Response Strategies to COVID -19 : Role of Veterans – Hot Wash of the Proceedings By Lt Gen Dushyant Singh,( Retd)

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Introduction by the Anchor: Lt Gen Dushyant Singh, PVSM, AVSM

            The webinar held on 23 May 2021, was dedicated to an issue that should have been taken up by the STRIVE, a long time back, given the devastation it has caused to human lives and to our economy. As of May 22, 2021, over 16 crore people in the world had been affected by it. 34 lakh people have lost their lives, but the comforting fact is that over 14 crore people have recovered as well.

The global death rate stands at 2.1 % and the recovery rate at 88%. Deaths per million stand at 443. If we contextualize the figures in respect of India in the wider perspective of the world,   India is now the second most affected country in the country with over 26 lakh cases with a number of deaths at 295,525 and recoveries at 23,070,365. AlthoughIndia’s death rate is much below the world mark and stands at 1.1 % and the reassuring news is that the recovery rate is also very high at over 98%, but the life of even one human being is valuable, and therefore, an all-out effort needs to be made to save every life.

Economically too our growth was in the negative last year and this year’s projections of 11% growth have been dashed to the ground by the Second Wave or the Tsunami of the COVID-19. As per the current assessment based on a news item published in the Dainik Jagran, quoting an SBI Economic report, India is likely to suffer a loss of over Rs 5.5 lakh crore up to June 2021. While the Government is doing its bit to save lives and the economy, can we as Veterans do something to mitigate the situation? What all sacrifices have the medical fraternity made in the line of their duty? Should they not be declared as war Heroes and recognized for their gallantry. There are many more such questions that need to be deliberated. To cover these issues, we the Team STRIVE decided to organize a Webinar.

We were indeed fortunate to have a highly distinguished panel to show us the way ahead.

The Key-note speaker of the webinar was Lt Gen (Dr) Ved Chaturvedi, PVSM, VSM-

The General, a former DGMS (Army), and now working as the Prof & HOD Rheumatology & Immunology at the Sir Ganga Ram Hospital, New Delhi raised some relevant issues and gave some excellent suggestions to deal with the COVID-19. Salient points were as follows:-

  • Ignorance of the problem was a major issue in the initial stages of the Pandemic even in the medical fraternity.
  • Lack of treatment has remained a constant worry hence the need for the observance of a strict COVID protocol by the people.
  • Till we can find a treatment, vaccination is the best way to deal with the problem.
  • There is corruption in the Pharmaceutical business, and it needs to be addressed on priority with a heavy hand.
  • The absence of any kind of strategy in terms of lack of a formal organisation and a protocol to deal with medical disasters is quite conspicuous. The NDRF appears to be totally inadequate to handle medical emergencies.

The General, made the following suggestions, with a  view to prepare for the next wave of the Pandemic:-

  • Safety of children and the best way is to get ourselves vaccinated so that we do not become a cause of the spread of the virus to our children.
  • Dealing with any symptom partial or complete irrespective of RTPCR result to be diagnosed by the doctors as CLINICAL COVID.
  • Finally, he also suggested raising of Medical Disaster Units and SOPs under the NDMC / NDMA on priority. (He also brought out that in this regard he had written an article in April last year in which he had suggested raising of Emergency Medical Response TA Battalions comprising medical and non-medical fraternity personnel from the ESM pool).
  • The General also strongly recommended that for better care of veterans, separate Veterans’ Hospitals be created.

Our next speaker was Dr Ashoka Jahnavi Prasad (educator & psychiatrist)-

We were indeed fortunate to have Dr Prasad, professor of psychiatry, Sawgrensha Institute Gothenburg Sweden,  amidst us to speak on the Psychological Impact of the COVID-19 Pandemic, which is highly relevant as the trauma on account of COVID-19 has directly or indirectly affected each one of us. The COVID-19 has not only impacted us physically, but it has also deeply affected us psychologically. A spate of Suicides due to loss of jobs, loss of near and dear ones, lack of socialization, disruption of social support system, loneliness and helplessness in even extending a helping hand to your near and dear ones living away from us are some of the factors contributing towards it. How can we get over it, has been a major cause of worry? Dr Ashoka Jahnavi Prasad suggested a number of measures. Highlights of his address were following:-

  • He, first of all, gave out the medical fallouts of the psychological stress generated by COVID conditions in an individual and the society. He also listed possible treatments for such stress-related conditions including drugs. Medical fraternity may go to the link to get the details regarding such illnesses on our website,  striveindia.in
  • He also spoke about the behavioural aspects of a person and their treatment such as anxiety disorders, insomnia, stress disorders, post-traumatic stress disorder (PTSD), de-stabilization effects, on an individual in the long run. He suggested besides drug-related interventions focus on psycho-social intervention (services of counsellors etc), ushering in a sense of autonomy through group therapy, socialization, counselling and trauma-focused therapies.
  • Finally, he highlighted the trauma suffered by the caregivers themselves due to excessive exposure to the infection, arduous and stressful working conditions, lack of sleep and rest. Most importantly witnessing patients suffering due to COVID-19, day in and day out, including hundreds of death in their line of duty. He suggested that the caregivers have to be treated in a similar manner as the patients if they start suffering from such symptoms. He also stressed the need to make their routine and working conditions in such a manner that stress-related disorders in caregivers are reduced to the minimum and if they do occur, adequate mitigating measures are there in place, to take care of them.

Our next speaker was Col Indranil Ghosh, Senior Advisor, Medicine and Nephrology, Command Hospital Central Command (CHCC)-

The CHCC along with their core team comprising of a team of doctors of the stature of Col Indranil Ghosh under the inspiring leadership of Maj Gen Ramesh Kaushik, VSM has been providing intensive care to the seriously ill and affected personnel both serving and veterans and their families especially at a time when most of the empanelled hospitals had raised their hands due to unprecedented overload. As per the Commandant, it has been a heart-wrenching experience to see that both the patients and the caregivers have suffered in equal measure.  Salient issues covered by Col Ghosh are as follows:-

  • He explained the details about the coronavirus as to what it is and how does it infect our lungs and the entire body thereafter.
  • He informed about the treatment of patients affected by the CORONA virus. In this connection to emphasize the line of treatment, he shared graphics and photos of the details of the suggested treatment being carried out at the CHCC. He informed that to improve the degree of care, the ICU COVID facility from few beds has been increased to 165 beds in a record time.     
  • He also highlighted the efforts made by the hospital to keep the supply of oxygen in the hospital going 24X7 without break. Construction of additional oxygen plants initially under the hospital arrangements and subsequently by the help of MES was also a praiseworthy effort. The effort by the CH to keep the supply chain going smoothly related to oxygen and medicine has been the highpoint of the effort made by the hospital, which has resulted in the saving of a number of lives of serving personnel, veterans, their dependents, and NE dependents of the serving and veterans.
  • Col Ghosh also listed the precautionary measures to be taken to remain safe from CORONA. He also cleared the air on some of the myths that are prevailing in the environment based on misinformation and advising the people to follow the ‘COVID appropriate behaviour’.

His entire presentation is available on the Website of STRIVE and those keen to go through it may kindly go through it.

The last speaker of the day was Col Mahender Singh, Director Regional Centre, Ex ServiceMen Contributory Health Scheme (ECHS) Lucknow- 

Col Mahender Singh has been the Director of the Regional ECHS HQ since Jul 2019. Given his experience in managing the first and now the second wave of the COVID 19, he is probably the best person we could have asked for, to speak on the topic, ‘ECHS: A Force Multiplier’. He in his presentation highlighted the role of ECHS in the Pandemic and the help & the assistance that the ECHS is extending to the ESM fraternity to deal with the impact of the COVID- 19 pandemics.

The highlights of his talk were as follows:-

  • The ethos of the ECHS is based on the motto “Action on Call.” He also listed out the range of assistance, which is provided to the veterans from providing medicine, facilitating tests, and helping them in admission in either a service hospital or empanelled or non-empanelled hospital. He also gave out the simplified procedure to claim the cost of medicines and medical equipment required in the management of the COVID or any other illness.
  • He informed the details of the ‘Home isolation package’ for the veterans, provision of oxygen cylinder on payment, reimbursement of dialysis cost either from empanelled or non-empanelled hospitals at CGHS rates. Procedure to claim these facilities will be put up on the ECHS website for a ready reference of the veterans.

Question and Answer Session

Question 1: The first question was addressed to Dr Ashoka J. Prasad on how to manage home isolation Trauma in respect of the Children?

Answer: Dr Prasad recognized this as a very major problem during the COVID crisis. He gave the example of the plight of migrant children who had moved from as far as Mumbai and Gujarat to UP, Bihar, Jharkhand and the NE. For such trauma, he suggested the construction of shelters en route by the Government bodies or the military. He also suggested community intervention for such children in terms of creating facilities either in form of covid safe playgroups or digital programs to keep the children engaged positively including online engagement in constructive activities under NGOs.

Note: My suggestion: There are some NGOs that are looking after aged people who are left helpless due to their family support getting affected due to COVID in Lucknow also. I managed to get one person placed in such a facility through my contacts- Author’s Note!

Question 2: What is a black fungus and why do medicines required for such life threatening diseases immediately are in short supply?

The question was explained by both Gen Ved Chaturvedi and Col Indranil Ghosh.

It was explained that it is a fungal infection. It goes through the nose, but it can go thereafter towards the eyes and then to the brain or downwards towards the throat. If it goes upwards, it becomes very difficult to treat. It is a treatable disease provided the medicine ‘Amphotericin-B’ drug is made available. The reason for the shortage was that it was a very rare disease prior to the onset of COVID 19 and therefore due to a sudden surge the medicine went out of stock. In order to prevent hoarding and black marketing of drugs like Remdesivir, the Government has taken control of the medicine to ensure fair distribution. The manufacturing of the medicine is also being ramped up, on a war footing and the supply would be improved shortly.

Question 3: The last question pertains to the procedure to get admission in the CH/MH/BH for veterans in the event of COVID?

Answer 3: The Director ECHS informed that the patient need not go to the ECHS in such cases they can go directly to the CH and if there is no place then he can go to any hospital empanelled or non- empanelled and he or she would be reimbursed as per CGHS rates. He also highlighted that the Regional HQ does its best to get the patient admitted by speaking to the CMO of the District because now all beds allotment has been centralized under the civil administration even for hospitals made by the DRDO in Lucknow and elsewhere.

Conclusion

The Webinar covered a lot of ground including issues such as generic information about COVID-19, managing the COVID cases, functioning of the CH and the support it is providing to the veterans and the role of the ECHS in helping the Veterans in dealing with this extremely life-threatening pandemic sweeping across the world.

Many misgivings and apprehensions related to the role and functioning of the CH and BH were allayed. We were also fortunate to hear some practical suggestions on preventing ourselves from sliding into depression and related ill effects from one of the best Psychiatrist in the World, Dr Ashoka Prasad. Also, the suggestion of Lt Gen Ved Chaturvedi to treat every patient displaying symptoms even remotely related to COVID should be treated as a Clinical COVID patient and to manage his further treatment as per COVID treatment protocol without waiting for RTPCR tests. His suggestion to formulate a Medical Disaster Emergency protocols under the aegis of NDMA/ NDRF is an excellent idea and needs to be acted upon by the Government to prepare society better for the third wave which in most likelihood will affect the younger children and the people in the villages. Gen Chaturvedi’s suggestion to go for dedicated hospitals for the veterans is another idea that is worth considering on priority. A related suggestion to the Amelioration of Stress-related disorders suggested by Dr Prasad in terms of psycho-social intervention, group therapy, cognitive behaviour therapy, developing a sense of autonomy through socialization, and treatment of insomnia would go a long way in combating the mental disorders related to COVID. His suggestion to take special care of the CareGivers is indeed very important and everyone in society must be sensitive to their needs. They are fighting a war and they need to be awarded for gallantry in the true spirit of CORONA warriors. Finally, we need to plan from now itself based on this devastating experience of the second wave as to how to prepare and mitigate the effects of the likely Third Wave as and when it hits us. Also, we have to now find innovative means to keep our economy and education on track because another setback will take us back by a number of years which we can ill afford.

Disclaimer: The views expressed are those of the author and do not necessarily represent the views of the organisation that he belongs to or of the STRIVE. The author is responsible for the content and the analysis.

STRIVE : (Society for Transformative Research Integration and Veterans Empowerment) is an initiative of veterans, who after hanging the uniform decided to have a “Think Tank Platform” at Lucknow, the capital city of Uttar Pradesh (India), with a view to harnessing the immense knowledge and experience of the retired community and use it for the betterment of the next-generation and society at large.