The Nepalese Society of Critical Care Medicine is providing a three-day intensive care training from Wednesday to doctors and nurses recently hired by the government for the treatment of Covid-19 patients.
The Ministry of Health and Population has hired 45 nurses—41 staff nurses and 4 nursing officers and 28 doctors, who had recently graduated from Patan Academy of Health Sciences—to deploy them in intensive care units where necessary.
“We can mobilise them in the intensive care units of hospitals designated for coronavirus treatment across the country.” Dr Yadu Chandra Ghimire, director at the National Health Training Center, under the Department of Health Services, told the Post. “We are also mulling to reduce three month’s intensive care training of nurses to 14 days—seven days online course and seven days’ practical training.”
Meanwhile, works to extend the intensive care unit are taking place in full swing in Sukraraj Tropical and Infectious Disease Hospital and other health facilities, as the government has decided to set up 120 ICU beds in hospitals of Kathmandu Valley to treat Covid-19 patients. Workers and technicians are breaking the walls of the hospitals to create spaces.
Public health experts, however, say that the government is lost and out of focus when it comes to the preparedness for the possible outbreak of the coronavirus infection.
“Instead of focusing on setting up and extension of intensive care units, the government should focus on management of patients infected with coronavirus,” a doctor at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “Only very few people, who need ventilator support will survive. ”
Survival rate of patients suffering from acute respiratory distress syndrome who need ventilators is only 30 to 40 percent even in developed countries, which have state-of-the-art technologies, the doctor said.
Dr Subhash Prasad Acharya, chief of the critical care department at the Tribhuvan University Teaching Hospital, says it takes years of rigorous training and experience for doctors and nurses to manage critical care.
“The newly trained doctors and nurses won’t be able to run the intensive care units on their own. Still, something is better than nothing,” Acharya said about the government’s plan to train medical staff for critical care in three days.
Acharya will be coordinating the training which will be held in Grande International Hospital and Hams Hospital.
Patients with acute respiratory distress syndrome need special care and only TU Teaching Hospital, Grande International Hospital, Nepal Mediciti Hospital, Hams Hospital and Om Hospital have the experienced staff and resources to look after them.
“What the government has comprehended is a few beds and ventilators are enough to set up an ICU, which is wrong. It takes five to six MD doctors and 15 to 16 nurses trained in critical care to manage a critical care unit. Such levels of preparations are not possible in the present context,” Acharya told the Post.
Doctors say government attention should be in case detection, isolation, contract tracing management of the positive cases.
The government has been unable to provide safety gear to health workers. Hospitals designated for treatment of coronavirus have complained that protective gear they received was only enough to last them for a week when the Covid-19 crisis is likely to last for months.
At this time safety and management of health workers should also be paramount, Acharya said.
“We can take lessons from Italy. Cases will reach 500 from five and 5,000 from 500 if health workers are not safe and have to be put in quarantine,” he said.
The Nepalese Society of Critical Care Medicine had submitted a list of 150 certified nurses trained to work in critical care and asked the Health Ministry to contact them if necessary. However, the ministry has not contacted any one of them and has instead decided to hire fresh graduates.
A member of the society said that the Health Ministry has hired nurses for three months taking undue advantage of their unemployment.
“Sending them to treat Covid-19 with three days of training will be tantamount to a death sentence,” the doctor told the Post.
The government has also asked private hospitals to make isolation wards and allocate beds in intensive care units, which is almost impossible, as entire wards have to be vacated if Covid-19 patients have to be treated there. Then there is also the risk of the disease transmitting in other patients and hospital staff.
Hem Raj Paneru, general secretary of the society, says since only a few patients infected with coronavirus need intensive care and ventilator aid, the government should be more focused on case management instead.
“We have given some suggestions in writing but we do not know if they were taken seriously,” he told the Post.
The society had suggested the government designate hospitals that would exclusively treat Covid-19 patients.
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19? Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19? Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from? The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territoriesaround the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe? The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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