[vivek95]

Being a Doctor myself ( I am still a junior doctor by the way ) I am totally confused with these rising instances of private hospitals being forced to shut down across the metros in our country, especially Mumbai. I am trying to dig the internet hard to understand and extract information on how the worst hit first world countries across the globe are dealing with this crisis, but to no avail. Request members in the forum to help me out by pointing out to such articles or news reports.

Is shutting down a hospital really an appropriate way amidst this crisis or this is yet another knee--jerk reaction by the local administration ??

I mean come on, keep Covid aside, what if a routine Stroke or MI patient doesn't get the necessary medical treatment on time ?? These salvageable patients will die like cockroaches or end up being paralytic and bed ridden for the rest of their life just because the nearest tertiary care hospital in the neighbourhood is shut down

An ischemic Stroke patient for example has high chances of good recovery as long as thrombolytic therapy or a mechanical thrombectomy is initiated early. Time is neurons in such a situation. A person loses 2 million neurons per minute. Now, lets assume such a patient contracts Covid-19 within the hospital. But the timely institution of an appropriate medical or surgical treatment could also well prevent the mortality and morbidity. So, why not weigh the risk-benefit ratio and parallely treat such patients ?? Ofcourse, there is risk of getting backfired by the general public and facing legal issues. General public is anyhow not co-operative towards Doctors and hospitals these days.

But are we focussing too much on Covid-19 and its spread and thereby denying standard medical care for the other emergency clinical conditions with established treatment protocols ?? Should these patients be let to die or heap a lifetime of severe morbidity in a pandemic situation like this ??

If Covid-19 is passing down as a mild to moderate illness in 80% of the patients, then why not take a chance. What is shutting down of hospitals achieving after all ?? How did other countries handle this ??


Kindly enlighten me.

--Dr. Vivek

[The Rationalist]

^^^ There’s always a collateral damage in such scenarios. Most hospitals are already running with the bare minimum staff, and now Corona has caused havoc. You can’t churn doctors out like machines in crisis situations. You would need to decide who gets the treatment. You may have to choose between a below 60 year old Corona patient and above 70 year old patient with Myocardial infarction or stroke, or when faced with two corona patients needing Ventilator support, one tend to offer that to the younger patient.

We are living in extremely difficult times. My friend in Newyork is dealing with 85 patients on Invasive ventilator and many patients are being denied ventilatory support. In UK my junior has people above 70 being taken care in Acute care wards instead of ICU’s and many won’t be given a chance to get life supporting treatment. You have to be pragmatic, this is not the time for unrealistic and unreasonable measures.

[V.Narayan]

Originally Posted by vivek95

….I am totally confused with these rising instances of private hospitals being forced to shut down across the metros in our country, especially Mumbai.

Is shutting down a hospital really an appropriate way amidst this crisis or this is yet another knee--jerk reaction by the local administration ??

But are we focussing too much on Covid-19 and its spread and thereby denying standard medical care for the other emergency clinical conditions with established treatment protocols ?? Should these patients be let to die or heap a lifetime of severe morbidity in a pandemic situation like this ??

If Covid-19 is passing down as a mild to moderate illness in 80% of the patients, then why not take a chance. What is shutting down of hospitals achieving after all ?? How did other countries handle this ??

Agree with you. This seems to be happening only in Mumbai. Seems like a knee jerk reaction by the administration which is in a grip of panic. The doctors and nurses who tested positive for Covid-19 need not have contacted the infection at the hospital. That could happen anywhere. Shutting down medical capacity when it is needed most seems counter intuitive.

[poloman]

Dr Vivek,
The general public is not very clear either. A few observations from my side.

1) In private hospitals who is responsible for the safety of doctors and nurses? Who is supposed to provide them the PPE kits? 56 staff including 26 nurses of Wockhardt hospital were tested positive for the virus.

2) One elderly lady died in my apartment due to cardiac arrest. She had a heart surgery and some post operative infection. Due to that she had a history of fever. Due to this no hospital was willing to certify her cause of death neither conduct post mortem due to lack of PPE. This in big Govt hospitals in Bangalore which had seen a history of only around 75 total cases Finally a doctor resident of the apartment issued the letter and was cremated after 15 hours.

3) How many private hospitals are operating normally anyway. There are news of normal patients not getting proper treatments in the lock down. Again due to lack of PPE. This is confirmed by a doctor himself. They don't want to risk their lives. Though the concern is genuine, public is in huge trouble due to this.

The doctors and nurses who tested positive for Covid-19 need not have contacted the infection at the hospital. That could happen anywhere.

Don't you think this is too far fetched? 56 people working in a hospital catching infection elsewhere.

[carboy]

Originally Posted by vivek95

I mean come on, keep Covid aside, what if a routine Stroke or MI patient doesn't get the necessary medical treatment on time?

Forget hospitals, a lot of the clinics are also shutdown voluntarily. In my colony, both the independent clinics are shut even though my colony hasn't yet reported a single case - I guess the doctors don't want to risk themselves - I don't blame them. One of my neighbours had not some pain issue & had to travel 3 kms to find a doctor whereas normally he would have walked to one of the clinics.

The medical shops in my colony haven't restocked medication since the time lockdown started. Because the distributors even if they are working don't have enough people to send to medical shops & medical shops don't have people to go and fetch medication from different distributors. Till now they were saying that they will restock after 14th. Now it's extended I don't know what they are planning to do. This lockdown is going to end up with many non-corona causalities also - because of medical issues & also hunger.

[Chetan_Rao]

Originally Posted by vivek95

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Is shutting down a hospital really an appropriate way amidst this crisis or this is yet another knee-jerk reaction by the local administration?

Of course, there is risk of getting backfired by the general public and facing legal issues. General public is anyhow not co-operative towards Doctors and hospitals these days.

But are we focussing too much on Covid-19 and its spread and thereby denying standard medical care for the other emergency clinical conditions with established treatment protocols? Should these patients be let to die or heap a lifetime of severe morbidity in a pandemic situation like this?

Doc, I want to preface this with two things:

1. Thank you to you personally, and your fraternity for being the silent heroes of the situation.

2. I don't envy anyone in a decision-making position right now, small or big. There are no perfect solutions, and each path taken brings its own unsavory possibilities, and I'm acutely aware of the burden of such responsibilty.

That said, the whole situation is a microcosm of the larger response to the virus. Containment is critical and necessary, but we need to balance that against the possibility of potentially kicking off a parallel public health crisis, as is slowly beginning to unfold. Ironically, that would defeat the whole purpose of containment to begin with.

We need hospitals to care for other issues that exist, may arise or get worse. Depleting local medical supplies that aren't being replenished due to logistics issues is another major problem in the making. Diabetics who rely on daily meds and insulin injections (like my late grandmother was) are just one example, several other possibilities that can be mitigated if attended early but can go downhill fast, if not, like you mentioned.

One the whole, we need to be very careful that our mindsets don't shift from 'containment needed to buy time to find solutions' to 'containment is the solution', because the latter offers short-term safety but is a false one, in and of itself.

The much-maligned 'What about the economy?' question can and will soon become 'What about others with medical needs?', and we won't be able to hand-wave it away with 'life over livelihood' slogans, because it will be life on either side of the scale. Try as we might, we don't have the time or the resources to create enough medical supplies, healthcare professionals and the ecosystem needed to entirely cover the worst-case scenario, so we'll need to lay down a marker at some point and get moving with what we've got and create more resources in parallel.

A COVID-19 induced national paralysis can still cause a lot of harm to lives left untouched directly by it, and our sole focus on the virus is blinding us to it, for now.

[speedmiester]

New studies are suggesting that the virus affects the red blood cells ability to carry oxygen by inhibiting hemoglobin. Partly why Hydroxychloroquine is effective as a treatment as this compound is used to treat Malaria which again affects the red blood cells.

Coronavirus treatment needs a rethink; and why Hydroxychloroquine matters

[wheelguy]

Originally Posted by vivek95

Being a Doctor myself ( I am still a junior doctor by the way ) I am totally confused with these rising instances of private hospitals being forced to shut down across the metros in our country, especially Mumbai. I am trying to dig the internet hard to understand and extract information on how the worst hit first world countries across the globe are dealing with this crisis, but to no avail. Request members in the forum to help me out by pointing out to such articles or news reports.

Is shutting down a hospital really an appropriate way amidst this crisis or this is yet another knee--jerk reaction by the local administration ??

I mean come on, keep Covid aside, what if a routine Stroke or MI patient doesn't get the necessary medical treatment on time ?? These salvageable patients will die like cockroaches or end up being paralytic and bed ridden for the rest of their life just because the nearest tertiary care hospital in the neighbourhood is shut down

Doc, what you said is absolutely true. Don't know why were they shutting down few private hospitals and clinics. Just few hours back got a call from a friend of mine that one of our friend's father passed away. He was a heart patient, he was previously hospitalized and recovered, but this time, sadly due lack of immediate medical care he passed away. There are better chances that he would have survived if it's not for the closure of hospitals.

[Guna]

Originally Posted by vivek95

I mean come on, keep Covid aside, what if a routine Stroke or MI patient doesn't get the necessary medical treatment on time ?? These salvageable patients will die like cockroaches or end up being paralytic and bed ridden for the rest of their life just because the nearest tertiary care hospital in the neighbourhood is shut down

Intention of the government must be to discourage the routine consultation but they shouldn't shut down the entire clinic/hospital so that the emergency or other critical cases do not suffer.

[Miyata]

Originally Posted by vivek95

Is shutting down a hospital really an appropriate way amidst this crisis or this is yet another knee--jerk reaction by the local administration ??

Appears to me that local authorities have taken hints and notes from the national authorities!

What measures do we take to limit the covid - a lockdown (of hospital); quarantine (the entire hospital); seal off (the hospital)!

National authorities could have set better example by - better widespread testing; offering protective equipment to the medical fraternity in a timely manner; better tracing of the infection and potential path it has taken; And then or simultaneously work on lockdown / quarantine / seal-off.

Hopefully we'll be better prepared for the next epidemic / pandemic. We like to learn our lessons the hard way, if at all we ever do!

[sunilch]

Originally Posted by V.Narayan

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Originally Posted by The Rationalist

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Originally Posted by vivek95

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Originally Posted by speedmiester

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The two private Mumbai hospitals that are in media for being quarantined (attention, no closed or sealed) are in such a state so as to protect them and also for them to get back to full ability ASAP.

Also, it is confirmed from a doctor friend of mine that Jaslok is not under full quarantine. It is operational and section of it is totally under quarantine as a large number of staff got infected. But there are patients who are admitted there having CoVid-19 and are recovering. They may not be able to admit new patients (any issue) due to lack of beds but the hospital is operational at reduced capacity.

All hospitals are operational at reduced capacity due to either lack of staff, including doctors (a few have decided to not to come unless it is an emergency needing them) and also to prevent spread of the virus to other patients who may have other conditions but are vulnerable to this virus. Many doctors are doing either online or phone consultations.

But yes, there is a high risk for all those who have some condition already and they may not get good medical care in time of crisis. My father had a surgery scheduled this week but we had to move it to May after consultation with the doctor as he said that it is a bit unsafe for now to bring him to the hospital for surgery due to this virus scare. My both parents are on immuno-suppressants and hence I am myself not confident of taking them anywhere - be it a hospital or a clinic. The doctor (physician) who died in Indore after contracting the virus was known to us :(

But yes, the situation with local clinics is alarming for sure. All of local clinics in my area too are closed since March 22. They should be operational for half duration at-least.

[nandadevieast]

Some big names, like Breach Candy, Hinduja, Sushrusha, Wockhardt, Jaslok, Nair and few others perhaps. I do not remember a similar event anywhere else in India or abroad. I understand that not all have been sealed off but the infections have been said to occur in multiple hospitals simultaneously. I find it strange that something like this can happen to such big and reputed healthcare businesses just like that. Difficult times.

[paragsachania]

It always feels good to hear positive stories like these, this time a baby from Coastal Karnataka:

10-Month-Old Baby From Dakshina Kannada Discharged

The 10-month-old baby, the youngest Covid-19 patient in the state, has fully recovered and discharged from hospital. The baby from Sajipanadu and was suffering from severe accurate respiratory illness and was admitted to a hospital.

[mvadg]

Originally Posted by vivek95

Being a Doctor myself ( I am still a junior doctor by the way ) I am totally confused with these rising instances of private hospitals being forced to shut down across ...

Blasphemy! Coming from a doctor! You will be accused of going against your own. But you are right. I have often wondered, how we could seal ourselves against a virus, if we can't even keep mosquitoes away with nets, sprays, lotions and potions. It requires just one mistake, and given how we humans are built, nature is not worried about us surviving as individuals, only barely as a species. The final and only guard against the virus is our immune system.

Given that I'm only human, I've already despaired of doing household chores without the maid around; constantly washing my hands and realizing that inspite of my best efforts I'm touching my face after unconsciously touching something that could have viruses on them (newspaper, goods from the store...); breathing in virus containing aerosols that I can't even see. And I'm someone trying to avoid the virus. Must be worse with other humans who are not even trying!
I'm predicting an early end to this war with the virus completing its job, despite all the hurdles we've put in its way - what a great employee it would make! It will spread nearly to every human very soon and each on of us will either survive or not. A timely vaccine or cure is the only antidote. Avoiding the virus is futile, but lets do something, so we feel better about ourselves as "intelligent" animals.

[skdking]

Originally Posted by sunilch

The two private Mumbai hospitals that are in media for being quarantined (attention, no closed or sealed) are in such a state so as to protect them and also for them to get back to full ability ASAP.

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But yes, the situation with local clinics is alarming for sure. All of local clinics in my area too are closed since March 22. They should be operational for half duration at-least.

Very well articulated. The parts of the hospitals that come into contact with the virus must not become tertiary source of virus. People come to hospitals for succour. Some restrictions are necessary.

In our impatience we must think of the have nots. A few weeks of self done maid work will keep both us and maid safe. Let us avoid being selfish.