Managing workflow, healthcare facilities during Covid-19 an uphill task

COVID 19 infection is highly contagious with significant morbidity and at least 2% mortality in our populations. There are already more than 43,000 confirmed cases in the country with an extrapolation that more than 800,000 infected patients are there in the community, the majority being asymptomatic but having an equal potential to spread the disease as the symptomatic ones.

We are very close to entering the countries having reported 1000 or above deaths and the two most densely populated cities i.e. Lahore and Karachi have more than 50 % of the reported patients. Few are in a panic, the majority are concerned and quite a few are in denial. Strong negative propaganda is also circulating in the naïve masses as the disease being hoax and possibly a fabricated story.

COVID 19 pandemic has led to a major reshuffling in the psychosocial and professional mindsets of healthcare providers and all associated. After the initial recognition of the infection in the country, the numbers of infected people are steadily rising. Few of the health care professionals and a good number of people of the community have yet to realise the seriousness of the problem. Mass infections occurring in a short span of time with the majority being asymptomatic and acting as mass spreader and at least 6 % developing significant symptoms requiring admission to the health providing facilities. These numbers are good enough to challenge the available health care resources of even the developed countries not to talk of already overburdened tertiary care hospitals, tehsil and district hospitals.

In the past few years, efforts have been made to improve the workflows for optimising the patient health care delivery practices after the extensive visits by public health experts from Turkey, our brotherly country which was also plagued with similar inefficiencies until recent past. Problems were identified, solutions recommended, policies reframed but in the face of rapid reshuffling of political, administrative and technical hierarchy, the necessary resets in the systems could not be implemented.

The current colonial administrative system is against the development of institutional memory. Though tehsil and district hospitals did show some positive changes, tertiary care hospitals failed to make the necessary changes for various reasons but in the absence of institutional memories, the impact and progress of the change failed to bring the desired results. 

COVID 19 pandemic, if putting stress on the existing health delivery systems, provides us with an opportunity to remove the glitches from the system which has made the system inefficient despite the fact that majority of doctors, nurses and paramedics are dedicated, hardworking, good-natured and want to contribute positively. It is worth remembering that it is the same health care workers who become the backbone, and are admired and appreciated by health delivery systems of countries like USA, UK and EU. After the announcement of lockdown in the country and declaration of a health emergency, non-COVID services and nonessential services were shut down as per the guidelines of World Health Organization and have remained suspended up till now but after the modification from partial to smart lockdown and now no lockdown state, challenges being faced and expected to be faced by the health care deliverers remain critical. The number of patients suffering from COVID 19 disease is likely to increase and so does the number of admissions for these patients in the hospitals.

In the present community spread stage of a pandemic in the country, health care workers are working on the principles that every patient and its attendant is suffering from COVID 19 infection unless proven otherwise. These patients may be suffering from an unrelated medical ailment or an unrecognised face of the COVID 19 syndrome, which we have yet to learn.

They are likely to cause the mass spread of infection in case hospitals are reopened to ‘business as usual strategies, and scores of healthcare workers, patients suffering from unrelated ailments and plenty of innocent bystanders are likely to acquire infection and thus becoming part of an already challenging problem. As these healthcare delivery persons shall get exposed to infected people in the absence of required necessary precautions, the morale and availability of the medical-related staff is going to go down steeply.

On the other hand, after lockdown of almost 9 weeks, there are patients suffering from serious non-COVID ailments and need admissions in the hospitals for their management. Careful management is so essential to managing the workflows in the health delivery facilities in these difficult times when the judiciary, political and administrative hierarchy want to reopen the services without putting in the roadmaps for management of various facilities. The stress of opening the quarters for non-emergent and non-priority patients shall be a major negative impediment for emergent patients in the health delivery system. This provides us with the need to remove the dust from recommendations made by our Turkish brothers and avail the opportunity to make necessary amendments for improving the working environment of the hospitals, bringing safety for healthcare delivery workers and optimising the existing services while looking for more number of beds, better equipment, digitalization of hospitals systems, establishing the referral systems, instituting the telemedicine and enhanced training as a later goal. 

Specialized healthcare & Medical education department, Primary & Secondary health department and various professional societies have issued satisfactory guidelines in view of COVID 19 pandemic to ensure the protection of the workforce, provide a safe environment for the visiting or admitted patients and ensure the standards of treatment. It remains for the administrators and heads of the departments to follow the guidelines in order to make necessary amendments in their working routines, provide missing facilities and generate a safe environment for the patients as well as doctors.

Administrative hierarchy also needs to put in a monitoring system for avoidance of overcrowding ensuring the sanitation, provision of adequate personal protective equipment and ensuring the congenial working environment. ‘Pre COVID business as usual’ implementation after the withdrawal of lockdown is likely to bring a major negative impact on the maintenance of healthcare services with more chaos in the health sector and an early breakdown of current fragile equilibrium. 

The author is a Professor of Gastroenterology. He is the former principal of Lahore General Hospital. He can be reached at gntayyab@yahoo.com