Coronavirus update: Medical students in final-year MBBS, PG may join Covid-19 fight
Covid-19 update: There were just over a million doctors registered with state medical councils in 2017, of which only 80% were estimated to be in active service, according to the government. This means, India has one doctor for every about 1,500 persons; World Health Organization (WHO) norms suggest that there must be one doctor for every 1,000 persons.
Medical and nursing students could join the fight against Covid-19 as authorities consider various options to strengthen the health care workforce and provide protective cover to ageing doctors who are themselves at high risk of contracting the infection and, possibly, dying of it, people in the know said on Sunday.
The development came after sector experts suggested an all-hands-on-deck approach with strategic protection to older specialists. The health ministry said in a recent guideline that dentists could be roped in for the anti-Covid-19 effort too.
“There are not more than 40,000 anaesthetists, who are specifically trained to handle ventilators, practising across the country. At least half of them are above the age of 50, who we would be putting at risk in a Covid-19 ICU. Of the others, most are in the cities. When we plan for the surge in cases, we should think of an AIIMS or other hospitals in the city which are usually training centres and have resident doctors,” said Dr Devi Shetty, chairman and founder of Narayana Health group.
“The district hospitals, which would handle the bulk of the patients, have maybe 15 or at best 25 specialists and only about two anaesthetists. If these 200 to 300 bed hospitals are converted to critical care facilities, who will handle the cases? The latest national health profile shows an 85% shortage for the existing work,” said Dr Shetty.
To be sure, there were just over a million doctors registered with state medical councils in 2017, of which only 80% were estimated to be in active service, according to the government. This means, India has one doctor for every about 1,500 persons; World Health Organization (WHO) norms suggest that there must be one doctor for every 1,000 persons. In rural India, however, this ratio goes down to as low as one doctor for over 10,000 patients.
Every year, nearly 38,000 postgraduation and 70,000 MBBS students graduate from colleges in India.
“Right now, we are in the process of procuring ventilators, but not all the doctors working currently are trained to handle ventilators. So, the first step would be to train a large number of people to use ventilators. We may also look at training postgraduation and BSc nursing students,” said Dr Srinath Reddy, president of Public Health Foundation of India and a member of the national task force on Covid-19.
“Those MBBS students who are doing their final internship might be allowed to take care of less critical patients. The option of allowing foreign medical graduates awaiting certification can be explored.”
“There are no hard and fast rules. If need arises, states can explore options of identifying people and training them as per the need. They can involve students or even AYUSH practitioners for screening of patients. When there is an emergency, it is an all-hands-on-deck situation,” said a health ministry official.
Some experts have also suggest mobilising human resources from various departments within hospitals while others say various forms of medical training recognised by the Medical Council of India (MCI) could be provided.
“Many doctors, nurses and technicians have already been freed up by stopping elective procedures. If there is a surge in the number of cases, doctors from other clinical departments who don’t usually manage critical care can be roped in after a short training. Then, there are several private medical colleges that are underutilised but have good ICU facilities and the necessary staff as per MCI requirements; these can be utilised too,” said Dr MC Misra, former director of All India Institute of Medical Sciences (AIIMS), Delhi.
In Delhi, doctors can be diverted from various hospitals to centres managing Covid-19 patients, according to Dr SK Sarin, who headed the committee guiding chief minister Arvind Kejriwal in readying a preparedness model.
“We are preparing infrastructure and manpower for a surge of up to 1,000 cases a day. Right now, we are not even getting 100 cases in a day, but in case that happens we have two hospitals ready,” he said.
MCI allowing people with various forms of training to join the Covid-19 fight will increase young manpower, said Dr Devi Shetty.
“Around 50,000 postgraduate students are training in various specialties, including some who might have failed the certification exams before. They have experience of working in hospitals and can be allowed to treat Covid-19 patients without waiting for examinations. The MCI had derecognised the College of Physicians and Surgeons in Maharashtra that has trained 40,000 specialists; we can ask them to work in district hospitals in return for recognition. There are 2,000 specialists who have been trained by the Society for Emergency Medicine and another 2,000 in cardiology by IGNOU; MCI can recognise all of them and let them work in district hospitals,” he said.