British Prime Minister Boris Johnson’s fulsome praise for the U.K.’s National Health Service (NHS) for his treatment for COVID-19 , has raised the profile of the public-funded healthcare service. A senior member of the NHS and alumnus of the Madras Medical College Pala B. Rajesh details the protocols to combat the pandemic.
How helpful is a lockdown in containing the spread of the infection?
Any decision that has been made thus far, regarding this unprecedented epidemic has been binary. Public safety and economic backlash have been the two considerations. In the United Kingdom, we took a decision in late March that the lockdown would be total and we would have a review it in three weeks. Public health experts have recommended the three week lockdown based on the experience of China, Italy, Spain and Singapore.
What we follow here is quite simple. Step 1: If you have fever, cough, muscle pain, stay at home. A high viral load usually lasts five days, but you may get a second peak- which is why we recommend the two-week isolation period. You may feel well in a week but please do not go out. If any one was in quarantine with you, your family, this applies to them as well. Step 2: If you are still ill, go to a hospital. In the NHS, you will be tested for coronavirus (COVID-19).
What about non-COVID treatments/surgeries?
Hospitals in the U.K. have a primary triage in place — COVID-19 and Non-COVID-19 sections. I know there is opinion in India that elective surgeries must be stopped. I both agree, and disagree. In the U.K., since the outbreak, we have prioritised surgeries as per the level. There are priority levels 1, 2, 3 and 4.
Priority level 1 is divided into emergency (Surgery must be done within 24 hours), and urgent (surgery in 72 hours); in Level 2, patients can wait for up to four weeks; in Level 3, the surgery can be delayed for three months, and Level 4 comprises of people whose surgery can be delayed for over three months.
Every speciality has been given guidelines as to what constitutes an emergency.
Every hospital in the U.K. has ensured a few operation theatres remain reserved for non-COVID-19 surgeries. The rest of the theatres have become extensions of intensive care units
COVID-19 theatres have intensive care specialists, anaethetists and general medicine practitioners. But at the moment, we have not been overwhelmed in our hospitals, possibly because 90% of the population has been following the lockdown.
India has done very well with the lockdown as well. There is infrastructure in place — both Central and State government health systems. Perhaps, the government may think of farming out non-COVID-19 patients to the private sector, as has been done in Assam, according to experts there.
What about treatment options for COVID-19?
We are collecting a lot of pre-publication material. At the moment, whatever we are doing is speculative measures taken by each group in their circumstances. In the U.K., we have begun to use hydroxychloroquine with antibiotics on a trial basis, of course, because frankly, we don’t know yet what exactly will work.
Meanwhile, BCG seems to offer some kind of protection mechanism.
But in the U.K., we are mainly offering supportive treatments. One thing that is appreciable during this pandemic is that everyone is freely exchanging information, so that other nations do not make the same mistakes.
In U.K., we seem to be on the upward crest of the curve; and experts are saying we should remain there for a couple of weeks. We will know the effect of the lockdown in a week’s time. So far, we have been recording only the COVID-19 deaths, but there may be others who do not come into hospital. The assumption now is that everyone is COVID-19 positive unless he or she tests negative.
We have reports from America of the particular vulnerability of African American people. Are you seeing some thing similar in the U.K.?
What we are noticing, however, is a certain predilection among doctors from overseas working here. There have been 39 deaths among NHS doctors and nurses so far in the epidemic. These include people from India, Pakistan, Sudan and Egypt, for instance.
COVID-19, I’m sure, will remain in the community, like perhaps dengue or chikungunya. It will raise it’s head during winters in this country. Once a vaccine is ready, recommendations may be made for vulnerable populations, including senior citizens.
