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Corona Reset 2020: Yet to Find the Key
Manish Baldia, Vedantam Rajshekhar
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
Department of Neurological Sciences, Christian Medical College, Vellore - 632 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The coronavirus pandemic has devastated human life. It has completely changed the way we live and work. Neurosurgical practice has also changed all over India and in most countries of the world with surgery being offered only to patients who need urgent care. The authors are to be congratulated for formulating comprehensive consensus guidelines for neurosurgical practice in India, both at present and as the pandemic wanes. While the authors have tried to accommodate different practice settings in their guidelines, they have set the bar very high and logistical problems should be anticipated in implementing them. It is likely that several clinics, hospitals, and institutions that offer neurosurgical services, will need to modify these guidelines while adhering to the main principles of protection and safety of patients and health care workers (HCWs) and optimization of neurosurgical services.
The two principal areas where HCWs are likely to be exposed unknowingly to asymptomatic or mildly symptomatic patients are the outpatient clinic and the inpatient “non-COVID” wards. Infrastructure constraints and the massive patient population that most neurosurgical centers cater to prevent any meaningful application of physical distancing guidelines. The authors' suggestion that all patients be triaged using telemedicine to determine whether an “in person” consultation is needed, will go a long way in reducing the footfall in outpatient clinics and thereby provide a safer environment for the patients and HCWs. Although telemedicine has existed in India for over two decades, a recent study found that it was not widely adopted. This is an opportune time to fully exploit the virtues of telemedicine which can widen the reach of neurosurgical care in an efficient and economical manner.
Screening of all the patients in the outpatient clinic before the consultation seems hugely impractical at present. But with the major worldwide efforts that are going into advancing testing technology, it is not unrealistic to hope for a rapid and inexpensive test (where a result is obtained within a few minutes) that will be administered to all patients and their attendants who enter the hospital. Besides protecting other patients in the clinic and HCWs, such screening will also have the secondary benefit of reducing community transmission by identifying asymptomatic or mildly symptomatic individuals and quarantining them.
Designation of areas of the hospital, where untested “non-COVID” patients are managed, as “non-COVID” zones, can be a dangerous strategy. HCWs working in such areas might lower their guard and ignore or downgrade the necessary PPE protocols and thus, expose themselves and patients to the disease. It is well established that more than 50% of COVID transmission is through asymptomatic or pre-symptomatic carriers. HCWs should be repeatedly sensitized to the fact that whenever HCW-patient interaction precludes physical distancing norms (eg. clinical examination), whether in the COVID zone or non-COVID zone, appropriate PPE must be worn. Finally, working in teams, ideally three or more, is advisable. This will avoid exposure of the entire neurosurgical team to a positive patient or an HCW which can potentially lead to shutting down of the service. This might be challenging for hospitals with few neurosurgeons but even in such situations it is advisable to work as two teams that attend to neurosurgical patients alternately for a week or ten days at a time.
While neurosurgical practice (and human life in general) is undergoing a reset, the other side of the coin (nature) is also in a reset mode. Integrity of the ecosystem plays a key role for harmony among the species. Due to lockdown measures in this pandemic, nature is recuperating and making its best effort to restore the quality of air and water for the benefit of all the species. The play for the integrity of the ecosystem is highlighted in this smiley abstract painting [Figure 1]. This is a yellow smiley painting with two halves representing the emotions of happiness (yellow arc on lower left) and sadness (yellow arc on lower right). The outer circle (orange) depicts the coronavirus affecting the entire world. In the left half, a happy playful whale is shown reveling in the sparkling ocean and a revived atmosphere. At the same time, in the right half, locked up and masked humans are waiting with hope in their eyes to find the key (vaccine) to unlock the cage (centre, key hole). Let us join hands with nature in this universal reset and take a vow to not only practice and live safely but also not impede the rejuvenation of the environment.
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