During the first wave of COVID-19, the most number of patients Kerala had reported on a single day was 11,755 in October 2020. The number of cases began to fall after that and the healthcare professionals, stretched to their limits, could tide over the crisis. Six months later, in the midst of a second wave, the average cases have gone up three times that of the October peak. It is now anywhere between 35,000 and 40,000 cases a day, one in four people tested turning positive. But the healthcare workers did not get multiplied in proportion. With all the hospitals reportedly serving maximum number of patients every day, there is an acute shortage of healthcare workers.
â€śWe still follow the staff pattern from 1958. Ideally in an Intensive Care Unit (ICU), the patient to nurse ratio should be 1:1 and in high dependency cases, at least 2:1. But now the ratio is about 5:1 or 10:1 â€“ one nurse to tend to five to ten patients,â€ť says Dr Binoy S, president of Kerala Government Medical College Teachers Association.
In a list of suggestions the association made to the state government, one is about hiring doctors, medical college teachers and junior doctors on a contractual basis to deal with the shortage.
â€śWe can and we do three to four peopleâ€™s work but even that would not be enough. Moreover, you canâ€™t extend a shift beyond six hours when a healthcare worker is wearing Personal Protective Equipment (PPE). It would also be a bad idea to expose doctors and nurses who are older than 50 years to the disease. When a healthcare worker falls ill, it makes the situation even worse,â€ť Dr Binoy adds.
A number of healthcare workers are testing positive for the coronavirus every day. It is not only a health risk for them, but they would also have to be kept off duty. â€śCOVID-19 beds are being increased to deal with the increasing number of cases but the staff strength is not increased accordingly. During the first wave there was clear distinction on who was on COVID-19 duty and who was not. But now a nurse on COVID-19 duty today would do non-COVID-19 work tomorrow,â€ť says T Subramanian, General Secretary, Kerala Government Nurses Association (KGNA).
Needless to say, the healthcare workers are thoroughly overburdened. â€śBut we are trying to keep a positive frame of mind since the situation canâ€™t be helped and we need to do this. We get support. We have been asking the government to hire more staff at least on a temporary basis,â€ť Subramanian adds.
People â€“ the general public â€“ have a big role to play in finding a solution to this situation, which is to exercise caution and not get ill, he says. â€śThe only way to deal with the crisis is for cases to come down. The government is working for this but people have a big role to play too. A good percent of the people testing positive do not experience difficulties and they should isolate themselves at home. Those who donâ€™t have facilities at home can be hosted at the domiciliary care centres. We need to increase the number of domiciliary care centres and the first line treatment centres where patients with mild symptoms can be accommodated,â€ť Subramanian says.
Thatâ€™s one of the demands that the Kerala Government Medical Officersâ€™ Association (KGMOA) placed before the government. â€śWe need an admission protocol in which people with mild symptoms will be isolated at home or domiciliary care centres while the hospitals can be kept aside for the seriously ill. In several hospitals this is still not the case. We had warned the government that there would be an exponential rise in cases during the second wave and the Test Positivity Rate will increase and so would the number of serious patients,â€ť says Dr Suresh TN, general secretary of the KGMOA.
Real time updation of availability of beds specifying the number of oxygen beds, ICU beds and so on, was another demand. They also asked for an urgent increase in the number of healthcare workers. â€śTwo reasons that demand it is the surge in COVID-19 patients as well as the fact that more and more healthcare workers are getting infected. During the first wave, we had a COVID brigade comprising doctors and paramedical staff. Many have left the service since. We need to fill all these positions. The government had also allowed a thousand doctors who had just completed their course for three months of COVID-19 service, during the first wave. Thatâ€™s not there now,â€ť says Dr Suresh.
He reckons that if social security measures such as insurance coverage for the infected are offered, more people will be willing to work.
A number of doctors who have co-morbidities also could not join real time service but they could instead be used for tele-consultation of patients undergoing home treatment, and in this way, save human resources, Dr Suresh adds.
As of now, there are about 7,000 doctors in government service (excluding in medical colleges) including those in administrative work. And there are more than three lakh active cases.