Of 700 ventilators and Kashmir

March 2020: Covid cases in Kashmir were gradually getting diagnosed. A local English Daily carried a news report with a headline—“Population 7 Million, Ventilators 97, Kashmir Valley Braces for COVID-19.” With a population of 68.88 lakh, the newspaper recounted that Kashmir Valley has only 97 ventilators to help critically-ill coronavirus patients who require invasive mechanical ventilation to survive. It added that Kashmir’s premier health care institute, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), has 40 ventilators while State Hospital (SMHS) has 18 ventilators and 16 ventilators are at Chest Diseases Hospital”

Initially, during the fight against Covid-19, health experts suggested dedicating one major hospital as Covid-19 hospital and gradual referral of non-covid patients to other hospitals. The rationale behind it was to keep other remaining hospitals available for non-covid patients. However, the suggestion was not welcomed and consequently, by now, almost all major health facilities in Srinagar have fully or partially turned into Covid-19 hospitals. This has led to extensive intermixing of attendants of covid and non-covid patients, posing a potential threat of coronavirus transmission among the masses. What’s more, a considerable number of non-covid patients are badly suffering as most of the hospitals are now Covid-19 facilities.

July 2020: Many guidelines and advisories were framed, rehashed and reformed during the last few months. Enough time to brace and equip health sector to fight Covid-19. Unfortunately, although the lockdown bought time, it was not used effectively to increase capacity in the healthcare system in Kashmir. As of now, it appears that the administration has squandered the opportunity afforded by the strict lockdown. There has not been any systematic restructuring of medical provision or redeployment of healthcare staff. No makeshift hospitals equipped with a basic facility like high flow oxygen units were established. These makeshift hospitals could have been run by augmenting medical staff of various health facilities on a rotational basis. Ironically, today after four months of witnessing excessive bureaucracy, we are still waiting for 700 ventilators to arrive!

Even procuring such a sizeable number of ventilators is again a misplaced priority. Basic science says that ventilator is not any CPAP (Continuous Positive Airway Pressure) machine that can be fitted to the patient for proper breathing without having any attendant around. On the contrary, a ventilator is an artificial respiratory machine fitted to an advanced oxygen point that needs an intensive care expert, ranging from doctor to technician with specialization and training, for operating it. Besides, it at least needs a dedicated laboratory, portable X-Ray and round-the-clock monitoring by the expert staff. Its improper handling can prove fatal for the patients.

As per the news report, Kashmir in March 2020 had the expert staff to handle just 97 ventilators. Let us assume that another 100 ventilators can be handled by the existing experts. But what’s worrying is the question about the remaining 600 ventilators—what to do with them and where to install them??  Perhaps, these may be dumped somewhere to rust! An added concern is about many non-covid patients presently on ventilators. The expert staff attending them can’t be assigned duties for managing Covid-19 patients on ventilators. It can go highly hazardous.

Of course, the virus continues to beat a concerning and complex path. No definitive treatment has been identified so far. However, studies suggest that much-talked about antiviral drug Remdesivir and high flow oxygen has shown promising results when used in Covid-19 patients. Experts also suggest that high flow oxygen therapy via nose reduces the need for ventilator support.

So, rather than 700 ventilators hyperbole, the administration must focus on upgrading existing infrastructure by equipping the hospital beds with high flow oxygen units, and also stock up Remdesivir so that it can be provided free to the symptomatic patients. Further, switching over of temporary quarantine centres into makeshift hospitals and augmentation of the medical staff there must be prioritized forthwith.

Bottomline: While administration here bungled taking appropriate steps to contain the Covid-19 surge, the dangerously slack attitude of people also has been upsetting. As the surge illustrates a perplexing pattern, people are shockingly turning into so-called ‘fatalist freaks’ who brush off the emerging dreadful situation as a trifling. They are not adhering to advisories. No masks, no social distancing, and needless venturing out will prove crucial in the coming days. Sounding edgy, the worse may be yet to come. God protect us!