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Key Learnings from the COVID Resurge -Putting Healthcare First and Ramping Up Resources: Recommended Action Points to Handle Such Pandemics in Future

Authors:
  • Dr Varsha's Health Solutions

Abstract

The second wave of the COVID pandemic has had a sudden and severe impact on India. This grueling period was associated with the shortage of healthcare resources like hospital beds, oxygen supply, and medicines along with overburdening of health workers, and a very high toll of community suffering and loss. A combination of highly infective viral variant strains with the backdrop of premature complacency, removal of restrictions and abandonment of COVID appropriate behaviour may be responsible factors in hindsight. However, important learnings and action points acquired from the COVID resurge, can be valuable to avert such situations in future. These include focusing on maximizing population vaccination; continuing enforcement of safety norms with the graded lifting of restrictions; using data tools and medical research for prediction, analysis and timely decisions; ramping up healthcare resources and production of medicines, lifesaving equipment and vaccines; and having regulations and mechanisms in place to tackle misuse and illegal activities. Above all selflessness and unity at the level of the administration, community and individual are the needs of the hour in such a challenging situation.
Editorial
The Indian Practitioner d Vol.74 No.6 June 2021
7
Key Learnings from the COVID Resurge – Putting
Healthcare First and Ramping Up Resources:
Recommended Action Points to Handle Such
Pandemics in Future
Dr. Naresh Purohit1, Dr. Varsha Narayanan2
1
Consultant, Community Health Care, Bhopal;
2
Health and Pharmaceutical
Consultant, Dr Varsha’s Health Solutions, Andheri West, Mumbai
Corresponding Author: Dr. Varsha Narayanan, Health and Pharmaceutical
Consultant, Dr Varsha’s Health Solutions, Andheri West, Mumbai.
Email: info@drvarsha.com
Abstract
The second wave of the COVID pandemic has had a sudden and severe impact on India. This grueling period was associ-
ated with the shortage of healthcare resources like hospital beds, oxygen supply, and medicines along with overburdening
of health workers, and a very high toll of community suering and loss. A combination of highly infective viral variant strains
with the backdrop of premature complacency, removal of restrictions and abandonment of COVID appropriate behaviour may
be responsible factors in hindsight. However, important learnings and action points acquired from the COVID resurge, can be
valuable to avert such situations in future. These include focusing on maximizing population vaccination; continuing enforce-
ment of safety norms with the graded lifting of restrictions; using data tools and medical research for prediction, analysis
and timely decisions; ramping up healthcare resources and production of medicines, lifesaving equipment and vaccines; and
having regulations and mechanisms in place to tackle misuse and illegal activities. Above all selessness and unity at the
level of the administration, community and individual are the needs of the hour in such a challenging situation.
Keywords: COVID, second wave, healthcare, learnings, pandemic
Introduction
The current second wave of COVID has hit the
world community especially India with a ven-
geance and the havoc it has created is much
worse than the rst wave in 2020. It is up to the sci-
entic community to quickly analyze how long the
present wave will last. During the rst wave, thanks
to technology, it did not take long for mankind to shift
to alternate means of survival and sustenance of busi-
ness operations.[1] The education system promptly
went into the online mode that has now become the
primary mode of teaching.[2] It didn’t take long to start
virtual laboratory sessions, and even the examinations
were held online so as to recoup lost oine sessions
and save an academic year. Work from home became
the name of the professional game, allowing people to
run oces and businesses through virtual workshops,
seminars, and conferences without having to travel
at all. Shopping has more or less become an online
phenomenon to avoid visits to crowded markets and
malls.[3] Food too is being ordered online like never be-
fore and sensing the demand for delivered food, entre-
preneurs have expanded the cuisines and culinary fare
available for the consumers. Even while there has been
a decline in some businesses in the organized and un-
organized sectors, many new entrepreneurs have also
sprung up ushering in a new wave of innovative ideas.
In the medical retail sector, products such as per-
sonal protective equipment (PPE), masks, nutrition-
al supplements and sanitizers, etc. are being increas-
ingly made and also subjected to innovations, while
those never manufactured in the country are being
exported in under a year.[4] The innovations and new
systems, however, largely eluded the country’s core
medical care apparatus. The health workers have been
The Indian Practitioner d Vol.74 No.6 June 2021
Editorial
8
struggling to cope up with the pandemic and trying to
put their best foot forward through the rst and sec-
ond wave, to treat aected patients, save lives and con-
tain the situation as quickly as possible. It is commend-
able how the medical community has immediately em-
powered itself with updated disease knowledge, treat-
ment and care protocols, and intensifying ground ef-
forts to tackle the resurge. The scientic community
and administration also did their best to counsel and
educate people to respect and follow safety norms and
wear masks, maintain social distancing and wash their
hands regularly.
The public healthcare system is bursting at the
seams, with a lack of resources, equipment and plan-
ning evident with the surging pandemic second wave,
which is only making things worse. This is something
very important to be guarded against lest it demoral-
izes the nation.[5]
There are also disturbing scenes of over-burdened
front line health workers overwhelmed by the scale of
the surge in terms of both the sheer number of people
requiring higher medical care for severe COVID and
the post-covid diseases like Mucormycosis.[6] Equally
disturbing are reports of black marketing of essential
drugs and oxygen, and news of possible unauthorized
hospital admissions, duplicate or fake medicines and
non-standardized medical equipment.[7,8] All this adds
up to a bizarre situation where the conscience of those
indulging in these practices seems to have perished.
The Indian government has taken some appreciable
and exemplary measures during the pandemic, how-
ever, the onslaught of unpredictable virus variants on
one of the largest, most diverse and high-density pop-
ulations of the world has understandably been crip-
pling and devastating. The need of the hour is for ev-
eryone to come together keeping politics, ego and per-
sonal gains at bay and ght the pandemic selessly.
Lessons learnt from the pandemic should make way
for caution and timely action points for eectively han-
dling such situations in the future.
Key Learnings
The learnings from the pandemic requiring consid-
eration for PPP (Prediction, Planning, Preparedness),
have been summarized below as ve aspects for action:
a) Not dropping guard before adequate population
vaccination: Even if the cases have dropped signi-
cantly, and it seems reasonable to restart workplac-
es, institutes and social life, there should be no lax-
ity in safeguards like protection with mask, sanita-
tion and social distancing. Opening up should be
guarded, gradual and graded with the continuation
of virtual and digital means wherever possible. This
should be the norm till vaccination of greater than at
least 50% of the population is achieved across ages-
groups including vulnerable groups like children,
to ensure one protected for each one not protected
and an imminent herd immunity.[9] Once eective
vaccines have been developed and made available,
the utmost priority should be to achieve and main-
tain the highest possible rate of population immuni-
zation and vaccine production capacity irrespective
of the stage or severity of the pandemic at that time.
Vaccine clinical trials in children should be initiated
post interim phase 3 evaluation in adults itself.
b) Improving prediction and informed decision
making with medical research and data analytics:
Investing in medical and epidemiological research
is now a requirement for all countries. Scientic
data generation and its analysis with extrapola-
tion through predictive models and articial intel-
ligence (AI) can be used for predicting subsequent
wave characteristics and intensity, to enable timely
decisions, preparation and resource allocations.[10]
During an ongoing pandemic, constant data mon-
itoring, studying trends and detailed statistical in-
terpretations can also greatly improve disease un-
derstanding and guide planning and management
strategies.
c) Ramping up healthcare resources: The pandem-
ic imparts the vital learning that in India even if a
small percentage of the population is aected, the
actual number and impact on healthcare is so se-
vere and huge that there is bound to be a shortage
on multiple fronts. Therefore continually enhanc-
ing and improving healthcare infrastructure should
always be a national and state priority.[11] This in-
cludes diverting more budget to healthcare, in-
creasing bed capacity in existing hospitals, improv-
ing the condition and facilities of district hospitals
and rural community health centers, creating more
basic medical treatment and isolation centers in the
interiors, making arrangements for more emergen-
cy and life-saving equipment like oxygen plants
and ventilators, and constantly increasing public
awareness of health and hygiene.
d) Increasing trained healthcare manpower:
Overwhelming and overburdening of healthcare
personnel has been an unfortunate bane of the
pandemic. Therefore, increasing trained health-
care manpower cannot be emphasized more at this
juncture.[12] Apart from more medical education in-
stitutes to produce qualied doctors, it is also im-
portant to design and put in place training pro-
Editorial
The Indian Practitioner d Vol.74 No.6 June 2021
10
grammes and certications in allied healthcare for
nursing sta, laboratory technicians, hospital work-
ers, digital health guides and counselors. Virtual
and simulation platforms can be eectively utilized
for the same like the Integrated Government Online
Training platform.[13] Bringing together family phy-
sicians and general medical practitioners of dier-
ent systems of medicines with a common treatment
protocol and pandemic management training can
be an eective way of scaling up access to the ap-
propriate treatment of a large population.[14]
e) Increasing production and regulation of medi-
cines: It is clear from the pandemic, that shortage
of essential medicines can become acute in a very
short span of time during a surge. However, to
avoid expiry and wastage of medicines when over-
produced, there should be both regulatory and
manufacturing planning on how to scale up pro-
duction of all identied essential and emergency
medicines in time of dire need.[15] Over the counter,
and non-prescription sale of medicines like cortico-
steroids and antimicrobials should not be allowed,
and strictly monitored. Hoarding, black marketing
and spurious/fake drugs should be promptly iden-
tied, curbed and punished.
Conclusion
The pandemic has imparted the valuable lesson
that nobody is safe unless everyone is safe, and pre-
mature shedding of safety norms and restrictions be-
fore maximizing vaccination can make further waves
and resurgences of the disease devastating. Healthcare
should be prioritized, planned and continuously en-
hanced at all levels with the help of constant medical
research and data monitoring. The current challeng-
ing situation in India calls for unied eorts from gov-
ernment and private quarters, with a major contribu-
tion by the common people, towards following safe-
ty norms and helping those in need at whatever indi-
vidual and collective level possible, puing aside per-
sonal, political and nancial gains. Life, not money or
power, is valuable as it will never come back once lost.
References
1. Dsouza S. Pandemic accelerates online shift for Small
Businesses [internet]. Bloomberg | Quint. 2020 July 20. [cit-
ed 2021 May 25]. Available from: hps://www.bloom-
bergquint.com/business/pandemic-accelerates-online-shift-
for-small-businesses
2. Mathivanan SK, Jayagopal P, Ahmed S, Manivannan SS,
Kumar PJ, Raja KT, Dharinya SS, Prasad RG. Adoption of
E-Learning during Lockdown in India. Int J Syst Assur Eng
Manag. 2021 Feb 24:1–10.
3. Peermohamed A. E-commerce is fast becoming the default
option for shopping in India [internet]. The Economic Times.
2021 March 15. [cited 2021 May 25]. Available from: hps://
economictimes.indiatimes.com/tech/technology/e-com-
merce-is-fast-becoming-the-default-option-for-shopping-in-
india/articleshow/81502440.cms?from=mdr
4. Kapoor A, Goyal S. India’s successful journey to self-suf-
ciency in PPE kits [internet]. The Economic Times. 2020
October 14. [cited 2021 May 25]. Available from: hps://eco-
nomictimes.indiatimes.com/industry/healthcare/biotech/
healthcare/indias-successful-journey-to-self-suciency-in-
ppe-kits/articleshow/78658109.cms?from=mdr
5. Barnagarwala T. The Oxygen Chain: Why India is falling
short of the life-saving gas [internet]. Indian Express. 2021
April 25. [cited 2021 May 25]. Available from: hps://indi-
anexpress.com/article/india/the-covid-crisis-falling-sho2rt-
india-covid-oxygen-supply-7287681/
6. Biswas S. Mucormycosis: The ‘black fungus’ maiming
COVID patients in India [internet]. BBC. 2021 May 9. [cited
2021 May 25]. Available from: hps://www.bbc.com/news/
world-asia-india-57027829
7. Karmakar D. Black Marketing of Drugs, Oxygen cylinders:
EOU gets 100 calls [internet]. The Times of India. 2021 May 10.
[cited 2021 May 25]. Available from: hps://timesondia.in-
diatimes.com/city/patna/black-marketing-of-drugs-oxy-cyl-
inders-eou-gets-100-calls/articleshow/82505122.cms
8. Bharadwaj T. Counterfeit drugs, medical devices during
Covid-19: Collective eort required to tackle menace [in-
ternet]. Financial Express. 2021 May 20. [cited 2021 May 25].
Available from: hps://www.nancialexpress.com/lifestyle/
health/counterfeit-drugs-medical-devices-during-covid-
19-collective-eort-required-to-tackle-menace-nakul-pasri-
cha-aspa/2255588/
9. Bartsch SM, O’Shea KJ, Ferguson MC, et al. Vaccine Ecacy
Needed for a COVID-19 Coronavirus Vaccine to Prevent or
Stop an Epidemic as the Sole Intervention. Am J Prev
Med. 2020;59(4):493-503.
10. Bertsimas D, Boussioux L, Cory-Wright R, Delarue A,
Digalakis V, Jacquillat A, Kitane DL, Lukin G, Li M, Mingardi
L, Nohadani O, Orfanoudaki A, Papalexopoulos T, Paskov I,
Pauphilet J, Lami OS, Stellato B, Bouardi HT, Carballo KV,
Wiberg H, Zeng C. From predictions to prescriptions: A da-
ta-driven response to COVID-19. Health Care Manag Sci. 2021
Feb 15:1–20. doi: 10.1007/s10729-020-09542-0. Epub ahead of
print.
11. Golechha M. India should ramp up its emergency med-
icine and critical care infrastructure to combat COVID-19.
Postgraduate Medical Journal 2021;97:266-267.
12. Mehta S, Machado F, Kwizera A, Papazian L, Moss M,
Azoulay É, Herridge M. COVID-19: a heavy toll on health-
care workers. Lancet Respir Med. 2021 Mar;9(3):226-228.
13. Nanda P, Lewis TN, Das P, Krishnan S. From the front-
lines to centre stage: resilience of frontline health workers
in the context of COVID-19. Sex Reprod Health Maers. 2020
Dec;28(1):1837413.
14. Garg S, Bhatnagar N, Singh MM, Borle A, Raina SK, Kumar
R, Galwankar S. Strengthening public healthcare systems
in India; Learning lessons in COVID-19 pandemic. J Family
Med Prim Care. 2020 Dec 31;9(12):5853-5857.
15. Marathe PA, Kamat SK, Tripathi RK, Raut SB, Khatri NP.
Over-the-counter medicines: Global perspective and Indian
scenario. J Postgrad Med. 2020;66(1):28-34.
+
... The emergence of second wave of COVID-19 within a short span of time indicates the possibilities of its emergence in the future as well without giving us sufficient time for preparation of basic hospital facilities and treatment of patients. Therefore, it is important to look at the sources and their preventing measures that could be undertaken at this stage in order to combat the upcoming waves [11]. There is also need to look at the true data of second wave to predict the pattern and level of destruction which could happen in the future [12]. ...
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Introduction: The COVID-19 pandemic in India has resulted in mass destruction in the form of second wave that hit the country during March-June months of this year. Indian citizens and government were affected by economic, social, and psychological consequences and were left constrained with basic medical facilities in treating the heavy load of patients. The possibility of re-emergence of virulent strains of SARS-CoV-2 still exists. Area covered: In this article, we tend to discuss why India is at high risk to be to be affected by the third wave and what strategies could be implemented to contain the viral spread. It provides these insights with reference to the gaps and the lessons learnt from the second wave along with the possible solutions to tackle the problems which were not effectively handled during the previous episodes of viral spread. We propose strategies for implementing effective vaccination programs, focus on different ways and speeding up of diagnosis, management of essential hospital aids, prevention from vaccine escape mutant strains like δ and δ + variants and implementation of COVID-appropriate behaviour in rural areas of India. The literature of this article was extracted from the Google Scholar and PubMed databases up to the month of September 2021 using the keywords like Coronavirus, second wave in India, viral positivity rate, emerging Coronavirus strains, COVID vaccination rate in India etc. Many points discussed in this article were also the result of close observation during the preceding waves. Expert opinion: This article has significance to the researchers and government officials in understanding the gaps that led to COVID-19 second wave in India and provides an opportunity to improve on certain areas for handling the future waves with more vigilance.
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Education institutions like Schools, colleges, and universities in India are currently based on traditional learning methods and follow the conventional setting of face-to-face interaction/lectures in a classroom. Most of the academic sector started unified learning, still most of them struct with old steps. The unexpected Plague of a deadly infection called COVID-19 caused by (SARS-Cov-2) trembled the whole world. The WHO announced it as a disease outbreak. This circumstance challenged the whole education system worldwide and compelled educators to change to an online mode immediately. Many educational organizations that were earlier unwilling to change their traditional didactic practice had no choice but to move exclusively to online teaching–learning. This article provides an elaborate discussion about the education sector's impact during a disease outbreak in India. It offers a detailed discussion regarding how India adopts the e-learning approach in this critical situation. Further, it describes how to cope with the challenges related to e-learning.
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Introduction Given the continuing coronavirus disease 2019 (COVID-19) pandemic and much of the U.S. implementing social distancing owing to the lack of alternatives, there has been a push to develop a vaccine to eliminate the need for social distancing. Methods In 2020, the team developed a computational model of the U.S. simulating the spread of COVID-19 coronavirus and vaccination. Results Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number [R0]=2.5–3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when R0 is 2.5, rising to 80% when coverage drops to 75% when R0 is 3.5. To extinguish an ongoing epidemic, the vaccine efficacy has to be at least 60% when coverage is 100% and at least 80% when coverage drops to 75% to reduce the peak by 85%–86%, 61%–62%, and 32% when vaccination occurs after 5%, 15%, and 30% of the population have already been exposed to COVID-19 coronavirus. A vaccine with an efficacy between 60% and 80% could still obviate the need for other measures under certain circumstances such as much higher, and in some cases, potentially unachievable, vaccination coverages. Conclusions This study found that the vaccine has to have an efficacy of at least 70% to prevent an epidemic and of at least 80% to largely extinguish an epidemic without any other measures (e.g., social distancing).
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Patients often approach a pharmacist instead of visiting a doctor for minor ailments such as cough, cold, allergies, pain, fever, acidity, diarrhea, and skin-related conditions. Purchase of specific medicines over the counter is legally recognized in most countries. 'Over-the-Counter (OTC) Medicines' means drugs which are legally allowed to be sold by pharmacists without need for a prescription. The term does not have a legal definition in India. Technically, drugs are OTC unless they are specifically stated as prescription only drugs. OTC drugs allow faster and cheaper access to healthcare; however, their misuse and adverse health effects cause concerns. This article describes concept of OTC medicines and practices in India against the background of globally prevalent regulations and practices. A recognized category of OTC medicines by law, patient awareness programs, and support of pharmacists and pharmaceutical companies are required to optimize the use of OTC medicines in India.
E-commerce is fast becoming the default option for shopping in India
  • A Peermohamed
Peermohamed A. E-commerce is fast becoming the default option for shopping in India [internet]. The Economic Times. 2021 March 15. [cited 2021 May 25]. Available from: https:// economictimes.indiatimes.com/tech/technology/e-commerce-is-fast-becoming-the-default-option-for-shopping-inindia/articleshow/81502440.cms?from=mdr
India's successful journey to self-sufficiency in PPE kits [internet]. The Economic Times
  • A Kapoor
  • S Goyal
Kapoor A, Goyal S. India's successful journey to self-sufficiency in PPE kits [internet]. The Economic Times. 2020 October 14. [cited 2021 May 25]. Available from: https://economictimes.indiatimes.com/industry/healthcare/biotech/ healthcare/indias-successful-journey-to-self-sufficiency-inppe-kits/articleshow/78658109.cms?from=mdr
The Oxygen Chain: Why India is falling short of the life-saving gas
  • T Barnagarwala
Barnagarwala T. The Oxygen Chain: Why India is falling short of the life-saving gas [internet].
The 'black fungus' maiming COVID patients in India
  • S Biswas
  • Mucormycosis
Biswas S. Mucormycosis: The 'black fungus' maiming COVID patients in India [internet]. BBC. 2021 May 9. [cited 2021 May 25]. Available from: https://www.bbc.com/news/ world-asia-india-57027829
Black Marketing of Drugs, Oxygen cylinders: EOU gets 100 calls
  • D Karmakar
Karmakar D. Black Marketing of Drugs, Oxygen cylinders: EOU gets 100 calls [internet]. The Times of India. 2021 May 10. [cited 2021 May 25]. Available from: https://timesofindia.indiatimes.com/city/patna/black-marketing-of-drugs-oxy-cylinders-eou-gets-100-calls/articleshow/82505122.cms