Should doctors be saved or stoned
“A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own.” — W. H. Auden
Doctors are critical to a successful response to the COVID19 pandemic. They play critical roles in diagnosis, containment, and care, and their willingness to treat despite elevated personal risks is critical to the effectiveness of public health response. Frontline employees have been subjected to high work volumes, personal risk, and social pressure in order to meet extraordinary healthcare demands. Despite this, conventional public health ethics has paid little attention to protecting doctors’ rights.
Credibility of a medical practitioner in present era
The position of doctors during the COVID19 pandemic, with a focus on the Health Service, by answering the following four questions: what are the essence and scope of healthcare providers’ duties? To whom do these responsibilities apply? What are the employers’ and patients’ mutual responsibilities to doctors? What do doctors do if these mutual duties are not met? While these questions apply to all healthcare professionals, it is important to note that different healthcare professionals have different responsibilities, which can influence the degree of their occupational risks and duties.
Doctors and COVID19: Why we need to be a wise human first
Many physicians around the world have had personal encounters with COVID19 infection. Many doctors/medical practitioners have a terrifying experience with COVID19 in the year 2020, when all of their family members test positive and have a turbulent path. The majority was of the opinion that the dreadful tale of COVID19 should be hidden in order to protect their patients in tough times by wearing masks and taking antibiotics on their own, which then degraded their health and caused death to numerous medical practitioners.
Courage to work and treat under INFECTED Culture:
The response is easy and straightforward: “because they handle contaminated patients.” It is a self-evident truth, but it is only a partial explanation. It is widely accepted that when treating patients, doctors subconsciously train their minds to be emotionally distant from the disease, which aids them in making reasonable decisions. They have persuaded themselves that the patient in front of us has a disorder that will not affect us. And if it does, they will benefit more than our patients. Too much of this leads some doctors to believe they are invincible. Early in the pandemic, doctors who were unconcerned about PPE and other safeguards were the most vulnerable targets. Many senior practitioners, physicians, and family doctors, especially those in private practice, underestimated the infective potential. They were comparing this to the yearly influenza outbreak and figured they’d make it through just fine. Many doctors carried on with their clinics as usual, without PPE, without monitoring patient numbers, and without paying special attention to social distancing or sanitization. Family doctors were the most vulnerable and were exposed to infected patients. Family physicians and doctors employed in smaller practices were unable to support the increase in operating costs due to the high cost of PPE/masks/sanitization kits combined with lower earnings. Those who kept hospitals and clinics closed found that this could not continue indefinitely and opened the clinics to a flood of patients.
At the same time, in other parts of the world, a few patients filed consumer complaints alleging infections from clinics and hospitals. Some of us forgot that doctors are not superhumans and that they too can become infected in non-hospital settings where they are not wearing PPE. The doctor’s identity may have saved them from police intervention during the lockdown, but it did not protect them from infection.
This pandemic has once again shown that doctors are poor patients. Doctors have a tendency to ignore their own signs. None of them evaluates themselves critically in the same way as they would evaluate our patients. A common mistake is to blame non-specific symptoms on non-medical factors such as too much stress or a lack of sleep. Many doctors hesitate to test for COVID19 when they have trivial symptoms or suspected contact due to the fear of getting a positive report. The majority of those affected remained asymptomatic and recovered, but this also suggests that more people had the test only when the symptoms were unbearable. Typically doctors test only when they have a persistent high-grade fever or significant breathlessness.
The authors are associated with SKUAST-K
Health Shocks versus Health Stimulants in COVID19
Dr Binish Qadri
The overpopulated and underdeveloped economies are characterised by the vicious circle of poverty having very low per capita income. It has been argued in the Critical Minimum Thesis of Harvey Leibenstein that underdeveloped economies are underdeveloped because there is a bad interface between the two forces of development viz shocks and stimulants. Since shocks are more intense in underdeveloped economies than stimulants, these economies are caught under a vicious circle of poverty. We must realize the fact that our health shocks are more than our health stimulants and, therefore, we are not in a position to come out of COVID19. What is required in this pandemic is that the economy should receive a stimulus to growth that is more necessary than a certain critical minimum size. To reduce the magnitude of health shocks and increase the magnitude of health stimulants all those forces which reduce the level of output, income, employment and investment etc. need to be suppressed and all those forces which increase the level of output, income, employment and investment etc. are to be boosted.
Shocks dampen the forces of development while stimulants boost the forces of development. Similarly, health shocks dampen the forces of health development parameters while health stimulants boost the forces of health development parameters. Health stimulants have the capacity to raise health levels in general and per capita income levels in particular above the equilibrium level. In backward and undeveloped countries as the magnitude of stimulants is quite small we can’t imagine long-run economic development. This further discourages the magnitude of health stimulants. Therefore, the efforts to evade economic backwardness (health in particular), impulsive or compulsory, are below the critical minimum effort needed for persistent growth that is all-inclusive. Even in our health departments, the efforts to do away with health disparities and COVID19 are very below the critical minimum effort needed for persistent holistic sustained health development.
According to Leibenstein, the attitudes and motivation of the people and the incentives given to them have a great bearing on the generation of stimulants. Nonetheless, the motivation and incentives have no worth without the key factors of economic development. The main factors that promote economic development are the inventors, the entrepreneurs, the discoverers, the innovators, those who have the capacity to accumulate and utilize wealth, and those who can accumulate skills and spread knowledge. COVID19 has depressed the masses to a great extent and reduced the motivation of the people to improve their immunity. Health authorities must give enough incentives to combat the detrimental impact of this virus, increase immunity, and generate health stimulants. No doubt the activities of health authorities and Frontline Health Workers are unending, but they must lay great thrust upon those activities which are in a position to generate health stimulants and promote economic development. COVID19 demands continuous efforts of various social, economic, and health agencies necessary for economic development. We need efficient human capital to produce other efficient human capital (particularly nurses, teachers, doctors, engineers). That is to say that we need a critical minimum amount of investment in human capital to produce more efficient human capital out of human resources. But, it necessitates an extraordinary type of human response towards motivations, attitudes, and incentives, which are created by a sound social and economic environment.
The author is an Assistant Professor at the Department of Economics, University of Kashmir. You can reach her at [email protected]
Third Wave: Precautions, not panic, please
Jammu and Kashmir is in the middle of what medical experts are calling the ‘third wave’ of Covid19. There has been a sharp increase in the number of Covid19 positive cases in the past one month or so. From 136 positive cases reported on December 19, 2021 to 5992 positive cases reported on January 20, 2022, the jump in the tally has been both significant and concerning. This has led to the imposition of a number of curbs across the Union Territory, including the closure of educational institutions for offline classes as well as the postponement of several examinations by universities.
While this increase in the number of positive cases has been concerning for both people and the authorities, the lethality vis-à-vis hospitalisations and deaths has been relatively very low when compared with the figures of deaths and hospitalisations during the second Covid19 wave when the Delta variant of the virus was at its peak.
Today, according to official versions, the bed occupancy is “very low” which is indicative of low levels of the lethality of the new variant called ‘Omicron’ despite the fact that scientists across the world have opined that its transmissibility is extremely high. Though there is no official data to support that the ongoing rise in Covid19 infections in Jammu and Kashmir is a result of the spread of the Omicron variant, nonetheless the rising levels of transmissibility are indicative of it. Truly, it is not possible for the government to go for mass testing for Omicron due to logistic requirements for genome sequencing, the levels of RTPCR testing for Covid19 have gone up significantly in the past few days, reaching as many as 80,000 tests/day on January 19.
Any complacency on part of people or authorities can have potentially dangerous consequences. The testing has to be ramped up. Furthermore, there has to be a close eye on the economic scenario and people’s daily livelihoods to ensure that the same are not jeopardised in any manner. Any decision on imposing lockdown has to be based on the levels of hospitalisations as against the number of daily cases, as some medical experts in J&K have already suggested.
At the public level too, the response to the fresh outbreak has been sagacious enough. Contrary to social stigma and ostracisation seen during the first and second wave of Covid19, when deaths and panic were at their peak, the situation today is far better. People appear to be handling the fresh outbreak with a fair degree of seriousness and maintaining the social cohesion that was seen in tatters in the first and second wave. That is a lesson that seems to have been learned the hard way at the public level, though it is important for the people to continue to mask up, maintain physical distancing and other Covid Appropriate Behaviour (CAB) to halt the fresh outbreak in its tracks.
There is no clear scientific data to suggest that the Omicron variant is going to behave ‘mildly’ in the near future as it is behaving today. That should serve as an alarming sign for both the people as well as medical experts and health professionals dealing with Covid19. There must be no lowering of guard whatsoever. The hospitals have to be fully equipped with Oxygen supply and ICU beds to keep them ready for any eventuality. Dedicated Covid19 hospitals have to be put in a ‘ready mode’ for next few months till the ongoing wave—believed to go in a couple of months from now—ebbs. Any complacency on part of people or authorities can have potentially dangerous consequences. The testing has to be ramped up. Furthermore, there has to be a close eye on the economic scenario and people’s daily livelihoods to ensure that the same are not jeopardised in any manner. Any decision on imposing lockdown has to be based on the levels of hospitalisations as against the number of daily cases, as some medical experts in J&K have already suggested. A reckless lockdown has the potential to hit the livelihoods of people which they are yet to revive after taking a massive hit during the first and second wave of Covid19. Additionally, it is important to explore ways and means to see to it that the education sector doesn’t get impacted any further. It has already taken a heavy toll on children’s education and their socialising in schools and colleges. All decisions have to be weighed in with ground realities and medical advice for a fine and balanced approach. Both people and government need to work together to realise these objectives.
Covid19 reopening: A close watch needed
Jammu and Kashmir, like other parts of the country, continues to battle the Covid19 pandemic. Though the number of daily positive cases is not as alarming as it would be a few months earlier, yet there are some indications of a slow rise in positive cases in the past few weeks. This situation clearly calls for very careful handling of the situation, especially in view of the apprehensions of a possible third wave hitting the country in the months of October and November.
In a welcome move, the Jammu and Kashmir administration recently ordered phased reopening of educational institutions, including colleges and higher-level schools. It was a long-pending demand of all stakeholders, in the larger interest of the student community, to allow children to return to their on-campus classes after a long hiatus. The move coincided with the phased reopening of businesses in the Union Territory to infuse a fresh lease of life into the otherwise ‘dismal’ economy that was badly hit in the wake of the Covid19 pandemic.
The post-pandemic situation calls for revival of economic activity to enable people associated with various trades to resume their businesses and earn a livelihood following a depressing scenario. There is a large section of the population directly dependent on daily earnings to make both ends meet.
There is no denying the fact that the post-pandemic situation calls for revival of economic activity to enable people associated with various trades to resume their businesses and earn a livelihood following a depressing scenario. There is a large section of the population directly dependent on daily earnings to make both ends meet.
It was therefore imperative upon the administration to take care of the interests of this section of the society. It is equally a fact that the resumption of academic activities across Jammu and Kashmir was the need of the hour to enable students to interact with their teachers and peers, re-socialise on the campuses and heave a sigh of relief. To this extent, the administration took certain welcome decisions. However, the fact that the pandemic is still not over can’t be overlooked in such a scenario. It is therefore important to watch the situation very closely for its better management and minimal disruptions in case of any eventuality like the third Covid19 wave.
The onus to ensure a close watch on the situation certainly lies on the officials concerned, especially the Deputy Commissioners of various districts. In the past two months, the number of daily positive cases largely ranges from 100 to 200. This is not alarming if a comparison of these figures is made with the figures of the previous few months. But the level of unpredictability is too high to be taken casually. On September 22, the UT recorded the highest single-day tally of 204 Covid positive cases—up from 145 cases recorded a day earlier. This is where the situation demands utmost caution. At the official level, it is important to keep a track of these figures to decide on further reopening. If the rate of positivity surges, it would be in the fitness of things to reconsider the further process of reopening and reimpose the curbs, wherever necessary. Alongside, it is imperative to ensure that mass gatherings are disallowed and people adhere to the Covid Appropriate Behavior (CAB) in letter and spirit. The administration also requires to watch the Covid scenario in other states of the country and handle the inflow of tourists and visitors to the UT accordingly in strict adherence to the SOPs. The situation just cannot be allowed to go out of control any longer. Sustained and focused attention on the situation can go a long way in facilitating its better management at all levels.
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