Trained ICU staff crucial in days ahead, say experts

With more health workers getting infected, govt. asked to conduct sero survey on them

A health worker using a nucleic acid extraction machine at the Manjeri Medical College.

With the COVID-19 curve in Kerala set to scale the peak, there is mounting demand to take up appropriate public health interventions to see through the next two months when cases will surge, overwhelming hospitals and testing the capacity and resilience of health systems.

“At this stage of the pandemic, testing more and more people will not give the State any incremental advantage in containing the pandemic. As it is, laboratories are straining to handle the current volume of nearly 50,000 tests a day. The most crucial requirement in the next few months would be human resource, especially trained staff to run ICUs, which are slowly filling up. On a war footing, we need to induct more health staff for ICU care after giving them a crash course in critical care and ICU management,” says K.P. Aravindan, senior public health expert.

“The State has managed to hold up so far because the proportion of people becoming critically ill and reaching ICUs has been less. But this situation will change dramatically and everything will boil down to oxygen, ICU beds, and human resource. Having more ICUs or ventilators would help only if we have a constant supply of adequately trained health personnel,” says S.S. Santhoshkumar, who has first-hand experience of working in a COVID ICU in Mumbai.

1,337 infected in Sept.

However, health-care workers have been increasingly getting infected in the past two months — the number till July 31 was 564. In August alone, the number was 1,062. Between September 1 and 22, the personnel affected was 1,337.

Now that community transmission is rampant, all hospitals, public and private, have become extremely vulnerable and cross-infections have resulted in many institutional clusters. Every time one health worker is affected, several others who are the primary contacts are also forced to go into quarantine.

Prior exposure

“A key strategy ahead would be to conduct a sero-prevalence study among the health staff so that we can determine the proportion exposed to the SARS-CoV-2 virus. While antibody detection is no assurance of long-term protective immunity against COVID-19, those with prior exposure would be less vulnerable to infection. With adequate protection, it would be relatively safer to engage them on the front lines,” Dr. Aravindan says.

Monitoring the prevalence of prior infection among them will also help identify how the disease spreads inside hospitals and particularly high-risk departments, plan human resource redeployment better, and avoid unnecessary quarantines.

Also, the Health Department should now encourage all districts to opt for home isolation and care of all asymptomatic and mild cases so that there is less pressure on first-line treatment centres.