We must be ever ready for pandemics

By Dr R Neerunjun Gopee

Next Pandemics 1 – Pic – University of San Francisco

The cumulative number of deaths due to Covid-19 that have occurred in Mauritius stands at 786 on February 1. What is noteworthy is the rapid increase between October to December 2021, extending to January 2022 though it has slowed down. As is known already, this surge was associated with the Delta variant which swept the world and caused similar upshots in total cases and deaths in all countries. This, however, is neither cause for pretext nor complacency. In a certain number of deaths, no doubt co-morbidities contributed, but when we consider the relative number of deaths in younger patients without any other contributory factor, we have to deepen our analysis. Because for the health and medical professional, every death resulting from a preventable and potentially treatable infection is one too many.

The question we have to ask ourselves is, therefore: could we have done better? If so, how? This number of deaths in such a short time should be a matter of grave concern to all clinicians, both nurses and doctors, who were and are directly involved in the care of such patients. At this stage, it is immaterial to us whether these patients did or did not abide by the sanitary precautions. When the patient presents to us suffering from the infection, we are not to judge their conduct: our sole focus at this stage – like for all acute cases, for example road accident victims – is how to best treat the disease and to save life. Especially for doctors, if we do not do that, we would be failing in our duty.

Under normal circumstances we proceed according to our established best practices. However, when an epidemic strikes, we are overwhelmed, and have to shift focus and rapidly learn the newer ‘best practices’ which keep changing or evolving according to latest studies based on limited data available. We are thus on a new, continuous learning curve and have to quickly adopt and adapt – otherwise our patients may perish. That is the burden of heightened responsibility that such an acute situation places on all of us, and fulfilling it successfully perforce has to be based on strengthened collaboration and cooperation by pooling together and sharing knowledge and findings.

When I started to write this article, I titled it ‘We must be ready for future pandemics.’ On second thoughts I told myself that given the rapidity of global spread of infection as Covid-19 has demonstrated, and the probability of mutants equally rapidly emerging – and not only coronavirus – it looks ever more likely that we may well be in continuous pandemic mode for an indeterminate period of time, if not permanently from now on. So just as we have a well-established standard procedure to deal with any cyclone which we accept as a ‘normal’ even if infrequent occurrence, so too must we be ever prepared and ready to deal with this pandemic ‘new normal’ – and hence the changed title.

In the Australian online publication,The ConversationofJanuary 27, 2022, there’s an article by Michelle Grattan, Professorial Fellow, University of Canberra: ‘A royal commission into Covid’s handling would serve us well for the future.’She writes, ‘This month about as many people have died with Covid in Australia – more than 1000 – as die in the whole of a bad year from influenza. On a seven-day average, we are now seeing more than 60 deaths every day, with no sign yet of a decline. Lessons from the UK and US are that without effective controls we may settle on a high baseline toll beyond the Omicron peak that is not much below this.’

And the telling comment that follows is: ‘Yet as deaths suddenly spiked in the last few weeks, attention on them doesn’t seem to have spiked proportionately.’

Further, ‘On various fronts, Australia’s journey through Omicron has not been managed effectively, which reinforces the already strong argument for a royal commission into how the pandemic in general has been handled.’

And more: ‘…the case for a commission is overwhelming, especially to inform us about what needs to be done to ready for pandemics in the future. It is needed to investigate all fronts: health, economics and governance.’ (bold added in both paragraphs)

However, there have been some criticisms about the idea of setting up a royal commission, as one commentator underlined: ‘… the usefulness of RCs are dependent upon willingness to implement recommendations which is entirely dependent upon political will. Again, politics is the reason for failure and thus it will always be.’

Unfortunately, it would seem that the same mindset prevails across countries at political level about implementing the recommendations of commissions of enquiry, royal or non-royal.

But as far as we clinicians are concerned, we don’t need to go down this road. There are already well-established procedures of clinical audit – which in any case we keep doing subconsciously when we review our own cases at individual level, trying to make out where there may have been gaps in management and what to do to avoid them in future cases.

In the case of the Covid-deaths, especially those that took place at the ENT Hospital, everyone who has been involved in one way or the other that I have spoken too has said that there were systemic deficiencies that needed to be addressed: number of personnel (in particular nursing), training requirements in particular the total lack of intensivists, adequacy and continuity of monitoring of oxygen levels, faulty ventilators that therefore reduced availability to only the ten existing ‘McKay’ ones, the management of patients on ventilators, specialists working in silos rather than in coordination, lack of proper guidelines about the roles of each level and category of personnel (Who does What) – these have been major issues of worry and concern which need to be urgently addressed.

What is required is for a team of clinicians, comprising both nursing and medical staff to be put together by the DG Health Services and the Chief Nursing Officer, to carry out a structured clinical audit of practices and procedures at the ENT Hospital ICU, followed by making prompt and actionable recommendations. This is not rocket science, and can be completed within a week. I am absolutely certain that there is enough local experience and expertise to carry out such an exercise, with quick results to follow so that we don’t have to lament more deaths and save more lives.

As health professionals, we owe it to our fellow citizens. Such an enquiry, unlike commissions, is not about witch-hunting or playing the blame-game. It is a dispassionate, scientific exercise with the welfare and life of the patient as its sole and unique focus. No more time should be wasted if we do not want another surge in deaths.

* Published in print edition on 4 February 2022