Dr A G Ahanger, Director SKIMS Srinagar tell Masood Hussain in a freewheeling interview
KASHMIR LIFE (KL): What is the state and status of the battle against the Covid-19 in Jammu and Kashmir?
DR AG AHANGER (DAGA): The situation in Jammu and Kashmir according to latest figures of SKIMS, Soura is that the Covid -19 infection diseases block has registered 918 patients in which 613 patients have been discharged and lately 113 people are going being treated. So far 150 have been treated and discharged. The mortality of this virus is 72 per cent in males and 29 per cent in females. More than 90 per cent of people who died had crossed 40 years of age in which most of them were with co-morbidities and in critical condition. In 22 per cent cases, the patients died in the first 24 hours after admission to the hospital, 17 per cent died in 48 hours and the rest in a week. Taking these facts into consideration we came to conclude that co-morbidities contribute more to deaths especially people with hypertension, diabetes, chronic kidney disease, liver disease, obstructive lung diseases, cancers or other such diseases.
KL: Earlier, we were told that the virus is spearing women and young but no there is no distinction?
DAGA: Initially, when we started the battle there was not much tracing, testing. Subsequently, as patient load increased out testing rate and capacity increased and also detection. Initially, people followed the government enforced lockdown and other strategies adopted to deal with the pandemic but unfortunately, off late, people became complacent and are not taking due precautions and adhering to health advisories. They take it lightly now which is the reason why cases are rising. The virus is infecting and turning out to be lethal for people with comorbidities.
KL: How correct is that the officials are devising the systems and the doctors are implementing them while it should have been vice versa?
DAGA: I disagree. Authorities dealing with this pandemic directly and indirectly from the Lieutenant Governor to the Deputy Commissioners and the field management staff to nodal officers are all in coordination. There are conference meetings, discussions, and debates assessing the evolving facts and figures, and eventually the framing up of policies, strategies, and guidelines which are shared with the public.
KL: Why was an advisory committee constituted so late?
DAGA: The advisory committee was on the basis of dealing with the situation created by the pandemic and revising the guidelines, SOP’s of WHO, ICMR, Government of India and Government of Jammu and Kashmir on need and scientific bases.
KL: Numbers are surging. So what is the way-out?
DAGA: The Covid-19 virus is invisible and lethal. No force but logic and science will prevail. As of now, there is no vaccine and till the vaccine is developed we have to deal with the virus with alternative strategies like lockdown, restrictions, social and physical distancing, changing of lifestyle to behaviour. We have to avoid religious, social, educational, and business gatherings. We have to live life in a new way. We have to adopt an electronic lifestyle. We have to use and adopt internet for work. We should look forward to e-education, e-governance, e-economics and e-management. Virtual life has become a reality. This is the only way we can fight it. We should follow the government health advisories and directions until the vaccine is found and urge, convince others to do the same.
KL: Is Kashmir undergoing a community transmission right now?
DAGA: Yes or No will not answer the question. We have to realize that infection and infectivity is increasing. The virus is mutative and presently there is a need for a lot of research to assess how lethal it is and will be. We do not know which strain is active right now. We need to follow the advisories of WHO which the local government can adopt and implement to control it.
KL: How far away is Kashmir from the elusive herd immunity?
DAGA: Globally there are debates about community spread. When 40 to 50 per cent of the population will be infected, at that time the seroprevalence will be checked which will determine how much of herd immunity has developed. If we assess seroprevalence presently it is low, thereby herd immunity is still a distant dream. (Seroprevance means the level of a pathogen in a population, as measured in blood serum.)
KL: A general belief is that with Covid-19 in focus, people are suffering on account of diseases otherwise treatable?
DAGA: Besides tackling Covid-19, SKIMS continues to treat people with diseases like heart attacks, strokes, cancers, kidney diseases, liver disorders, paediatrics, metabolic disorders and other services. The OPD has been kept open all. We opened tele-clinics and telemedicine for those who were not able to come to the hospital due to lockdown and non-availability of transport and kept our access available through mobiles and virtual clinics.
Every day more than 5000 people report to OPD. Our emergency services receive more than 2000 cases per day. We are aware of the fact that this institute is last hope for everyone and destination – Covid or non-Covid. I am thankful to the SKIMS staff that is working tirelessly round the clock with limited resources and risking their lives to deliver duties.
KL: What is the state of infrastructure in the battle against Covid-19?
DAGA: The SKIMS has enhanced its infrastructure. A separate infection diseases block has been dedicated for Covid-19 patients. Our equipment has been enhanced like ventilators; portable, fixed, invasive, non-invasive monitors and other health care infrastructure procured on a war footing. Besides, coping with human resources and also requested the government to engage more people on an outsourcing basis for the limited period of time until this crisis is over. We have redistributed the manpower where we can deal with non-Covid patients. We have our own oxygen concentrator transplants that cater to institutes needs fully. We are also ensuring proper biomedical waste management because disposing it off on scientific bases is equally important.
KL: What is the number of serious sick Covid-19 cases that SKIMS can manage?
DAGA: Presently we have 113 patients who are on advanced intensive care like ventilators, high flow oxygen, and advanced life support. We have a lot of intensive care areas where we are treating patients with advanced life support to non-Covid patients. We are ensuring if the need for advanced life support arises due to Covid-19 we are prepared.
We have adopted the World Health Organisation policy of test, test, and test. It is the only weapon to fight the pandemic. We have also enhanced the testing facilities. SKIMS is the first institute in Jammu and Kashmir which tested Covid-19 Samples. Up till now, more than one lakh tests were done which is probably the maximum data of any lab in our country. The credit goes to people associated with the microbiology department who have been working 24 x 7 as many among them have not been to home since months. I am thankful to all who are involved in the process from data entry to the data processing to data delivery.
KL: In absence of a treatment, how are doctors managing sick patients?
DAGA: The treatment protocol for Covid-19 includes the use of anti-viral drugs, anti-inflammatory drugs; conventional plasma therapy, steroids or the basic is oxygen. Work on developing vaccines is going on across the world and around 200 vaccines are at various state’s of development. But up till now, no final word has come. Given the speed and rush to develop a vaccine, it is predictable the by the end of this year the vaccine will be out.
In certain patients, we use equipment called ECMO (extracorporeal membrane oxygenation) which is similar to the heart-lung by-pass machine used in patients whose lungs have been damaged and can’t function anymore. In various places of the world, even lung transplants are taking place.
KL: Even the SKIMS has started plasma therapy?
DAGA: Persons who recover from Covid-19 develop anti-bodies that can be used as plasma therapy to fight the virus in another patient’s body to save the lives. We have brought it into government’s notice and with the approval of ICMR and Government of India have adopted it on compassionate grounds. We are planning to create a plasma bank so that lot of people can benefit and contribute to saving the lives of others and awareness programme is being held to ensure people participation.
(Khalid Bashir Gura processed the interview)