Qualification & Affiliation-M.B.B.S., Bihar Health Services,
Government of Bihar, India
The current ongoing coronavirus pandemic caused by
SARS-CoV-2/covid-19/novel coronavirus is an acute infectious
communicable disease spreading mainly via respiratory, eye, mouth and
other possible routes from person to person as well as through contact
with infected non living objects. Added to previous global burden of
NCDs (non communicable diseases) & other communicable diseases this new
pandemic burden of covid-19 pandemic have put a stress on already
overstressed health system of India particularly poor states like
Bihar.11Kumar P. What Impact Have SARS-CoV-2/Covid-19 Pandemic
on the Reproductive and Child Health Programme of Bihar in India over
the 3 months after nationwide Lock down announcement in March 2020?
How SARS-CoV-2 Pandemic era does influence RCH Programme?
Immunisation, Maternal Health, Family Planning, Research Square, 2021
DOI: 10.21203/rs.3.rs-348841/v4. The delivery of health services is
of utmost importance and prime concern in India particularly poor states
like Bihar due to high population load with limited resources, poor
infrastructure and huge demand on healthcare system. The
Healthcare workers (HCWs) are particularly vulnerable
group hence this topic needs essential attention and
protection.22https://www.researchsquare.com/article/rs-360551/v1
The SARS-CoV-2 pandemic had presented a challenge even for developed
healthcare systems around the world.33https://europepmc.org/article/ppr/ppr304897
A sense of fear gripped the whole world due to pandemic and India is not
an exception. The scarce healthcare resources including manpower,
infrastructure, transportation (ambulance services) etc. have been
largely deployed to tackle the situation of pandemic of Covid-19. This
shift & covid-19 pandemic has tremendous and detrimental effects on
HCWs. The healthcare workers of India as well as Bihar are getting
frequently infected leading to death of thousands of
healthcare workers till date . Although there are several guidelines
issued for precaution and safety at workplace by WHO (world Health
Organization) & several accredited organizations but a
protective and supportive approach from local management
and governance is need of the hour . It seems that there is failure of
protective and preventive measures at workplace documented and evidenced
by several deaths of healthcare workers. Consequently it is apparent
from above scenario to ensure the health and safety of healthcare
workers in order to control the outbreak and decrease panic and fear
among healthcare workers. In this article I am sharing
methods and various ways for protecting healthcare workers
(HCWs) while having hospital duties as well as policy makers and
management people can also find this article useful while making
policies for protecting and safeguarding HCWs. This article aims to
reduce incidence/prevalence as well as mortality and morbidity of HCWs
in Bihar by suggesting important precautions, preventive measures and
other facts to be adopted by healthcare workers at workplace as well as
drawing attention of policy maker, important stakeholders and management
people to provide protection to HCWs.
Healthcare workers (HCWs), covid-19 infection, safety, pandemic
Background: The case fatality rate among doctors due to
Covid-19 infection is far more in Bihar says IMA (Indian Medical
Association) official “Doctors account for 0.5 per cent of the total
deaths in India due to Covid-19. However, in Bihar, the
percentage of doctors’ death is 4.75 per cent, which is nine times
more than the national average,” said senior vice-president of
IMA-Bihar Dr Ajay Kumar. “In other states, doctors doing duty in
Covid-19 wards are quarantined for 15 days after 15 days of continuous
work. This arrangement is not followed in Bihar, as a result of which
our doctors remain exposed to Covid-19 patients far longer than in other
states. In fact, in Bihar, doctors are working continuously at a stretch
since mid-March2020, without even an off day,” said Dr Kumar.
Protective gears available here are
questionable .44https://www.hindustantimes.com/india-news/death-rate-among-doctors-due-to-covid-far-more-in-bihar-says-ima-official/story-I6hRm0eoJAVXMWSgcyu8zN.html
There is a growing concern and sense of fear among healthcare workers of
Bihar erupting from the news regarding daily death of
HCWs due to covid-19 infections acquired at workplace, violence &
struggle at workplace, scarcity and supply of inferior quality
PPE55https://www.telegraphindia.com/india/bihar-doctor-deaths-blamed-on-inferior-ppe/cid/1788730
see figure 3 a doctor (author himself) working in Bihar using
bedcover as PPE kit for protection due to scarcity of PPE kit. The
healthcare workers are under undue stress due to several factors added
to this which may affect mental health as well as physical and social
health status of care providers. On March 11, 2020, the World Health
Organization announced covid-19 as a pandemic and within no time
infection first discovered in china (december2019), Hubei province
reached India in January 2020. The health work force in Bihar is
struggling since then with strict regulation and legal bindings as well
as scare resources added with regular death of workers and patients
creating stress and panic. In the current year 2021 and last year 2020
healthcare workers have had a high rate of infection
hence for safety of healthcare workers it’s important to ensure that
procedures, equipment and training are fully protective. At the same
time long term, nursing, and resident care providers should have
guidance for long term care, nursing homes, assisted patient living
facilities and other resident care facilities such as ICU/covid-19 wards
for protective measures to reduce the high incidence and prevalence of
covid-19 cases and deaths of workers. Emergency services must have
critical infrastructure to be able to function properly including law
enforcement, fire and violence safety etc. This time last year in 2020
India was under lockdown phase, many theories about India’s surprisingly
low rates of Sars-CoV-2 infection included variety of factors including
hot weather, natural immunity, heard immunity, robust health system,
highly qualified doctors and the country’s high proportion of young
people; some also attributed it to the country’s harsh lockdown. India
was doing so well that in megacities like Mumbai and Delhi, officials
had begun dismantling temporary COVID-19 facilities. Comparing it to
current scenario in April 2021, cases and deaths are soaring. The
shortage of beds and space is so acute that people are dying in car
parks and other places while waiting to be admitted in hospitals. Daily
rates are currently over 300,000, the world’s highest-ever daily
infection rate. The SARS-CoV-2/COVID-19 pandemic is still going on and
globally as well as in India particularly healthcare system is
overstressed with this new burden added with previous NCD(non
communicable diseases) & CD(communicable diseases). The First human
case of this global pandemic was reported from Wuhan city of China in
December 2019. The first case of COVID-19 in India was found in January
2020. Today India is having more than 3 lakh cases per day and thousands
of deaths daily due to this pandemic. The situation is very worse as
compared to previous year and is worsening day by day due to several
factors.66https://covidscholar.org/article/608d13484e85066fbf2f1797
Objective and Goals: The key objectives and goals are to
increase safety and healthy lifestyle adoption among
healthcare workers & providers to reduce mortality and morbidity.
Creating awareness & providing training to health care
workers for infection control, protective measures, home care, long term
care, clinical care etc. The government and policy makers should ensure
making and enforcement of safety/preventive/protective
protocols to ensure safety at workplace
by reducing exposure to SARS-CoV-2 infection sources by
using PPE & WASH measures etc. The health department should provide
training for Capacity building & awareness among
healthcare workers to protect themselves & Creating awareness
particularly about good nutrition and sleep which often
remain neglected.
Establishment of Central advisory committee and research
wing at state level to keep health workers updated about latest
information and guidelines of treatment as these things are changing
continuously & almost daily with new findings. Use of reliable and
highly accredited sources such as WHO, ICMR, MoHFW, CDC , peer reviewed
publications of reputed science journals etc. for providing information
to healthcare workers can be utilized to explain basic
factsheet of covid-19 virus and disease through IEC etc., incubation
period & transmission through droplet, aerosol, contact and other
possible routes (stool etc). Risk assessment of
workplace should be carried out by analyzing various parameters
related to infection & Stepwise approach instead of
high technical letters to demonstrate steps of worker protection in real
scenario by experts giving clear description and vision on worker
protection and IPC (infection prevention and
control).Special capacity building & training of healthcare workers
involved particularly in invasive and aerosol generating
procedures to protect themselves as well as training of
healthcare workers for using PPE , respirators, ventilators etc as well
as regarding decontamination of medical and surgical equipments.
Health promotion and motivation of healthcare workers by
traditional yoga, moral and financial support as well as providing
working environment with adequate rest hours to ensure good health added
with entertainment programs to divert anxiety.