Keep Calm and Receive
–Dr Mallika Fonseca
Grant Government Medical College, Mumbai
Another senior citizen with a sniffle. Another hypochondriac probably here just to escape the dreariness of a winter alone at home. Another case of a cold and fever, a standard upper respiratory infection. With an outlook as grey as the dull December sky outside, he proceeded to consult. But it wasn’t just another case of the winter blues. With every passing day, they came in droves. And those who were already ill, just seemed to get worse. A ward full of patients with pneumonia, an outpatient department with patients halfway there. This winter’s flu was proving to be more difficult than he thought.
That’s when he heard the news. It was no ordinary flu. Identified in a town less than a 100 km away, this seemingly innocuous URTI was causing an unprecedented number of fatalitiesfrom pneumonia and spreading like wildfire.
90 infected cases on the 9th of the month. 200 on the 22nd. 2700 on the 27th.
In a matter of days, he would be battling for his own life.
As first line doctors standing at the front lines of epidemics, would we have any idea of what to do when faced with a situation like this doctor from China?
Panic mongers a myriad of questions- Is this a highly infectious disease? Is it likely to become an epidemic? How do we diagnose it? Do we isolate? Do we transfer? When a well-oiled machine like the People’s republic of China struggles to control a viral fever, it’s proof that it’s no mean feat to deal will a monster of such epic proportions.
And SO MUCH is liable to go wrong!
Most of us are barely trained to deal with epidemics of such proportions. In developed countries, training programs and government handouts, self-quarantine and drive-through diagnostic centres streamline the management of such crises. However, in developing countries, when such a reality seems miles away until it hits, when training for hypothetical situations is considered a waste of time and resources are scarce on the ground, what CAN bedone? Well, the answer is deceptively simple. Keep calm and be receptive. Not to the disease, but to all the other challenges it brings.
Firstly- Be alert. Multiple patients coming in with similar symptoms? A fatality rate or morbidity disproportionate to a commonly diagnosed disease? It all comes down to something a senior professor once told me- “If you feel a tingling feeling that something is going wrong, it probably is.” In a country like ours, with the patient load we face and the extent of pressure junior doctors are under, it seems easy to overlook such things. Clinical intuition is numbed by sheer workload. But it’s an essential skill to keep in touch with that ‘tingling feeling’- a survival instinct of sorts.
Once we sense something is wrong, our work is cut out for us. Some essentials that we all know through long hours of community medicine lectures include the importance of taking standard precautions. A simple mask and gloves, handwashing and appropriate use of sanitizers can go a long way. Other essentials include surveillance and reporting, contact tracing and proper coordination and communication both between healthcare workers as well as between HCW’s and their patients.
A very important factor to consider is that of ‘Infodemics’. This can be defined as the rapid spread of information of all kinds, including rumours, gossip and unreliable information. They are spread instantly and internationally through the growing popular use of mobile phones, social media, the internet and other communication technologies. A proliferation of web-based “experts” with diverse and often contradictory views can generate confusion, anxiety and even panic in times of serious infectious outbreaks. Our job as primary healthcare providers is to make sure such a spread of misinformation is curtailed. We are also responsible for preventing stigma and discrimination of people suspected of or diagnosed with the disease. If people are calm and controlled, and do not subscribe to mass hysteria, half our work is cut out for us.
Finally, what are the advantages of having a properly defined health protocol set out? Proper spread of information by both healthcare workers and government institutions can help calm public hysteria and promote a certain sense of security among people. Take for example, the stellar measures set out by 2 health departments- that of the NHS in the UK, and our very own health department in Kerala. The layman needs to have a sense of confidence that his country and his doctors are under control of the situation. For after all, as most of us have learnt through experience, a large share of therapy lies within the patient’s own mind. Believing that everything is under control, having faith in the medical system and a peacefulpositive outlook are, as yet, our greatest weapons in the arsenal against uncontrolled epidemics.
References and source of images:
WHO Handbook: Managing Epidemics; Published May 2018. https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf