key: cord-0816281-ekrky7cu
authors: Velayudhan, Bashi; Idhrees, Mohammed
title: COVID‐19: An Indian perspective
date: 2020-11-22
journal: J Card Surg
DOI: 10.1111/jocs.15203
sha: 8d103cd5213b46427b42dc1dd0457abb16c2d7d0
doc_id: 816281
cord_uid: ekrky7cu

Lockdown, quarantine, self‐isolation, personal protection equipment, and social distancing have become words of daily usage ever since the world health organization declared coronavirus disease 2019 (COVID‐19) as a pandemic. The impact of COVID‐19 extends over the medical field, economy, education, and politics. Though the knowledge of the virus is evolving, we are yet to find a solution. India, country with the second largest population, went into a phase of lockdown from 25th March 2020 to 31st May 2020. There was phased measure to “Unlock” starting from 1st June 2020. This has affected the clinical practice and training of the resident. The challenges faced during this unprecedented time are multifaceted which includes overcrowding, healthcare system, and educational background. Indian Association of Cardiovascular‐Thoracic Surgeons kept continuing the educational program through a series of “Masterclass.”

India entered the phase of lockdown on 24 March 2020 when the total number of cases was less than 606 with 10 deaths. The increase in the number of cases was exponential high to 33,000 and 1075 deaths on 30th April. As on 27th October, India ranks second in total cumulative cases and third in the total number of deaths. 1 On analysis the total number of cases per million, India ranks 89th (5772/million) and stands 86th in total death per million (87/million). Though the total number seems to increase, in the majority of the cities, where there was an initial peak of cases have slowly plateaued. 1,3

The Indian Government left no stones unturned to be with the people during this global predicament. The phase of lockdown extended from 25th March 2020 to 31st May 2020. There was phased measure to "Unlock" starting from 1st June 2020. During the period of lockdown, people were ban to step out of their homes except for hospitals, pharmacies, banks, grocery, and other essential services.

During the fourth phase of lockdown, the Union Ministry of Health gave the power to the individual state government to delineate the districts into three different zones-Red (hot zone), Orange, and Green. These zones were categorized based on the total number of cases, cases per lakh population, doubling rate over a 7-day period, case fatality rate, testing ratio, and sample positivity rate. These zones will have a different set of restrictions for the citizensmaximum for the red and the least for the green.

All educational, training, and research institution were suspended. There are steps being taken to integrate the private and public healthcare system. Few state governments have already undertaken certain private health care with the interest of the people.

Separate COVID blocks are designated in the public health sectors.

Efforts are being taken to convert railway coaches to beds in need of a dire emergency. The emergency military hospital has been established to handle patients with COVID-19 during an emergency. To handle the crisis, the government has converted stadiums, large auditoriums, convention centers, and colleges to "emergency care centres" to handle patients with COVID-19. Doctors, nurses, paramedics, technicians, and other healthcare professionals involved in the care of patients with COVID-19 will get a special insurance cover of Rs. 50 lakh ($65,000) during this period. India's average number of bed/1000 person is less than one. Hence, there have been efforts to increase the number during the crisis. Numerous education awareness programs were organized by celebrities through radio, television, and social media. 

An online study was conducted by our team among the cardiac surgeons practicing in India. 5 It was noted that 27% of the surgeons did not operate during the lockdown and nearly 90% of the surgeons stopped elective surgery before 31st March 2020. Just over 1/5th of the surgeons (22.2%) continued to perform elective surgeries during the period of lockdown. Nearly 90% of the surgeon agreed that there is a drop in more than 50% of the surgical volume during the period of lockdown. A few surgeons (12.1%) agreed that their "traditional" postsurgery intensive care unit was transformed into a COVID-unit.

This was more common in the public sector.

Although the focus is on the patients and the community at large to treat and prevent the spread of the COVID-19 disease, it has undoubtedly rattled the educational and training program of the residents especially the surgical speciality. The residents have a 

Worldwide "stay home" and "social distancing" is followed. But the medical profession are prepared to do the opposite. They risk going to hospital to take care of the patients infected with COVID-19.

China's National Health Commission reported that more than 3300 healthcare workers have been infected as of early March. In Italy, 20% of the responding healthcare workers are infected. 6 More than 60 doctors have died in Italy. Spain has reported that 14.4% of the total reported cases are healthcare workers. A total of 1302 doctor and trainees were infected and 108 deaths have lost their lives as on 13th July 2020. 7, 8 This gives a staggering 8% mortality rate among doctors as compared with 3%-4% in the general population. Threequarter of death was among doctors who are more than 60 years of age. The cardiovascular unit team works in close proximity. There is every possibility to come in contact with all body fluids during the pre/per/postoperational period. It is essential that the head of the unit takes measure for staff management. It is advisable to have two teams of staff members so that when needed, quarantines can be applied to members within the team, rather than the entire unit.

There are guidelines established for the personal protection equipment during the surgery by the apex societies. It is of paramount importance to adhere to them religiously. Doors of the operating room should be shut always, providing optimal negative pressure. All the contaminated equipment should be left in the operating room before leaving.

Constant efforts are being made in research to find ways to conquer this pandemic. But as where we stand today, we are still in the process.

"Prevention is better than cure"-there is no better words which can fit this pandemic. Until we find a way out-"Stay home. Stay safe."

Issues of creating a new cadre of doctors for rural India

An Indian study: impact of COVID-19 on clinical decision-making and consensus in cardiac surgery practice across the country

COVID-19: protecting health-care workers

A hundred lives lost: doctor deaths in India during the times of COVID-19. Preprints

Indian Medical Association Press release. Red alert for doctors

COVID-19: An Indian perspective

The authors declare that there are no conflict of interests.

The data that support the findings of this study are openly available at https://www.worldometers.info/demographics/india-demographics and https://ourworldindata.org/coronavirus.

https://orcid.org/0000-0002-3634-4134Mohammed Idhrees https://orcid.org/0000-0001-5981-9705