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BRIEF RESEARCH ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 237-239  

Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey


Senior Residents, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Tanda, Himachal Pradesh, India

Date of Submission11-May-2020
Date of Decision11-May-2020
Date of Acceptance12-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Shailja Sharma
Senior Resident, Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Tanda - 176 002, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_472_20

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   Abstract 


A rapid cross-sectional survey was conducted across India among frontline allopathic doctors to know their prime concerns. Four hundred and five responses were received from 16 states and 3 union territories. Among doctors working in COVID-dedicated hospitals, 56.18% are formally trained for the same, and 40.5% of these are satisfied with the training. 47.3% of these have personal protective equipment (PPE) kits, 35.1% have no PPE kits, and 17.6% are not aware of their availability. 31.1% of doctors reported attending to COVID suspects without PPE. 58.1% of institutions have a dedicated task force, 20.3% do not, whereas 21.6% of doctors are not aware of such a task force. Only 21.6% of the participants consider their institution to be fully prepared for COVID. After performing COVID duties, 45.9% are being provided with an alternative place of stay, whereas only 16.2% have been quarantined. In non-COVID institutions, 82.4% of doctors are using protective gear, of these 35.2% procured them on their own.

Keywords: Concerns of doctors, COVID warriors, COVID-19, frontline doctors


How to cite this article:
Singh H, Sharma S. Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey. Indian J Public Health 2020;64, Suppl S2:237-9

How to cite this URL:
Singh H, Sharma S. Concerns of Frontline Doctors in India during COVID-19: A Cross-Sectional Survey. Indian J Public Health [serial online] 2020 [cited 2020 Jul 3];64, Suppl S2:237-9. Available from: http://www.ijph.in/text.asp?2020/64/6/237/285602




   Introduction Top


As the world faces the challenge of the COVID-19 pandemic, the health-care providers face dearth of face masks, personal protective kits, medicines, ventilators, and above all a robust protocol to manage a patient of COVID-19.[1] The guidelines of the World Health Organization changed several times in a short span of time leaving many countries baffled.[2],[3]

In India, health-care workers (HCWs) are facing a grave challenge. Limited personal protective equipment (PPE), lack of proper training, and the ever-changing protocols pose a significant risk to their own health.

The COVID-19 pandemic has hit over 22,000 HCWs across 52 countries and regions as per the latest WHO report. In some countries, there are reports of up to 10% of health workers being infected.[4]

Hence, it becomes inevitable to know and address the immediate needs of these caregivers by identifying the gaps and bottlenecks in the arrangements. With this background, the study was conducted with the objective of to assess the preparedness of the health-care institutions in the country involved in COVID-10 management and to identify & highlight the concerns of frontline doctors working during the pandemic.


   Materials and Methods Top


This was a rapid cross-sectional survey conducted across India among allopathic medical practitioners presently practicing either in government or the private sector. A questionnaire with 34 questions was developed which included questions regarding the place of practice or service, whether the participant was serving in COVID special hospitals, facilities available including PPE kits, training received with respect to COVID-19, and facilities for stay or quarantine after attending to such patients. Those not working in COVID special hospitals were also required to fill the form and were asked questions with respect to PPE kits, practice of social distancing in outpatient departments and waiting areas, and infection control measures in their respective health-care centers.

The questionnaire was prepared on Google Forms which was pilot tested on 20 doctors (10 working in private clinics and 10 in government health-care centers), and corrections were made thereafter. The questionnaire was preceded by a consent form wherein the participant was assured of complete anonymity during the study and thereafter. The form was then circulated on various social media platforms and E-mail for 5 consecutive days. On receiving 405 responses, the e-form was closed for further responses. According to the Krejcie and Morgan model, 384 responses would suffice for the present study taking into consideration approximately 12 lakh registered allopathic doctors in the country with 5% allowable error. The ethical clearance for the study could not be taken due to the sudden lockdown in the country and suspension of all academic activities in all educational institutions.


   Results Top


A total of 405 responses were received from 16 states and 3 union territories with maximum responses from the states of Himachal Pradesh and Karnataka constituting 74.1% of the total. Of these 405 participants, 324 (80%) are seeing patients during the current pandemic. Of these 324 participants, 222 (68.5%) are working in dedicated COVID hospitals, whereas 102 (31.5%) are working in other institutions. From among the respondents, 168 (41.5%) are senior and junior residents, 123 (30.4%) are medical officers, 87 (21.5%) are consultants working in medical colleges, whereas 27 (6.6%) are on other posts.

Among the doctors working in COVID-dedicated hospitals, only 56.18% are formally trained for management of COVID-19 patients. Among these, only 40.5% are satisfied with the level and content of training. Only 47.3% have ready availability of PPE kits. The rest either have no PPE kits (35.1%) or are not aware of their availability in their institutions (17.6%). Among the 222 doctors working in COVID-19 hospitals, 69 (31.1%) have reported attending to COVID suspects without PPE kits. While 58.1% of institutions have a dedicated task force, 20.3% of institutions do not, whereas 21.6% of doctors are not aware of such a task force in their institutions. Only 21.6% of the participants consider their institution to be fully prepared to meet the COVID challenge. After performing their duties in COVID specific wards, only 45.9% are provided with an alternative place of stay. Among the rest, 52.5% are staying with their families, whereas 37.5% are staying at their residence but alone. Doctors are spending an average 21 days away from their families due to duties in the COVID wards. Only 36 (16.2%) doctors have been quarantined after performing duties in COVID wards [Table 1]. From among doctors serving in non-COVID institutions, 82.4% are using protective gear. Of the total doctors using PPE kits (in COVID and non-COVID institutions), 35.2% procured or managed them on their own [Table 2].
Table 1: Responses from doctors working in institutions with COVID-19 management facilities

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Table 2: Responses from doctors working in other facilities and common responses

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   Discussion Top


The health agencies across the globe have long been anticipating an outbreak of infectious disease, especially after the Zika and Ebola outbreaks. RAND Corporation researchers in a report published in the year 2015 identified future hotspots, emphasizing the transnational nature of infectious diseases.[5] The Centers for Disease Control and Prevention in October 2008 stated that the next flu pandemic was sure to happen and also insisted on following the guidelines for cough etiquettes and social distancing in the same document.[6] The WHO checklist on influenza planning and preparedness by the Department of Communicable Disease Surveillance and Response Global Influenza Programme published in 2005 was an effort in the said direction.[7]

Despite these directions being in place for about 15 years, every country including all the first world countries was found struggling when the pandemic struck. As per this study, with 56.18% of doctors in India having received training related to COVID-19, <50% are satisfied with the quality of the training. Had training been imparted to HCW as preparedness for the pandemics as advised by the WHO, we would have had a well-trained workforce in place.[8]

In the present study, approximately 30% of doctors reported attending to COVID suspects without the required equipment. In a desperate attempt to save themselves, 35% of doctors procured some form of PPE which included self-made face shields, masks, plastic gowns, and even raincoats. In a cluster-randomized trial, the rates of all infection outcomes were highest in the cloth mask arm, with the rate of Influenza like illness (ILI) statistically significantly higher in the cloth mask arm compared with the medical mask arm. Moisture retention, reuse of cloth masks, and poor filtration may result in increased risk of infection.[9]

The question of endangering the families and close contacts of health-care providers is another major concern, as <50% of the doctors were offered an alternate place of stay after performing COVID duties as per this study. The rest are residing in their homes and some with their families.

Only 36 (16.2%) doctors reported to have been quarantined after performing duties in COVID wards. Although quarantine overzealously may result in an extremely depleted workforce, overlooking the matter may lead to an increase in the number of cases among HCWs, which the country is facing right now.[10]

The lessons learned so far include prioritizing preparedness for such pandemics by regular training of health-care professionals, even in the absence of a real threat. Robust supply chain mechanism of Infection prevention and control (IPC) materials including PPE kits and masks should be in place, along with exclusive guidelines for HCWs covering all aspects of pandemic management at all times. Along with this, a dedicated mechanism to address the concerns of HCWs should be in place.

Acknowledgments

We acknowledge the support of the hardworking doctors of our country who, despite their busy schedule, took out time to respond to this survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. News Room; March, 2020. Available from: https://www.who.int/news-room/detail/03-03-2020-short age-of-personal-protective-equipment-endangering-health-workers- worldwide. [Last accessed on 2020 Apr 28].  Back to cited text no. 1
    
2.
World Health Organization. Strategic Preparedness and Response Plan for COVID-19. Available from: https://www.who.int/publications-detail/strategic-preparedness-and-response-plan-f or-the- new-coronavirus. [Last accessed on 2020 Apr 28].  Back to cited text no. 2
    
3.
Government of India, Ministry of Health and Family Welfare. Revised National Clinical Management Guidelines for COVID 19. Available from: https://www.mohfw.gov.in/pdf/RevisedNationalClinical ManagementGuidelineforCOVID1931032020.pdf.[Last accessed on 2020 Apr 28].  Back to cited text no. 3
    
4.
World Health Organization. News Room. Press Release; 11 April, 2020. Available from: https://www.who.int/docs/default-source/coro naviruse/transcripts/novel-coronavirus-landscape-ncov-11april2020.pdf?sfvrs n=ac0b3c1d_6. [Last accessed on 2020 Apr 28].  Back to cited text no. 4
    
5.
Rand Corporation. Infectious Disease Vulnerability Index. Available from: https://www.rand.org/pubs/research_r eports/RR1605.html. [Last accessed on 2020 Apr 28].  Back to cited text no. 5
    
6.
Centers for Disease Control and Prevention. The Next Flu Pandemic: What to Expect? https://www.cdc.gov/flu/pandemi c-resources/index.htm [Last accessed on 2020 Apr 27].  Back to cited text no. 6
    
7.
World Health Organization. WHO Global Influenza Preparedness Plan. Available from: https://www.who.int/csr/resources/publications/infl uenza/WHO_CDS_C SR_GIP_2005_5.pdf. [Last accessed on 2020 Apr 27].  Back to cited text no. 7
    
8.
World Health Organization. WHO Checklist for Influenza Pandemic Preparedness Planning. Available from: https://www.who.int/csr/resou rces/publications/influe nza/WHO_CDS_C SR_G IP_2005_4/en/. [Last accessed on 2020 Apr 27].  Back to cited text no. 8
    
9.
MacIntyre CR, Seale H, Dung TC, Hien NT, Nga PT, Chughtai AA, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open 2015;5:e006577.  Back to cited text no. 9
    
10.
The Wire. Science. Available from: https://science.thewire.in/health/coronav irus-healthcare-workers-risk-quaran tine-guidelines-icmr-heal th-ministry/. [Last accessed on 2020 Apr 27].  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]



 

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