Whatever preparation we make, it may turn out to be less

Dr Randeep Guleria, director, AIIMS, and member of National Task Force for Covid-19

42DrGuleria4 Dr Randeep Guleria | Sanjay Ahlawat

Q/What is your understanding of the situation?

A/As of now, we are in the grey area between stage 2 and stage 3 of the epidemic. Luckily, we have had limited reports of indigenous cases. But if such cases are missed, then we might see a spike in the number of cases. My concern is what we can do in terms of preparing for the future­—developing enough resources, planning on rotating and managing human resources and infrastructure, as well as accounting for other exigencies. For instance, we discussed today, if we get a pregnant patient of Covid-19, then how do we manage that patient; where do we conduct the caesarean, and how do we manage the newborn? The guidelines are there, but how will you manage that patient in your set-up. We are ordering as many ventilators as we can; and we have even started making our own sanitiser. But the industry also has to step in [for ventilators, monitors]. And..., the question remains—will this be enough? The situation is unprecedented; when we look at other countries, will there be enough ventilators? Whatever preparation we make, it may turn out to be less.

Q/How do you see the situation unfolding in the coming days?

A/Countries with supposedly better health systems than ours are not being able to cope. But we have some time to prepare, and if we follow aggressive quarantine, isolation and social distancing measures, we may be able to flatten the curve. We will have community transmission at some point, but we need to avoid the peak. If the peak doesn’t come, we may have fewer cases, albeit for a longer period of time. Then the health systems can manage. In my view, even that would be a big achievement. But if there are thousands of cases in a day, no health system can manage.... This should not happen here. The lockdown is to ensure that that does not happen.

Q/What is your biggest worry now?

A/Since this is an infection that is primarily confined to cities, where a large population lives in slums, things like social distancing and home quarantine have no meaning. If the infection spreads into that population, then, I am afraid, there will be a large number of cases, and we will have very little to offer. That will be a big challenge for India.

Q/How are you preparing for the coming days?

A/Two things are taking up time right now: firefighting and planning. There is panic among the general public—and hence, firefighting—and then, the concerns of the health care workers. There are reports of significant mortalities among health care workers abroad, and they are worried whether enough PPE (personal protective equipment) will be available. Besides, many of our health care workers are not being welcomed by the public, with the cases of some of the landlords asking them to vacate homes because they might have been in a facility that is managing Covid-19 patients. The hospital at AIIMS is being readied to manage Covid-19 patients, as many may need additional care such as dialysis or cardiac care. We are also working to operationalise the new burns and plastic surgery building for the purpose. We are also preparing the JPNA Trauma Centre and the National Cancer Institute, Jhajjar, for Covid-19 patients.