Doctors send letter to KCR, outline 20-point action plan for the state

Hyderabad: A slew of senior doctors, many of them with distinguished service and recognition for their work, have written a letter to Chief Minister K. Chandrashekar Rao outlining a 20-point action plan to improve Telangana state’s Covid-19 management policy-making and implementation.

The letter said that a group of 39 medical professionals, and one lawyer, met recently to discuss and understand the challenges and policy responses in emergency health care, across all departments of the government. The doctors said they identified several areas that the government should act on to build a more resilient management of the crisis across various levels of administration.

With the virus now believed to be airborne, the letter called on the Chief Minister to ensure manufacture, sale, and use of poor-quality masks does not occur. The government should provide good quality masks to people in the lower socio-economic strata, and ensure mask compliance as “this seems to be one of the most effective preventative measure for this pandemic”.

The government should issue an ordinance and take control of all oxygen plants and channelise the distribution of the gas through a single window system. It also called for creating community oxygen centers for easy access of mild to moderately ill patients. “This will reduce burden on the hospitals. The oxygen production and supply should be regulated by government immediately,” it said.

The group of senior doctors also said that the daily Covid-19 bulletin must be “transparent” and display test positivity, daily active cases, deaths and discharged; and also an active dashboard of bed availability of isolation beds with oxygen facility, ICU/ non ICU beds in both public and private health sector for patients to easily choose their care based on their budget, location and bed availability.

Other suggestions:

* Need for government intervention and regulatory mechanism to ensure unobstructed movement of raw and packing materials, finished products and manpower related to manufacturing and distribution of drugs and medical devices. Invoke emergency provisions and full implementation of ‘Disaster Management Act’ to create a rescue zone to provide all needed facilities such as N-95 masks, PPE kits, Ventilators, medical oxygen, essential medications, by the manufacturers as a priority for those who need them;

* Need for government intervention to make available emergency medications such as remdesevir etc., in a fair and a quick way to hospitals to avoid price gouging by various players. Remdesivir and tocilizumab are injectables given only in hospitals, so should be completely available in “in-patient pharmacies” of hospitals under prescription by treating doctors, no other route should be available for people to scramble about. Same is the case with medical oxygen;

* Consider using a hospital preparedness checklist and the COVID-19 Surge spreadsheet to estimate and respond to the surge in demand for hospital-based services

* Create plans to reduce staffing shortages and assess the need for alternative care sites, such as emergency field hospitals;

* Consider setting up an Emergency Operations Center (EOC) for hospitals if not already in place and ensure the EOC has enough staff for an extended response;

* Work towards resuming/maintaining essential healthcare services using a risk/benefit analysis for in-person care visits while optimizing tele-health;

* Consider involving many of our available home health care, elderly care centers to provide isolation and medical care by telemedicine to mildly affected COVID-19 patients to lower panic, inconvenience, and burden on the infrastructure;

* Creating new infrastructure to increase the bed availability with help of organisations like DRDO to create isolation wards with beds, oxygen piping and ventilators to meet the increasing demands over and above the existing system;

* Expediting Rt-PCR testing and the turn-around time of conveying test results in public health sector by keeping availability of test analyzers and Lab Technicians at multiple near-by spots of testing facilities. Rt-PCR/RAT testing centers should avail 24 hours service in public health sector to cover the needs of the emergency;

* A proper triage at the entry of government tertiary hospitals for ICU beds not just based on Rt-PCR positivity but the overall picture of sickness in view of HRCT and clinical findings based criteria will prioritise admissions for the most needy at this time of crisis. Government should develop and expand ICU beds in Medical college attached hospitals and urgently incorporate them in to Covid-19 care facilities;

* Medical education of public regarding home isolation of the 80 per cent of the mild illness or asymptomatic patients by providing home kit of paracetamol, antibiotic /antiviral tablets and pulse ox meter and information of when to reach a hospital in case of worsening of symptoms. This will reduce an unnecessary burden on the infrastructure both public and private;

* Procurement of vaccines from the manufacturers as pre-orders at the earliest to reach our demands as the new guidelines decentralized the vaccination drive. There should be strict price caps and strict vigilance to not slip vaccines in to third party middlemen with high prices;

*After the availability of vaccines, expedited vaccination by adopting the past successful methods of door to door campaign and vaccination at work and residential areas to overcome vaccination hesitancy and delays due to transportation difficulties of extreme age groups, also this will enhance social distancing norms to prevent further spread of Pandemic. Vaccination program should cover 24 hours to cover the entire population quickly;

*Maintenance of good non-COVID related health care facilities in all public health sector and awareness education of public to not neglect their regular health care as non COVID emergencies can equally be life threatening in the long run. Converting an entire facility to Exclusive COVID facility may not be a correct alternative as all health emergencies are life threatening. There should be a plan to continue the other health needs as before;

*Developing telemedicine to the best of its expertise & capacity to reach out to the farthest of the people in rural areas to benefit for patients who cannot reach the cities for both preventive and cure of the virus infection. Involving many of our available home health care, elderly care centers to provide isolation and medical care by telemedicine to mildly affected COVID patients to lower panic, inconvenience, and burden on the infrastructure;

*Provisions of incentives, compensation, and adequate rest/ break time to the COVID care doctors, nurses and paramedic teams to ensure commitment and endurance in public health sector during these difficult times of pandemic fatigue. Application of ESMA may not be needed if government can take care of our health care team well with respect, rest and remuneration and full medical/life insurance coverage;

*Private hospitals charging beyond the norms should be checked by Peer review and legal committees to have a cap on the price. On the other hand, some private hospitals despite working very hard, get the rage, violence and destruction by angry families after losing their loved ones and having to pay heavy bills need to be protected against violent destruction by timely law and enforcement and judiciary committees;

*Society at large watching and filming the struggles of pandemic and politicizing the issues, either blaming doctors, hospital owners, police and municipal officials, state government, or Central government in media or social media should be penalised as a special pandemic precaution to maintain peace and focus on scientific priority at this time of emergency;

*Dead body disposal protocols should be standardized across to all private and public hospitals and the enforcement should be guided by law and enforcement strictly to ensure transportation of corpses from hospital to homes and cremation/ burial methods;

*Convalescent serum donation, banking, and information to seek the serum should be centralised with one standard single help line for the entire public health sector. This can be done with help of several NGOs and police departments which have done a phenomenal contribution in this crisis. Handing over to a single organization would be easy and take pressure off the government administration too;

*Finally, gaining trust of people of Telangana by connecting to them, by displaying the numbers correctly and honestly admitting the problems and challenges incurred through media every day like a 'Pandemic update’ will allow seeking a helping hand from many private organizations, union government, NGOs and private health sector for all needs that we are unable to fulfill at this critical time.

*The following doctors and other professionals who met with each other and/or discussed the points as mentioned above are listed below and signatures have been verified-

• Dr Gurubachan Singh, President Indian Medical Association- Airport Hyderabad.
• Dr Gokhale AGK, MBBS, M. S, M. Ch, DNB, SMP (IIM C),D.Sc. Senior Consultant Cardiothoracic and vascular surgery, Apollo Hospitals, Padma Shree Awardee 2016
• Dr Manjula Anagani, MD, FICOG, Padmashri Awardee, Guinness World record holder, Director and Head Sr Consultant Gynecologist& Obstetrician, lap, Infertility specialist, Assoc Prof, Kaloji Narayana Rao Univ of Health Sciences
• Dr Sai Ravi Shanker, MD, DM, FACC, FESC, HOD & Sr Consultant Cardiologist, Vaidya Ratna Awardee, Best Samaritan Telangana state.
• Dr M.S.S.Mukharjee, MD, DM,DNB, FESC, Sr Interventional Cardiologist, Medicover Hospitals, Director, Pulse Heart Center.
• Dr Lakshmi Lavanya Alapati, MD, FACP(USA), FACE(USA), Consultant Endocrinologist, Diabetologist, Managing Director, American Institute of Diabetes and Endocrinology, Hyderabad
• Dr Sanjeev Singh Yadav, Honorable Secretary AMS India, Vice President- IMA- Telangana, Consultant Surgeon and Proctologist.
• Dr Ravindra Nallagonda, MD, FCCM, IDCC, FCCP, Sr Consultant Pulmonary Critical Care, MD Ravindra Hospitals, Chaitanya Puri
• Dr M V Jagannadham, Prof and Ex-Chief scientist, CSIR-CCMB
• Dr Dilip Gude, Senior Consultant Physician and Critical Care Specialist, Virinchi Hopsital, Hyderabad
• Dr Lakshmi Kona, Senior Consultant Bariatric &La- GI surgeon, GLOBAL-Gleneagles Hospital, Lakdikapul
• Dr Vijaya Bhaskar Reddy, Orthopedic Surgeons association, TS Secretary,Chairman Ethics committee Clinical Trials and research, Hyderabad
• Dr Sai Lakshmi Dayana, MD, MRCOG, CCT (UK), Consultant Surgical Gynae-Oncology, Apollo Hospitals, Hyderabad
• Dr Prabhakar, Pulmonologist, Prof and HOD, MNR Medical College
• Dr Vijayanand, MD, MCPCH, FRCPH Consultant Neonatologist, Neonatologist, Rainbow Hospitals, Hyderabad.
• Dr Nanda Kishore, Senior Consultant, Physical Rehabilitation Medicine, MD:Gaman Hospitals, Hyderabad
• Dr Geeta Nagasree N, MBBS, MD (JIPMER), M. Ch (Surgical Oncology) Senior Consultant Surgical Oncologist, CARE Hospitals, Hyderabad
• Dr Ranga Reddy, President, President- Infectious Control academy of India, Prof of ID Univ of Hyderabad.
• Dr K Soma Shekhar Rao, MBBS, MD, DM (Gastro)Senior Consultant Gastroenterologist and Hepatologist, Therapeutic Endoscopist, Apollo Hospitals
• Dr Sharmila Kaza,Senior consultant Pediatrician, Apollo Hospitals
• Advocate Lakshmi Prasanna Chodavarapu, Member, District Commission, Hyderabad
• Dr Meeta Singh, MBBS, MD Obst and Gynecology, MD & Senior Consultant; Tanvir Hospital, Hyderabad
• Dr C.Surendranath MBBS,MD-VijayKrishna Nursing Home, CEO –WinVision Hospital, Hyderabad
• Dr Nanda Kishore Dukkipati, MBBS, MD, FASMBS, FIBC, Clinical Director and Chief Surgeon- Bariatric surgery, Live Life Hospitals, Hyderabad
• Dr Srikanth Susheel Kumar, MBBS, MS. General Surgeon, Lakshmi Hospital, Vanasthalipuram, Hyderabad
• Dr Sunil Mangalam, MDS, Dental Surgeon-Endodontist, Prof and HOD-Sarjung Dental College, CARE hospitals, Mahavir Hospitals
• Dr Chandra Shekhar Reddy, MD, DM (Neurology)Neurologist, Managing Director of Nizamabad Neuro Super Specialty Hospital, Nizamabad
• Dr Satyam Yadav.M, MBBS, MS (Ortho), MCH (Ortho), Director and Consultant Orthopedic Surgeon, Trident Hospital Shamshabad, Hyderabad
• Dr Rajasekhara Chakravarthy,MBBS,MD ,DM ( Nephro) Consultant Nephrologist, STAR Hopsitals, Hyderabad
• Dr V.M Shankar Reddy, MBB, DNB, EAES, FIAGES, FMAS, E-FIAGES, FALS, Consultant Surgeon SPARTA Surgical Services, Hyderabad
• Dr Sravanthi Gadhiraju, MS (OBG), FMAS, DMAS, Robotic Surgeon and Gynecology (USA), Yashoda Hospitals, Hyderabad
• Dr Ashish Chauhan, MD, Internal Medicine (CMC), Fellowship (CMC Vellore), CCLHA(CMA) New Delhi, Apollo Hospitals, Secunderabad
• Dr Vijay Janagama, Director-New Initiatives, Founding Medical Director, Suvitas, Post Hospitalization Rehabilitation Care Center,Hyderabad
• Dr Rajeshwar Kamineni, MBBS, MS (Gen Surgery), FMAS, FACSRI Consultant General & Laproscopic Surgeon, Pristyn Care HospitalDr T.TirumalRao, MBBS,DO,Senior Consultant Ophthalmologist &MD of Global Eye and Laser Hospital
• Dr K.Raghava Sunil, MBBS,MS(Ortho), Fellowship in Endoscopic Spine Surgery, Consultant Othopedic and Spine Surgeon, Avis Spine Center, Hyderabad
• Dr L.Vanaja Reddy,MMBS,MRCP,Consultant Physician and Diabetologist, Sree Teja Clinic, Hyderabad
• Dr Vinay Kumar, E.C , MBBS,DLO,MS(ENT), Senior Consultant and Co-Ordinator ApolloHospitals-Hyderabad, Sec SAHI- Society to Aid the Hearing Impaired, Hyderabad
• Dr.G.P.V. Subbaiah, MBBS,MS(Ortho),Fellow in Spine Surgery( Switzerland, Sweden,Germany &France) Senior Consultant Orthopedic and minimally Invasive Spine Surgeon, CARE Hospitals, Hyderabad
• Dr Pulli Vanaja Reddy, MBBS,MPH(USA), DCP(UK), MRCP(Psych), Consultant Psychiatrist.
• Dr ShravanKumar Reddy Panyala, MBBS,MS(Ortho), Consultant
• Orthopedic Surgeon, Shravana Hospital,Hyderabad
• K.Prabhakar Reddy, IAS, EX- Special Secretary to CM 2005-2009, Dist Collector, Warangal , Dist Collector Mahbubnagar.