‘Whether children would need Covid vaccine or direct viral infection is going to be a big debate’
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‘Whether children would need Covid vaccine or direct viral infection is going to be a big debate’

Dr Suhail Naik in an exclusive interview with Rising Kashmir’s Health Correspondent Mansoor Peer shares his experiences during this time, suggestions and way forward.

Post by on Thursday, December 17, 2020

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Over the past nine months, healthcare workers are at frontlines to treat people suffering from Covid-19 and contain the deadly virus. President Doctors Association Kashmir (DAK) and senior paediatrician, Dr Suhail Naik in an exclusive interview with Rising Kashmir’s Health Correspondent Mansoor Peer shares his experiences during this time, suggestions and way forward.

Excerpts

RK: When COVID-19 started what was the first thought that came to your mind?

Dr Suhail Naik: The virus was a big threat to human life. It overburdened health sector in developed countries and later devastated world economy. Scientists were confused about the nature of coronavirus, its modes of transmission, clinical spectrum, treatment modalities to be used. While observing developed nations who were helplessly fighting the virus, I thought it was going to create havoc in India. I thought at least fifty thousand people would die in Jammu and Kashmir.

RK: Initially even doctors were scared of the virus. How did you manage the maternity services and OPDs?

SN: There was huge fear factor and a psychological impact. Everyone was scared and people were assuming that any individual or family infected with the virus would die.

Despite fear, none of the frontline health worker resigned or left their job. With commitment, we collectively took this pandemic head-on to save human lives. I salute them all.

The patients visiting hospitals were screened properly, classified and treated with best possible treatment. Running maternal and child services were a big challenge as you know child birth is a continuous process with potential to lose mother or child.

Maternity services were clubbed in separate facilities. All expecting mothers were screened for Covid 19. Sustaining mother and child services and managing other non Covid emergencies amid pandemic is a herculean task.

With collective efforts of administration and health department, we managed all Covid-19 and non-Covid 19 emergencies, though those were sleepless nights for all of us.

RK: The pandemic has affected children. Could you explain how?

SN: The immune system of children behaved in a balanced way to viral infection and no one developed acute respiratory distress syndrome. None of the children in J&K died directly due to Covid-19 complications or required level-1 ICU care.

Children are main amplifiers and transmitters for respiratory viruses. But in this pandemic they weren’t main transmitters or amplifiers of virus. They got infected from family members who used to go outside the home for routine work.

As children remained indoors, large number of children has developed behavioural abnormalities and aggressive behaviour. Many have developed phone addiction and have headache and eyesight problems.

They have literally frustrated their parents and in coming months situation will be more worrisome. Psychological, emotional and ophthalmological issues due to phone addiction will be a major public health problem in coming years.

The closure of schools and home confinement has affected behaviour and development of children. Many children gained lot of weight by eating of junk food, prolonged screen time and lack of exercise.

I advise parents to maintain a psychological balance with children and not stress them. It is important to cut the screen time, stop junk food and encourage exercise.

RK: What are your suggestions for parents as they cannot send children to schools?

SN: Due to the pandemic, we are all locked inside our homes. It is indeed a tough time for all of us, including our kids. Although isolation, physical, and social distancing is the new normal, it has led to immense physical and psychological pressure on the kids.

Right from their academic calendar to annual examination, everything has turned upside-down. Plus, the introductions of online classes and restricted contact with their buddies and relatives have left them in a tough situation. 

It is time to give more attention and care to your children, the better they will find to sustain this stressful condition. Try to spend quality time with them, play with, help them with their studies and hobbies to make them feel better.

A creative environment for them must be developed so that they stay away from negativities related to the pandemic. When their minds are onto something creative and rewarding, they will be happy and relaxed.

Kids are used to a particular routine owing to their school life. However, during the pandemic followed by lockdown, this routine has somewhat disrupted.

People should schedule the daily routine for kids. It will allow them to be disciplined. Make a structured routine for studies, games, physical activities, entertainment, meals as well as their sleep time. In this way, children will feel relaxed.

RK: Are our hospitals ready to treat the growing number of diseases?

SN: Successive governments have not spent much on health sector. The budget stands choked. At the same time there is no corporate help in healthcare sector in J&K.

So people invariably are dependent on public health sector which is fragile and overburdened. It is very difficult for our health sector to sustain load of indigenous diseases and then pandemics become very big challenge to deal with.

It is high time to inflate health budget, expand infrastructure along with modern technology, machinery, train manpower and create jobs.

J&K is in dire need of separate infectious diseases hospitals with high-end critical care facilities. Government should strengthen the already available health infrastructure with man and machinery, so that people get required treatment at their door steps.

RK: Please share your observations where we are lacking in providing treatment?

SN: Covid-19 has spectrum of clinical severity from asymptomatic illness to respiratory failure to death. But majority of patients, around 95 percent, are asymptomatic and don't require any special treatment other than observation.

Such patients can be safely managed at home under strict observation of medical officers with close monitoring. The home management of asymptomatic patients helps in keeping hospital beds available for desired patients and reduces fear of contraction. Covid-19 patients who are moderate to severely ill must be admitted and treated as per medical protocols.

Though, JK is providing all possible treatment to Covid-19 patients, but we lack in large-scale critical care units, so it is responsibility of people to follow public health advisories religiously and separate the elderly with comorbidities.

RK: Hospitals never close their doors on patients. What lessons have you learnt from the ongoing pandemic?

SN: As I said, there was fear of fatal virus and we have a large burden of non Covid-19 patients in JK. Overcrowding in hospitals could have proved favourable for spread of pandemic and devastating for people and health department.

Administration was very busy in upgrading and classifying health system and people were very scared to visit the hospitals.

We started online consultation and appealed people to stay home stay safe and don't visit hospitals for minor ailments.

We advised them to consult their doctors through online consultation. The online services were free and doctors from all specialties including super specialists were providing their professional services.

Thousands of patients took online consultation and were satisfied with services. The mode was praised by health department from time to time.

I congratulate all doctors who have helped the desired patients during tough times. I also salute the engineers for designing such portable web services which was easy to operate.

Despite low internet speed, we have delivered the best with high level of professionalism and enthusiasm.

Whenever a person falls sick, he always runs towards a hospital. During the pandemic even religious places were closed for months but hospitals were open for patients.

Doctors who get education and training while utilizing money of public exchequer should not be allowed to leave to green pastures for their personal family benefits instead jobs must be created to accommodate them to treat the patients here.

People must respect hospital property and any individual trying to vandalise or harm hospital resources must be punished. Covid-19 made it amply clear that health sector is the only hope during health crisis and now people largely believe in pure science.

People have high hope on modern science and technology. It is responsibility of government to provide all modern facilities and amenities to its citizens.

RK: DAK was at forefront demanding infrastructure upgrade. Do you think any major change has happened?

SN: We at Doctors Association Kashmir (DAK) have always demanded upgradation of health care. Welfare of doctors and people is basic preamble in DAK constitution. We stand for maximum possible health package for people at their door steps.

In recent past, health sector was in complete shambles. Even it was hard to get urine analysis at government hospitals. Now, health sector expanded at central and rural hospitals. The major contribution is that of National Health Mission.

The opening of five medical colleges has extended healthcare to rural areas. Now, government is starting DNB courses in rural hospitals which is going to augment special care.

 J&K should have two separate medical universities for all medical colleges so that standards of medical profession would be taken to highest level.

RK: Complaints continue to pour in about mismanagement in peripheral hospitals?

SN: To err is human and no one completely perfect in universe. Even medical science is incomplete, dynamic and changing. There are examples where a drug was the treatment of choice for particular ailment and later was described as harmful and withdrawn from protocols.

Medical science is an ocean, and drugs used to treat allergies can cause severe allergy in patient. I have myself seen a patient who developed anaphylaxis to injection hydrocortisone, which is otherwise treatment of choice to treat anaphylaxis.

See whenever a patient dies in hospital, people here feel that it is medical negligence. Recently a house in Uri Baramulla was engulfed by fire and a person died due to hypoxia. People call it medical negligence and an enquiry committee was framed.

People must understand that doctors try their best to save human lives and no one intentionally mismanages care of a patient.

No doctor wants to harm patient and it is scientific jargon which makes people to feel that mismanagement is done by doctors. Personally, I feel the term medical negligence doesn't exist in our profession, though black sheep are everywhere. 

Sudden cardiac deaths, maternal deaths, neonatal deaths and children deaths happen throughout globe. Around 80 thousand people die in America every year due to sudden cardiac arrest.

People must understand disease, complications and death are part and parcel of our profession. We try our level best to save people.

RK: Still there is a lot of misinformation about Covid-19 in Kashmir. What should people do in such a situation?

SN: See a lot of information is updated on social media every day. People must read scientific literature from authentic websites like WHO, CDC, FDA , ICMR, etc. It is better not to read scientific literature loaded with misinformation and can prove harmful for individuals or society at large. People are advised to believe and listen to their health experts and follow them. I request people don't try to become Google doctors as it can harm their patient.

RK: I have seen at many places that women refuse to go for Covid test. Why so?

SN: Women are psychologically strong and most of them don't show any reluctance to get tested. Some of them feel that if the test results are positive they will be isolated from their kids and family.

The psychological impact of testing positive was such that some women felt testing for Covid was inviting trouble for their families. But when they are properly educated about the importance of testing, tracking and isolation, then things become very easy.

Reluctance shown by some people means they lack information and education. It is the responsibility of professionals and media houses to spread scientific information among masses from towns to hinterlands.

RK: What lessons did you draw from this pandemic?

SN: The pandemic has taught us many lessons and has changed many aspects of our lives ranging from healthcare to social norms. The virus sounded warning bells across the globe, that despite scientific claims that world has reached the peak in achievements, the nations (including developed) are not prepared to handle a pandemic. 

The virus forced nations to go for war-like preparations required on the healthcare front. Governments have spent huge money on nuclear weapons, and failed to strengthen the health care system, the fundamental right of people.

Because pandemics can kill thousands of people in short span of time and can occur at any time as mutations don’t follow any calendar. Government should focus on safe water supply, sanitation, ban junk and unhealthy food. People should focus on self-hygiene and hand washing should be our habit.

The pandemic taught us one more lesson that vaccine is an important preventive measure to control or eradicate infection. So people should always vaccinate their children as per vaccination program of particular country.

NGOs play an important role during disasters or pandemic. So every village should have a health committee, which can take care of desired patients during crisis.

RK: What about the vaccine. Is it for all?

SN: Right now Food and Drug Administration (FDA) has recommended coronavirus vaccine for more than 18 years. Further trials are required to check its safety in pregnant women and people less than 18 years of age.

As I mentioned that Covid is mild illness in the paediatric age group and fatal in elderly people with comorbidities. Therefore in first phase government should vaccinate high-risk priority groups like health care workers, elderly people with age more than 65, people with comorbidities, people associated with emergency and essential services.

Targeting risk population would be best strategy to prevent Covid mortality and morbidity. Vaccinating priority group will definitely control the ongoing crisis created by pandemic and is indirect strategy to allow children to return to schools.

We must understand that only few people who were less than 18 years of age died due to the virus. Majority of them were suffering from some significant underlying illnesses or immune system compromise. It will be a big scientific debate in coming days whether children need Covid vaccine or direct viral infection is best strategy to sensitise their immune system.

Science is ever-evolving subject and consensus is drawn after broad research. The concepts become clear after analysing primary outcomes and adverse effects statistically.

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