Covid-19 and the PHC’s role

The Punjab Healthcare Commission (PHC) is fulfilling its role as a health regulatory body in assessing and facilitating the healthcare establishments (HCEs) of Punjab for preparations to manage Covid-19 patients. The Commission is further ensuring that the well-equipped, private-sector HCEs in all the major cities of Punjab, with additional support systems, become treatment centres for patients infected with the coronavirus.

The stress on the health sector across the world has left even the well-advanced countries in wilderness, not to speak of developing or underdeveloped countries where the provision of healthcare has never been part of the developmental spending. Chaos is setting in amidst the confusion about how to deal with a virus that is both lethal and hospitable — it can kill a person while it can spare many even after having lived in the body. Such paradox can put anyone in quandary. The future is on hold and yet progressing. A cure is being looked at so is the algorithm to ascertain the number of deaths in the future.

While the rest of the world is under lockdown, healthcare practitioners, including doctors, nurses and allied health professionals, are struggling round the clock to save human lives. The nature of their profession and the sense of responsibility they carry do not permit them to stay home. Inevitably, health professionals including doctors are dying, getting sick, disappointed and fatigued. But they are working, nevertheless, in hospitals, laboratories, and in the field.

That also goes for the doctors working at PHC. They are contributing their share of effort to make sure that standardised healthcare facilities are provided to the Covid-19 patients. It is important to note that not all hospitals are expected, or even allowed, to treat corona patients. As per the stated policy of the government, only a few hospitals are eligible to treat patients infected with Covid-19.

The PHC, led by the Board of Commissioners and its Chairperson, Dr Attiya Mubarak Khalid, has prepared an Assessment Tool to gauge the preparedness of the healthcare facilities and laboratories to handle Covid-19 cases. The Assessment Tool has been prepared with inputs from the representatives of WHO, UHS, the Chairperson DEAG, Director CDC Punjab, Infectious Diseases experts from CMH Lahore, Institute of Public Health, PKLI, and the Infection Control experts from the private sector, including Shalamar Medical and Dental College and Shaukat Khanum Memorial Cancer Hospital and Research Centre.

The Commission has since directed all Category 1 private hospitals (having 50 plus bed capacity) to follow the Covid-19 SOPs and guidelines developed and revised by the Government of Punjab on February 29, to assess their preparedness against the Assessment Tool finalised and disseminated by the PHC, and submit to the Commission a compliance report.

When the outbreak began, a few of the big private hospitals in Lahore refused to treat corona patients and asked them to go to public hospitals. The Commission took swift action against those hospitals and warned that any such refusal in the future could be met with serious consequences. The PHC is now ensuring that selected private-sector HCEs in each large city of Punjab prepare themselves according to the required protocols and admit Covid-19 patients. This would help in lifting the burden off the public-sector HCEs.

Meanwhile, those private-sector laboratories, which are claiming that they can perform the test for coronavirus but do not have the necessary equipment and expertise, are being shut down.

Since dental procedures have been long considered convenient virus transmission routes, dental clinics have been guided to use disposable gowns, gloves, facemasks and caps. Special instructions have also been given to multiply the sterilisation episodes of dental instruments and to use intra-oral X-Rays only in cases of emergency. Dentists have been asked to pass up patients not requiring urgent care to avoid overcrowding.

In view of the importance of keeping a log of suspected and confirmed patients and the trend of the disease in terms of deaths and rehabilitation, the Commission has directed all Covid-19 treatment healthcare facilities to submit these details to the Provincial Disease Surveillance and Response Unit, Directorate General Health Services Punjab.

Invisible to the human eyes, viruses are by nature mysterious and problematic. By the time the scientists find the solution to tame the virus it would already have claimed thousands of lives and put many more in peril for its disposition to mutate, commute and transpose.

Louis Pasteur, the 19^th century famed microbiologist, once said: “Gentlemen, it is the microbes who will have the last word.” In the battle against nature, it has always been nature winning and putting scientists to a new road of experimentation, discovery and adaptive management. Nobody knows how long it will take scientists and virologists to come to grips with the coronavirus’ behaviour within the human body. Mutating rapidly, the virus has crossed over from China, the country of origin, to the entire world. Asia, nonetheless, remains the most vulnerable continent for having a dilapidated health sector.

Maria Van Kerkhove, the acting head of emerging infectious disease at WHO, said that since the coronavirus typically causes respiratory symptoms, the frontline safety measures may include: keeping hands clean by washing them with soap and water, maintaining distance with people who are sick, and keeping a sneezing nose covered with a tissue or flexed elbow.

Pakistan is also part of the global effort to defeat the coronavirus and is under a partial lockdown. Though it is a long fight and our resources are insufficient, the outbreak does provide a window of opportunity to put our house in order by adopting at least three pathways: one, by enhancing public health capabilities and infrastructure, especially in the primary healthcare; two, by reorienting the role of leadership and coordination for preparedness and response; and three, by propelling research and development in the arena of infectious diseases.

Together, these solutions would build a comprehensive and coherent framework to make the country safer against the threat of not only infectious, but all kinds of diseases.

Published in The Express Tribune, April 2^nd, 2020.

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