These are unprecedented times. We are worried, confused an. Distressed. The world is struggling to copewith the COVID 19 pandemic. There is no health system in the world which canface the wrath of this unseen force. More than 700, 000 are already infectedand about 32, 000 deaths already and the numbers are increasing day by day. Thewhole world has come to standstill, economies are crashing, people losinglivelihoods, and in some places, chaos is already setting in. Lots of rumours,misinformation, fake news, and conspiracy theories, are making rounds. Mankindis at war with itself. Countries which have far advanced health systems andresources like the USA, Italy, the UK, and Iran are finding it hard to provideappropriate treatment to everyone. What should we do in a place where there ishardly any system and a makeshift administration? In times of such chaos, youneed a leader who people trust and listen to. We don’t have that either.
We need to be realistic. The health infrastructure, number of doctors,nurses and other allied staff is nil to nothing when we look at the magnitudeof this pandemic. We cannot build hospitals like China did and even if we getsome ventilators, there are no intensive care facilities in most districts andwho will operate them when we do not have any trained nurses or paramedicsavailable. The things are more complex with COVID 19. Usually first port ofcall is a doctor or hospital when we become unwell. Here if you go to thehospital, you can spread it to others including the healthcare staff. There isno evidence that going to the hospital will help even if you are testedpositive. For those who do become severely unwell and need oxygen andventilator support, the prognosis is poor. In our setting, with a dearth of nursingcare, usually, families stay in the hospital, feed, nurse and buy medicationsfrom the market. But here family members are likely to be infected if notsymptomatic and if not already infected, a hospital stay with an unwell patientwill infect them. This raises the question over who will nurse COVID 19patients as there are not enough nurses to do that job in Kashmir valley.
The authorities have just focused on testing and tracing peoplewho had travelled from outside state and this went to the level of propaganda,creating fear and worsening preexisting stigma. Many people did not comeforward with a travel history and those put in so called quarantine, fledciting justifiable reasons like lack of basic hygiene and putting dozens ofpeople in the same room that feared likely to get infected from eachother. Even entire extended families ofpatients who died because of COVID 19 are being put under alleged quarantine.This is not only inhumane but hardly based on any scientific facts. Even insuch pandemics, people will need to grieve their dead.
Overall no one seems to be in-charge. One could have thoughteither director health services or some other senior specialist from the publichealth or community medicine will take the lead. Here we have differentofficials from the administration trying to overdo each other without anystrategy. Demonizing people, talking them down and then chasing them likecriminals is not going to help. There is no focus on education; informationsharing and making sure people don’t get inundated by rumours through WhatsAppgroups only. Can one fight a pandemic using the decades’ old strategy ofmanaging a political conflict with force? No.
What can be done?
It is time to be realistic keeping in view the infrastructure,healthcare staff and magnitude of the pandemic which is only going to getworse. Everyone cannot be tested or treated in a hospital. The virus hasalready spread in the community and just focusing on anyone with a history oftravel is not going to work. About 50 percent infected do not show any symptomsbut are contagious and carry on infecting others. About 80% only have mildsymptoms. So it is the asymptomatic people walking around you who are spreadingit as we speak. Everyone cannot be put in quarantine or hospital and if weassume only 4 million will get infected out of 8 million; there is no way ofmanaging this pandemic in the hospital setting. If people are educated and informed with clear guidelines, most can stayhome if having mild to moderate symptoms of cough, fever, malaise and othersymptoms. It is ideal to test people to reduce contact and stress on selfisolation in homes, but are there enough resources to do mass testing.
Training and educating faith healers, peers, imams, and teachersand then using them to propagate the message at the grassroots level. Socialdistancing and self isolation is key to break the chain. We know the elderlyand those with co-morbid medical conditions are vulnerable. We have to buy timeand protect the vulnerable in a hope that some treatment or vaccine may beavailable in the near future.
The healthcare staff and doctors need personal protectiveequipment (PPE), otherwise we many lose may of them to illness and even deathand if that happens, we cannot deal with the pandemic for even few weeks. It isnot enough to call them god or bang plats for them unless there is aninvestment in healthcare and that needs to be done now. Just focusing on buyingnew ventilators would hardly make any difference if the healthcare staff is notprotected in first place. The administration needs to move on from the attitudeof a police state to one of supportive to doctors, rather than harassing themon the streets and beat them if they try to reach hospitals.
Finally, people need to take responsibility. In this age, there isno dearth of information. As Camus writes in his famous book Plague, ‘What’strue of all the evils in the world is true of plague as well. It helps men torise above themselves’, and I am sure we will overcome this current age plagueand be human again. Do not rely on hospitals, doctors, peers, it is your lifeand only you can protect it for now by staying in your homes and following therules.
The author is a consultant psychiatrist and health advocate.