EASING THE BURDEN ON HEALTHCARE DURING COVID-19 PANDEMIC

COVID-19 is not a very dangerous disease as far as diseases go. Many who contract the virus don’t seem to be affected at all. Of those with symptoms, 80 percent end up modestly ill. Among those who do come down with severe illness, only five percent end up in critical condition. We are quite good at treating the disease. If people get adequate medical care, chance of survival is high.

Yet, this virus is plunging the world into chaos for two reasons. First, from the start of the pandemic, nobody in the world had natural immunity to it. Second, the world has no medication that can cure and no vaccination that can prevent the disease. The virus suddenly emerged a few months ago and is spreading rapidly through the world, infecting people in huge numbers and overwhelming health care systems of nation states.

Where the pandemic is in full swing, hospitals are being filled to the brim with patients. In some areas, hospitals lack enough room to take in the surge of patients and new facilities have to be built hastily.
The inability of healthcare systems to cope with the scale of the pandemic is a factor behind the severity of the COVID-19 crisis. When the pandemic gets into full swing in the developing world, which it is likely to do, a massive globe-spanning catastrophe will likely ensue.

Relieving medical systems from the burden is necessary. As preventing people from ever contracting the virus is not likely, the goal most of us hope to achieve is preventing too many people from being infected with the virus at the same time, known as flattening the curve (the curve on the diagram showing the prevalence of infections over time). Most people might still end up getting infected by the time the pandemic is over, but at least patients aren’t streaming into hospitals too fast.

To achieve flattening of the curve, highly restrictive measures are being imposed upon society. Mass gatherings are done away with, people are made to stay home, and non-essential economic activity is halted, but the economic slowdown adversely impacts the capacity of the medical sector itself. Even in the most advanced countries, such measures have often not eased the severity of the medical crisis. Healthcare systems are still feeling tremendous strain in the midst of the pandemic. Italy, for example, turned itself into a ghost country yet ventilators were still rationed for a period of time. As the virus continues its expansion across the world, we will need to find ways to solve this issue.

The overburdening of healthcare is terrible not only for people suffering from COVID-19 but people suffering from other illnesses that requires urgent treatment. People get injured, get cancer, suffer heart attacks, strokes, kidney failure, respiratory distress, etc., and as coronavirus spreads, none of this stops.
This means that this pandemic further endangers people who need medical treatment for ailments besides COVID-19. Conversely, people who have coronavirus find it harder to get treatment because hospitals are busy treating other conditions. It’s happened in Italy. It’s happening in India. Reportedly, it has started happening in Japan. Patients suffering from another disease also run the risk of being infected with COVID-19 if they go to hospitals. If they contract COVID-19 in addition to the conditions they already have, the consequences can be severe. Lockdown measures also make it difficult for them to access treatment.

The situation is the worst for people needing treatment for respiratory ailments, because they need the same equipment and personnel used for treating COVID-19. Ventilators are essential not just for COVID-19 but for a lot of conditions. Most people with severe medical conditions have therefore become indirect victims of the pandemic. It is a grave issue.

We need to find a solution to the conundrum of healthcare systems buckling under COVID-19.

A solution can be found in the alteration the global education system is currently undergoing while in the throes of COVID-19 pandemic. The globe is turning to online education as temporary response to Covid-19 till vaccine is found. All over the world, including Pakistan, buildings that were being used for imparting education to people are shutting down as students are made to stay home and turn to online lessons.

PPLDM has already written about how online education provides cure to many of the fundamental faults in Pakistan’s education system while simultaneously freeing capital for investment in other sectors to accelerate our economic progress. Bill Gates has extrapolated that online education is the future of education because this pandemic will make families afraid to send their children to school and online education will evolve to be of too much convenience to be set aside.

Pakistan can convert its nation-wide school buildings into hospitals where Covid-19 patients are treated. Each room can isolate and serve a single patient, mitigating intra-hospital spread. We can convert some of the local school buildings into testing facilities. Some should be utilized for stockpiling of PPEs. Imran Khan wants to reopen the construction sector to boost economy. Let us start with converting our schools in our urban metropolis, and our rural areas, into general hospitals, hospitals that treat only Covid-19 patients, and medical test facilities including separate Covid-19 test facilities and for stockpiling of Personal Protection Equipment. Part of the buildings in far flung rural areas can be converted into safe housing for doctors with security that includes CCTV cameras. We are currently using our police to strong arm people in urban areas for lock-down enforcement. Police should be instead appointed to ensure security of school buildings thus converted into medical facilities, medical professional’s residences, testing facilities, labs, hospitals and stockpiling facilities. Military can collaborate in this endeavor.

Let us equip our school buildings with state-of-the-art medical machinery. Let us convert them into Covid-19 test facilities for now, and other essential medical facilities for population’s long term benefit. Let us use some of the school buildings as labs and some as PPE manufacturing factories. Let us spend the money international donors are providing Pakistan to fight Covid-19 pandemic in this manner. We will ease the burden on our health care system. We will also provide health care facilities to far-flung areas where Covid-19 is breaking out and where health care is either non-existent or in short supply.

Needless to mention, we have to make 4G and 5G technologies available to our areas where the same is hitherto nonexistent. We have to do this on war footing because these technologies are indispensable for online education/ home schooling to keep students safe from the pandemic without halting our human resource development because we are driven to halting our educational system.

The lawmakers will have to make emergency laws to mandate doctors to work in designated far flung areas during health emergency. Many of those who have recently graduated from medical hospitals in Pakistan, but have opted out of working in the health care sector, should be drafted to work under enforced medical emergency and penalized for not doing so without good reason. In fact, many of our medical graduates do not go on to working in health care sector for no good reason at all. The state spends a huge amount on training of these individuals, but because the state is lax and has no laws for ensuring this crucial sector is staffed with adequate personnel, dropping out is easy and the rate is high. One NGO has estimated the dropout rate among female medical graduates and young workers to be 80%. This high rate is the rate of drop out only among medical doctors and does not include nurses. This practice must be discouraged and the Covid-19 emergency is an apt time to make laws to discourage this practice, indeed, a crime against society because a poor state’s precious capital is wasted by such irresponsible conduct. Those who don’t want to work as medical professionals should not avail the precious seats in Pakistan’s medical colleges and those who have availed them should be committed by law to give a specific period of their post-graduation life to serving in medical profession inside Pakistan. They can go out for further training, but work in Pakistan they must.

The contact tracing is an essential part of containing the spread of Covid-19. It helps collect essential data for researching the pandemic. For instance those who were in contact with a Covid-19 positive person but did not contract the virus are needed for researching if there are natural immunities to the virus.

Pakistan should utilize its students, including medical students, to carry out contact tracing. It can use teachers to supervise how students are carrying out their contact tracing responsibility. Contact tracing can be done from home through emails, cell phone text messaging and mail systems. Those who are entrusted with the job of tracing will have to work in close liaison with the police. Local police stations can make field visits to the residences or work places to help collect data on those who were exposed to the virus. A contact tracing hub should be established where data is collected and shared within Pakistan and with the international community. Pakistan’s software engineers should be mobilized on war footing to establish the hub and its operational mechanism should include local and provincial government, the education sector, the medical sector and the law enforcement, among other necessary personnel.

Infection prevention and control policy at local levels will be enhanced through buildings which have been converted from schools into health care and testing facilities. We should aspire to test as many as we can. We can instruct people in safety measures at testing facilities. We can enter into an arrangement with China and other friendly neighbors whereby we collect samples in Pakistan but send them for testing to labs in friendly neighboring countries that have capacity to do so. China has offered to help. Establishing testing labs in Pakistan and helping with test results is where we should ask China to help. We can also seek help from any friendly neighbors where domestic testing labs are not overburdened.

Testing our population, providing adequate medical treatment to our population and equipping our population with protection against the virus is the most effective way to overcome this calamity.

If our state follows the guidelines provided in this policy brief by converting our education system into online system and converting our existing school buildings in urban and rural areas into healthcare facilities, we would have a long term solution to the most fundamental problems in two critical sectors of our domestic economy; our health care system and our education system.

This PPLDM policy brief has been authored by Zeenia Sadiq Satti & Shahzeb Khan.

Author: Zeenia Satti

Zeenia Satti lives in Islamabad, Pakistan, where she works as Executive Director at Pakistan's People Led Disaster Management. She is also a political analyst and columnist. She has studied Middle Eastern Affairs at Harvard University, USA. Follow her on twitter@zssatti.