Photo: El Nacional, retrieved.
The COVID-19 pandemic has been regarded by many world leaders as the most important challenge the world has faced in decades, forcing governments to adapt to unprecedented and changing situations with extremely short notice. Health systems considered solid and efficient have found themselves overwhelmed by the quick spread of the disease, among the general population and health workers alike.
In order to cope, healthcare capabilities are being increased in many countries. Some of these interventions are straightforward and relatively easy to implement, like buying new diagnosis kits to test larger numbers of people, or more ventilators to increase the capacity to care for patients. This is vital of course, but we must remember that only a small proportion of all infected patients will need them, and these measures can be centralized in high-level, pre-existing hospitals.
On the contrary, all patients will be highly infectious, so identifying them before they pass on the disease is extremely important. This means that all pre-existing primary care facilities, such as outpatient clinics and small hospitals, must be adapted to deal with suspected cases in such a way that they don’t represent contagion sources.
On the contrary, all patients will be highly infectious, so identifying them before they pass on the disease is extremely important.
Upon admission, all patients should be given a mask and wash their hands, then placed in a waiting room with a separated area for those with respiratory conditions, before finally being taken to a screening area to be seen by a doctor. Non-suspicious cases could then be managed in the facility, while suspicious cases should be moved to an isolation area where samples should be collected before they’re hospitalized, discharged to self-isolate at home, or referred to a designated treatment center, depending on their individual characteristics.
A constant supply of masks, protective gear for doctors and nurses, as well as soap and regular access to water must be guaranteed in all these places so they can be adapted. The use of point of care tests to quickly detect the virus in a low-technology setting would also improve the impact of these interventions, although there are still doubts regarding their capacity to correctly detect patients.
In any case, providing these seemingly trivial resources to the pre-existing healthcare network is perhaps the most complex challenge in underdeveloped countries.
Some of the patients may not require a ventilator or going to the ICU, but could still benefit from other simpler treatments, like oxygen therapy, or continuous monitoring, which can’t be carried out in self-isolation at home. These moderately sick patients will be the bulk of all hospitalized cases, and they represent the most significant strain on the health system, since their large number and the complexity of isolation procedures, can quickly collapse existing hospitals. These are also the patients you’ll see being taken care of in stadiums and convention centers turned into field hospitals.
Providing basic care in these instances will translate into a smaller proportion of severe cases, fewer deaths and, more importantly, better use of more complex and expensive resources. These areas must be designed carefully, following very detailed parameters summarized by WHO in this document.
Finally, it’s also key to guarantee the protection of healthcare providers. All doctors and nurses in direct contact with potential cases, like those working in primary care settings, emergency rooms or ambulances, should receive masks and gloves at the very least, and count with the infrastructure to regularly wash their hands. Personnel taking care of suspicious or confirmed patients should also count on eye protection and disposable aprons. Those in the ICU or areas where invasive procedures take place should have full personal protection, including high-grade filtering facepiece respirators and disposable gowns and boot covers.
Not guaranteeing these conditions is simply irresponsible and could have devastating consequences on health systems of developed and underdeveloped countries alike.
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