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Monday, 24 May 2021 | Vinayshil Gautam


Many protocols in these testing times are at different stages of evolution

COVID times will someday get chronicled.The coverage will have a special place in history. The experience will add to human endeavour to be healthy. The responses to the virus have been diverse in different parts of the globe. Solutions in the field to meet the situation have somethings in common, but much in diversity. Understandable because of the changing variables in different countries in terms of sophistication of technology, application of science and how exhaustive planning is. And then there is the pharmaceutical sector, evolving from drug producer to vaccine creator, its profit motive never completely written off.

There are many protocols for response to COVID circulatingin the world. From the World Health Organisation to the designated bodiesin nation states they all have some kind of a protocol they have adopted. In India, the protocol which has the highest authority is that of the Indian Council of Medical Research. Instead of comparing protocols, it is purposeful  to realise that each one is a sincere effort to find a solution in terms of the empirical evidence available to that given agency. It also dependson research competency.

Possibly,several of these respected protocols are among themselves at different stages of evolution. Illustratively, in one research environment an elevated D-Dimer, (a sign of thrombosis), is taken as something which has to be responded to with anti-coagulants of different types, compositions and potency. In another environment, research points out the abundant use of ambulation, plenty of fluid intake and letting nature take its course. In certain other environments, response to Covid requires quick use of steroids. The pros and cons of these approaches cannot and need not be analysed here. More to the point, it is this lack of uniformity which can and does cause a problem in the range of responses.

Add to it the fact of bulging numbers and how there are simply not enough qualified doctors. Apart from the sheer numbers of patients, it is also because physical examination has become a rarity and teleconsultation has become the norm. It ultimately boils down to chance as to what kind of doctor one has access to. It is these issues that will ultimately determine the effectiveness of the response to the disease.  

Each patient is unique and whereas standard protocols do go a distance they do not necessarily enable an organic progression that can fully respond to a patient's need. When this is coupled with less than total reliability of the screening tests of the disease, the level of confidence the line of treatment evokes becomes ambiguous. Under the circumstances, there needs to be a far greater accessibility of medical solutions so that the patient has an intelligent choice of what works for him or her.

One can make out some of the complexities of and shortcomings in our Covid responses. Singapore, Taiwan and now in the United States of America have succeeded in overcoming the problems. So much so that in parts of the US they are considering stopping usage of masks, media reports say. The point is a simple:one has to collectively create a climate of evidence-based protocols making allowances for individual characteristics of body system. There is no crash course to achieve this target. What can be done is strengthen a policy framework for enabling it. It will take time. The journey must begin somewhere.

(The writer is a well-known management consultant of international repute. The views expressed are personal.)

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