Dr Shishir Shrivastav, an alumnus of IGGMCH, was among the few critical care specialists of the 1990s in the city. After the pandemic started, Dr Shrivastav has treated over 1,000 Covid patients since the August-September first wave peak at his DCH. In this interview with TOI, he shares insights on Covid management, various crises and challenges.
Excerpts...
What is your opinion on the second wave of Covid?
This time it’s more infectious and more deadly as it is a mutant strain. Because it adapts or modifies itself to stay in a habitat so that it can survive longer and replicate more. People have become relaxed about Covid-appropriate behavior and behave as if corona is no more in existence.
What are the burning issues while treating Covid patients?
Lack of essential drugs like Remdesivir, Itolizumeb, Tocilizumeb and oxygen. Shortage of skilled healthcare personnel are the most acute issues. The number of beds and ventilators are inadequate to meet the demands of the large number of patients requiring them. Also, hundreds of distressed calls, exhausted and overworked staff and the discomfort of wearing PPEs in the hot climate increase stress levels. Then there is the fear of mass casualty due to lack of oxygen. All this is taking a toll on the mental health of the hospital staff. Adding to the woes is the big worry of family members of healthcare workers getting infected.
Why is there so much of chaos and panic regarding the shortage of Remdesivir?
I receive continuous phone calls regarding admission of Covid patients and I also get numerous calls enquiring about the availability of Remdesevir. I’m also getting patients who have taken 2 or 3 injections of Remdesivir at an exorbitant cost in desperation because they feel that this is the only drug which can save their life. I would like to state that no doubt Remdesevir is very useful as it reduces the viral load and also reduces the hospital stay but it is not a panacea for Covid. There are many factors at play. Studies conducted so far do not indicate that it has any mortality benefits. Therefore I appeal to people at large to not panic and buy Remdesivir indiscriminately and hoard it. There are other drugs too which are given to Covid patients and that Ramdesivir is the only drug is a myth.
What should be the approach in dealing with such Covid waves?
We should be two steps ahead of the virus by following strict norms of social distancing and hand hygiene practices. The government machinery as well as the healthcare industry should also be alert and in a state of preparedness for the abrupt rise of cases by increasing the infrastructure and manpower. Unfortunately, we believe in chasing the virus after the wave is on us with a vengeance due to which there is chaos all-round.
As a doctor and hospital administrator, what kind of problems are you facing?
Patients are of the younger generation. With more fulminant virus strain, they are deteriorating fast. There are many patients who require a high flow of oxygen and ventilators. Managing all hospitalised patients and making beds available for the ones who are in great distress is a herculean task where you have to triage the patients on merit basis. Relatives of patients need virtual counselling and sometimes, a one-to-one session. The cost of treatment goes up when a patient needs high-end modalities and medicines but unfortunately many of the needy patients can’t afford it.
How has Covid affected the people of Nagpur?
Covid has affected the social, physical, mental and economic health of our society. Many with non-Covid illnesses are unable to get treatment. The elderly and children are unable to enjoy social freedom and it affects them adversely. Many have died untimely leaving behind devastated family and friends. It seems like a battle with no end in sight if timely intervention with a proper strategy of rapid vaccination and strict distancing and hand washing are not implemented.
What kind of suggestions would you like to give people?
Physical distancing, don’t be a part of gatherings, avoid unnecessary outings, spend more time with your family, don’t obsess over Covid news, don’t create panic in your circle. Fight Covid by following strict protocols.
Is there any way by which the demand for beds can be reduced?
One way to utilize the bed optimally is to give early discharge as soon as the patient shows signs of improvement and needs only about 2 to 3 litres of oxygen. This may be achieved by using home oxygen concentrators or oxygen cylinders. Unfortunately, both are in short supply and thus we cannot discharge patients who could otherwise easily be managed at home and free up the bed capacity for more critical patients.