|Ahead of print publication
Live in fear or make our lives better?
Rakhee Goyal1, Anju Grewal2
1 Department of Anesthesia and Critical Care, Madhukar Rainbow Children's Hospital, New Delhi, India
2 Department of Anesthesia and Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
|Date of Submission||23-May-2020|
|Date of Acceptance||19-Jun-2020|
|Date of Web Publication||31-Jul-2020|
Madhukar Rainbow Children's Hospital, New Delhi - 110 017
Source of Support: None, Conflict of Interest: None
There is a constant chatter about the ongoing COVID 19 pandemic in our phones, television, radio, newspaper, and so on. Internet is loaded with it, family and friends are chatting about it, and every conversation is around COVID. The COVID pandemic has created fear and panic all over the world on one hand, but on the other, it has unmasked many inadequacies that we were living with.
Are the anesthesiologists the new front liners taking undue risks in our emergency departments, ICUs, and operating theaters? Or are we allowing ourselves to live in constant fear, continual fatigue, and an undeniable sense of impending doom? Is there a way forward to continue our so-called new normal routines?
We have always been in a habit of following guidelines and advisories, all based on “evidence-based medicine.” We have followed them, we have taught them, and we have audited them from time to time. Information on the novel corona virus and the COVID-19 disease is ever evolving currently. Today, we know so much and yet so little about this novel virus that we are at a complete loss at what to follow and what to teach. However, as the disease spreads in our country and across the globe, we can collate our data and gain new insights. Indeed, these insights and genuine scientific data can help allay our fears and help us regain control of our lives and livelihoods as well.
Hence, constantly updating ourselves with ever-evolving scientific information can help us to move forward safely. In this context, this special COVID issue attempts to encompass guidance on intensive care management and anesthetic concerns, with a focus on safety measures for the health-care provider.
Among the various measures to protect each other are three simple measures, namely, thorough hand hygiene, wearing well-fitted appropriate medical masks, and social distancing. There has been a surge in the production of innovative face masks, hand sanitizers, and other personal protective equipment. There are images and videos going viral on how to effectively use and reuse these items. People are thinking, and improvising, and making do with what they have in hand. This was seldom seen earlier. It is a progressive step toward the realization that our world has limited resources and we all need to respect it.
In the critical areas, as in our operating rooms (OR) and ICUs, the concept of hand hygiene was always underestimated. There were posters that illustrated good hand hygiene on the walls of every ICU and OR scrub stations, but seldom were they noticed or followed rigorously. These days every individual has started making an honest attempt to put in place the laid down recommendations and also encouraging their colleagues to follow the same as well.
Similarly, surgical masks have been used in the ORs for ages but now everybody ensures that they cover the nose and the mouth completely. We have started testing the fit of the mask to make sure that it is effective and safe.
There is a new change seen in the practice of the anesthetists. Earlier, we thought that we could do without gloves while putting an intravenous line and during airway management. Unless made mandatory by the institution, this step was often forgotten or simply ignored by many of us. The stethoscope that we carry around and used on every other patient was also not cleaned as frequently as it should have been. The pen, torch, hammer, and the common tools that we filled our pockets with were rarely sanitized. The current scenario has changed all that. Everybody wears gloves, everything that we carry is cleaned after every use, and there is a conscious effort to avoid contamination.
Some people have had an explosive screen time on their mobile phones, even at workplace. They tend to succumb to the primal urge of checking the phone repeatedly, unless of course it was strictly banned or officially discouraged. The fear of missing out has been very strong. In the recent past, there has been a realization that these mobile phones may be the biggest carriers of the viral fomites. People have started making an effort to minimize the frivolous use of their mobile phones. It appears to be a step toward better focus on patient monitoring as well as improvement in interpersonal relationship at work.
Talking loudly or talking too much may cause aerosol generation, and this may lead to increased spread of respiratory droplets, and hence the spread of the virus. We have started talking less, both in the ORs and the ICUs. There is less loose talk, limited criticisms, lesser probability of patients, or their attendants overhearing dangerous conversation, and there is more focus on the work commitments.
Hugging, hand shaking, and high fiving have suddenly become outdated. We may have stopped shaking hands with each other but the urge to connect with others is not diminished. We have promptly invented elbow touches, foot kicks, and butt bumps. We have revived our traditional “namaste” and adopted some touchless greetings from other cultures. We have been quick to reconnect, with a mindful attention to social distancing.
The pre-COVID-19 world was continuously participating in a race to do better to an extent of outdoing or running down each other. A sense of contentment is now overcast on our souls and we are ready to accept it. We have a common motto to stay “alive.”
The last but the most important realization is that it is no longer only about us. We are worried more than ever before about how our colleagues and other staff members are protecting themselves. We know that if we do not take adequate precautions, we can infect each other. We are learning to live together, sharing limited resources, and creating room for everyone. We are imbibing a better sense of self-discipline, a better tolerance of work culture, and a better understanding of work ethics and professional behavior. We have started gathering more respect for the colleagues who are making it to work, risking their own lives, and that of their families. This cultural shift to adapt and practice the basic preventive measures is the core of the much-needed control of our lives to move ahead. In his recent article in The New Yorker, Dr. Atul Gawande, a surgeon and a public health researcher, writes in detail about the measures that are being taken in his health-care facility at Boston. He also emphasizes how the culture of the place and the people plays a role in implementing these policies. He says that it is one thing to know what we should be doing, and it is another to do it rigorously and thoroughly. It is time that we understand who we are and how we can make ourselves better, and culturally, more evolved.
In many ways, the present situation has given us opportunities to improve the quality of care not only to our patients but to ourselves as well. It has called for higher standards of infection control practices that we never bothered to heed to. It has allowed us to look within ourselves, evaluate the way we have been working, reorganize work in tandem as a team with a more preemptive, focused, protocolized, and a minimalistic approach. It has given us an insight into our standard operating procedures, the bureaucracy of our work ethics, and laid bare our shortcomings. Indeed, this can be taken as an opportunity to fix our inadequacies and move toward a healthier, safer existence together.
It took a pandemic of this proportion to teach us a few basic principles of life: anticipate, prevent and protect, make room for everyone, and live together. We should seize the opportunity to move ahead toward the new beginning of survival with excellence. Let us focus on getting back to normalcy amidst chaos and adopt a culture of practicing our basic norms.
| References|| |
Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic – A narrative review. Anaesthesia 2020;75:920-7.