Need infectious disease hospitals

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Need infectious disease hospitals

Wednesday, 08 April 2020 | Karan Thakur

Given the advances in design and architecture, it is possible to create a hospital within a hospital that can be used during outbreaks

The Covid-19 pandemic has led to the emergence of multiple global strategies on prevention, containment and management of the disease. Tactical and strategic systemic approaches that nations have evolved include testing, strict lockdowns and contact tracing with a majority adopting a hybrid model of all of these approaches.

The World Health Organisation (WHO) has been espousing identification, isolation, testing, tracking and treatment as its stratagem for effective handling of national and cross-border outbreaks since the beginning of the crisis. While most nations adopt this approach, a critical unsettled debate revolves around hospital allocation and infrastructure division for Covid versus non-covid patients.

Given the precipitous spread across borders, most national health systems were coming to grips with the pandemic by utilising all available resources to control the outbreak. Hospitals were asked to prepare Covid-19 wards, train staff and buffer up inventories. As in any disaster management protocol, it was important to use all levers to manage the crisis given the geographic spread of the disease. However, a critical differentiator between other disasters and this infectious disease variant was the risk posed to staff and “normal” patients.

The influx in most disaster management cases does not pose a direct and significant threat to the well-being of others in the physical proximity of the relief site. Infectious diseases turn that logic on its head. Not only does the disease hold catastrophic potential for a section of those infected, it also poses consequential risks for others. This has been tragically witnessed in the current outbreak with a large number of health workers having contracted the disease in the line of their work.

The use of personal protective equipment, preventive procedures and physical segregation are foremost in our defence against infectious diseases but they do have their limitations. Additionally, the exposure to positive cases necessitated the protective quarantine of a large number of health workers, just as they were required to be rendering care in the face of the rising numbers.

Second, the risk posed to those seeking care for other ailments poses moral and ethical questions. Already at a higher degree of risk because of their underlying condition, the potential exposure in hospitals treating both covid and non-covid patients can be catastrophic. This risk is further complicated by the fact that lockdowns and the unavailability of hospital beds for non-covid patients become a compromised reality in a pandemic. The need to protect these patients and ensure that an adequate number of precious health workers are available make the case for dedicated covid/infectious disease hospitals stronger.

One approach to circumvent the problem above has been to take any patient at the hospital as a potential covid-positive case. This has an enormous cost attached towards it, in both clinical and monetary terms. Given that global supply lines, even of invaluable medical stock and equipment, remain stressed, the judicious use of preventive goods cannot be adequately underlined.

Given these multitudinous complexities that health systems are only just coming to terms with, there is a major need to find solutions for this and future pandemics. The need for dedicated infectious disease blocks within hospitals and dedicated hospitals themselves is a possible way forward.

Given the advances in hospital design and architecture, it is possible to create modular health infrastructure — a hospital in hospital  model — that can be efficiently “turned on” in times of outbreaks. This will help safeguard health resources — manpower, material and beds — and enable better allocation on the basis of the burden of the outbreak and peacetime healthcare needs.

Second, the creation of dedicated hospitals that are used to treat infectious diseases needs to be part of the health systems policy. These institutions would need specialised manpower, equipment and hard infrastructure to adequately manage future outbreaks. The risk pooling of infectious disease loads will help in ensuring that during outbreaks the entire health system machinery is not thrown into existential peril. In peace times, these institutions could double up as research institutes and also carry out outpatients or ambulatory care, which can be relocated in times of acute need.

This approach, though capital intensive, is a dawning reality that systems across the world need to assess, engender and adopt in order to do equitable justice to those who acquire an infectious disease and those who do not, but remain vulnerable due to the state of their health.   

(The writer is a doctor and administrator, Apollo Hospitals Group)

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