finally, gaining the trust of people of Telangana by connecting to them, by displaying the numbers correctly and honestly admitting the problems and challenges.