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A lot of doctors in India are old and have pre-existing illnesses themselves… Keeping that in mind, should we expose our elderly doctors with pre-existing illnesses? Or should we tell them to keep away and bring young doctors who have very little experience? All these are very hard decisions,” physician Dr Swapneil Parikh, co-author of The Coronavirus: What You Need To Know About The Global Pandemic, which releases on April 1, tells Archana Masih/Rediff.com in the concluding part of the interview.
What can healthcare workers in India learn from their Wuhan healthcare compatriots?
Some top doctors have said that Indians are strong and imply that we will tide over this, but the right message needs to go out that this is a serious crisis and we have to get our act together.
Doctors need to be ready for very hard times ahead. Colleagues in US and Italy say they are dealing with a war-like scenario. Italy has reached a point where doctors have to make a choice about which patients have a chance of surviving and which will we let die.
My worry is that we are going to get to that point soon because we don’t have enough resources.
We also have to understand that a lot of doctors in India are old and have diseases themselves. Our buffer stock of protective equipment is very limited, we will be out of stock soon.
Keeping that in mind, should we expose our elderly doctors with prevailing illnesses? Or should we tell them to keep away and bring young doctors who have very little experience? All these are very hard decisions.
The conservative estimate is that between 20% to 60% of all adults are going to be infected — so if we use up our stock right now, then we will reach a stage when we will not have any masks left for later.
If healthcare workers start getting sick when the pandemic is peaking, it will be a huge crisis.
We need to take very thoughtful and strategic decisions.
How does a 14 day quarantine of those coming from affected countries according to the government’s list of those countries help in reducing infection?
If you have come from a country with a high number of cases, then people must self-isolate for 14 days. There is a guideline by the government about how to do that and not infect others staying with you.
But that is not enough, we have passed the point when we can contain it from the outside. Containment from the outside is not going to save people from getting infected. It is about flattening the curve.
Let me explain the concept of R0, which means how many people at an average will an infected person infect. On an average, for Covid, each infected person infects 2 to 3 people — it means that it is going to propagate exponentially.
You can’t stop that growth, you can slow it until a sizeable chunk of the population becomes immune.
Some researchers in Britain are talking about herd immunity. What is that?
Herd immunity is a concept based in vaccination. When a certain number of people have developed immunity to the infection it then disrupts transmission.
What the UK is betting on is that let young people get infected now because then they will have immunity and will disrupt transmission later.
They feel they can manage the old people who get sick, but if they let everyone get sick later it will disrupt their healthcare system.
But this is a gamble. There is no evidence to show that this is going to happen. Experts have strongly condemned this strategy and in fact UK has thankfully backtracked.
We know what has worked in China, South Korea, Japan — the reason the UK is mulling this option is because no free people will accept the conditions imposed in China. Countries have gone to war for far less freedom.
The UK, the USA, Europe and India won’t accept that kind of strict conditions. Tomorrow, if the government says everyone stay at home, many will starve.
There has to be a universal basic income programme to compensate for the loss of wages, but more importantly there is so much distrust in the government in some communities.