The SKIMS Medical College Principal, Dr Riyaz Untoo is managing a major Covid-19 facility. He tells Syed Samreen that the cases are going to increase exponentially if the people continue ignoring the basic precautions like wearing the face mask and social distancing
KASHMIR LIFE (KL): You are a member of the Apex Level Committee on Covid-19. What exactly has been the role of this committee beyond issuing advisories which are otherwise in the public domain?
DR RIYAZ UNTOO (DRU): There are two types of advisories: Those related to the preventive aspects like making people aware of the benefits of wearing a mask, practising social distancing and proper sanitization. But, the committee does more than that. The advisory council deals with the management of patients, the line of treatment, the discharge policy and all other related issues.
KL: The hospital you head has an improved rate of recovery. What could be the possible reason?
DRU: In Covid-19, the most important factor is the management of the patients. Patients have to be put on special treatment and there has to be continuous monitoring. Our junior staff and the paramedic staff remains aware of the patient’s condition. Apart from that, we have installed CCTV cameras in many wards to continuously observe the patients and keep a watch. Our phone numbers are available to the patients in the wards; they are free to call any officer, from the principal to the casualty medical officer. Quick and immediate redressal of grievances has helped us in getting good results.
I have installed TVs in fifteen wards so that the patients don’t overthink about their condition. Keeping the patients entertained has helped in overcoming their anxiety.
Apart from that, a proper nutritious and hygienic diet was ensured to all the patients.
KL: How difficult was it to manage normal pregnant ladies at the hospital?
DRU: It has been extremely difficult. By far we have done more than 63 childbirth cases. These cases included 38 such women referred to us by various centres across Kashmir, who had complications but with the help of our efficient team of doctors, the major surgical procedures were carried out without any mishap.
KL: You fired a young doctor for asking for a mandatory PPE kit. Has SKIMS medical college restricted the right to the safety of its workforce?
DRU: Basically, there was a group of faculty members that were reluctant to attend to their duty, due to which there was some agitation. The incident you are talking about is totally wrong. The PPE kits were available in the institution from day one. Thousands of duty hours have been given by the staff members on Covid-19 duty, who have used these PPEs. Not a single member on Covid duty was affected by the virus. There are reportedly 4-5 cases of infections among the employees but they were not on Covid duty. I have to necessarily be a tough and strict administrator on non-performers. Under the disaster management Act, I would take strict action on anyone. A couple of days back, I terminated the services of two casual labourers who have been working for the last fifteen years, for not attending their duties. Patients can get badly affected if even a single member is missing from their duties during the day or night. Suspension of staff for dereliction of duties has helped me in maintaining proper accountability, discipline and patient care.
KL: Why Kashmir has not seen doctors and experts taking the lead? Why does someone from administration tell medicos what to do and what not?
DRU: When a pandemic occurs, the mere role of doctors is not enough to solve the issue. Pandemic isn’t confined to just treating patients. There has to be the identification of places and proper contact tracing. In all that, we need the administration to cooperate and coordinate. For example, if I identify a patient, my job will be to treat the patient but all the other work has to be carried out by the administration like tracing the contacts of the patient, quarantining dozens of the patients’ contacts, which cannot be done by the doctors alone. For the effective containment of the virus, joint efforts of the medical fraternity and the civil administration are important.
Doctors have been telling people to wear masks but the question is how many people have obeyed to it. So, unless the administration jumps in and enforces it on people, it won’t be possible.
KL: The crisis seems to be brewing. What is the stage Kashmir is currently in? What do you think about the next few months?
DRU: I think that the situation is grim. The cases are going to increase. Most of us do not follow the guidelines and SOPs. In a pandemic of such a nature, we have to prevent the entry of the virus into the human body. This can be done by simply wearing a mask. If we religiously wear a mask for six weeks, our valley will be free of any virus but the problem is that we don’t use it 100 per cent. We don’t have to leave any gap, once we do, we let the chain to continue and hence, there are more infections.
My advice to contain this virus which is at a stage of community transmission is that everyone should treat the other as a Covid suspect unless proven not.
Ninety per cent of the times, the virus has an aerial route, so to stop that we have to plug it by wearing a mask and rest, hands have to be timely sanitized.
KL: As the head of an institution where do you see the infrastructure of our hospitals? Do we require new facilities to cope up with any eventuality? Is the health system prepared to deal with any situation?
DRU: Our hospitals are prepared with the expansion of capacities day and night but there is a limit. It is not just about expanding the capacity, there has to be increased manpower as well. The medical fraternity is overstretched and fatigued. There should be some incentive for the class-IV staff, the nursing staff, the technicians and the junior doctors as has been done in Orissa. That way, more and more people will come forward and the staff will be increased.
KL: Do you feel plasma therapies are working the way they are being promoted? Also, is there an introduction of any new drug used to treat patients?
DRU: Plasma therapy is very important in treating patients. We have started it some time ago. However, the volume and the quantity of antibodies, as well as the number of neutralizing antibodies, differs from individual to individual. Everyone doesn’t have a significant number of antibodies, so once someone donates plasma, the quantification has to be carried out.
By far, the therapy is effective.
We have started using the latest drug by the name Tocilizumab, a monoclonal antibody against the interleukin-6 receptor. We use it to inhibit the cytokine release in patients and decrease the inflammatory response.