Will the American experience in fighting Covid help Georgia
The leading countries of the world met the pandemic completely unprepared. The United States was no exception. Problems arose in absolutely all spheres of healthcare: in the logistics of supplies of medicines and equipment, in the rotation of various groups of medical personnel; in the process of training and equipping, in the creation and refinement of new treatment protocols. Experience was accumulated, which daily adapted to new challenges, we often learn from mistakes, and sometimes we arrive at the correct result by logical calculations with preliminary forecasts. The so-called frontline combatants in the fight against covid have gained tremendous experience, and today their experience is no less valuable than the experience of combat officers in any army. Today Georgia is going through exactly the same stage of the pandemic that America experienced in early spring. The country is not ready for this struggle either psychologically or financially, and therefore it needs to go through a process of rapid adaptation, just as it did abroad. But, fortunately, Georgia has one big advantage, Georgia can learn not from its own mistakes, but from the mistakes of others, and thus minimize losses. That is why we gave ourselves the right to summarize the experience gained in American clinics so that our colleagues in Georgia, as well as the society, without whose participation and cooperation it is impossible to achieve success, can use it effectively.
Treating Covid infection requires proper work and proper, dynamic coordination of all health care providers (primary health care, hospital sector, rehabilitation systems for timely discharge of patients from hospitals and post-discharge management). Taken in isolation, the hospital sector becomes completely incapable of this struggle even in ideally functioning conditions. The basic principle of managing a coinfected patient is based on intensive observation, since the patient’s clinical condition often changes literally instantly, literally before our eyes. Deaths from severe covirus infection are still high. Timely intervention, predicting complications and building treatment tactics to prevent them is the key to success. This approach requires sufficient human resources and reliable medical logistics to manage the patient. Even with the use of the most modern technological or medical means, it is impossible to achieve the desired result in conditions of a shortage of medical personnel, because without timely medical intervention it may be too late.
The basic knowledge of a doctor in any specialty allows them to be trained to the point where they can answer incoming hotline calls. Thus, telephone consultations will become available to everyone, will help to inform the public and to some extent deal with people’s anxieties. Protective mobile teams can be created to visit high-risk patients at home and periodically assess their condition. These approaches will help unload the hospital sector and ambulance services. It is imperative for the health care system, volunteer donors or political parties interested in advertising to somehow ensure the supply of masks to the population; it is necessary that the pulse oximeter be accessible to patients at risk, which will allow relatively safe treatment of this disease at home. It is critically necessary to adequately and timely inform the population about the symptoms of the disease, its course, principles of management or features of prevention. A properly informed patient will protect the healthcare system from overloading and misusing resources. We must also remember that knowledge in this area is changing rapidly, and that keeping the public and medical personnel informed is critical. Every news about covid should be clearly and clearly explained to people. Mass testing should also be carried out at the primary health care level to facilitate early detection of infected patients and limit the spread of disease. Therefore, testing should be easily accessible and geographically convenient. Any medical institution, starting from a rural polyclinic, including district polyclinics, should be provided with the equipment necessary for testing. This will reduce the queues and thus the chances of getting infected in the queues.
The state is simply obliged to urgently mobilize new specialists. What does mobilization mean in this case? Obviously, ideally, a seriously infected patient should be referred to the intensive care unit / anesthesiologist in the intensive care unit. However, due to the scale of the pandemic, there is an acute shortage of such specialists, and for seriously ill patients, the hospital sector will have to make do with more than just intensive care units. Moreover, they will have to be treated by physicians who have no prior experience with controlled breathing. This was the case in America. Fortunately, the main workload here has been with residents and fellows, which is a positive experience. Any second or third year medical resident in America can administer a patient on artificial respiration; perform all the necessary procedures, whether it is invasive introduction of an intravenous or arterial catheter, paracentesis, puncture of cerebrospinal fluid, and so on. This allows the physician to take on the role of supervisor and to adjust the work of students and fellows working in the department. we must understand that the situation will certainly come to the need for such a practice and the health sector must be ready for this, otherwise a catastrophe cannot be avoided. Attention should be paid to the fact that severe forms of Covid are extremely complex, and the vast majority of patients require invasive hemodynamic management. Obviously, resuscitators and anesthesiologists cannot install so many invasive catheters alone, so nursing staff need to be trained to perform these complex procedures. Ideally, initial training should be carried out on a simulator dummy, then 5 procedures under the supervision of a licensed specialist are enough to get the right to use these methods independently. This is the American version of certification, which was used in the dock era. In every hospital, it is very important to have a so-called “line team”, which will include specialists in anesthesiology, general surgery, invasive radiology, vascular surgery, who will perform all procedures. Frequent and prolonged transfer of the patient from the supine position is especially effective in the treatment of respiratory failure caused by Covid. This requires physical strength, knowledge of the rules and constant attention. To ease this burden on the doctor and nurse, hospitals need to have dedicated teams of rehabilitation specialists.
The work schedule of the medical staff has also changed. All changes were aimed at ensuring that the clinic had the minimum required number of staff at the same time. The specialists who could be consulted virtually were transferred to a remote location, for example, the first stage of consultation with an infectious disease specialist, endocrinologist, rheumatologist, oncologist, cardiologist began with a telephone consultation with the patient. Doctors of these specialties examined hospitalized patients in person only if virtual contact could not provide sufficient information. Thus, personal protective equipment was retained, and the staff was maximally protected from infection. Those who work directly with patients have been allocated additional physical space to maintain social distance, which reduces the chances of infection. The medical staff worked according to the schedule, replacing each other. When one group was working, the other was resting, and in the event of infection, a reserve from the “resting” group was mobilized from the medical staff.
It should be noted that working with patients infected with Covid is a serious physical and psychological burden for the doctor, therefore, insufficient care of the medical staff can lead to disruptions in the hospital sector. It is forbidden to use hospital rooms as classrooms for training or meetings. All such events have moved to the online space with the help of technology. It is essential for healthcare professionals to have access to up-to-date information. There are several excellent online platforms, such as up-to-date, that provide the latest information on covid, which each doctor needs to be funded by the clinic to access. This is possible only in case of sufficient funding, the bonus / salary increase for one official is quite enough for a technological breakthrough and access to information for an entire hospital. Information on such platforms is updated daily and allows any doctor to provide patient care based on new evidence. Specialist groups can be formed from medical university students to prepare reviews so that physicians who work directly with the patient can update their knowledge quickly.
Clearly, changes are needed in the teaching of medical students in hospitals. In America, similar rotations are generally prohibited for several months, and the entire learning process has moved to the Internet. Patient contact with medical personnel should be minimal. It is also necessary to adapt the wards to the conditions of minimum contact. Part of the ventilator was placed outside the hospital room. The need to change the parameters of the artificial respiration apparatus is often hourly, and this saved doctors from being unnecessarily in the same room with the patient. The same was done with the infusion sets. The plastic transfusion tubes were lengthened and attached to the body of the device through special sealed holes in the doors. The reason is the same, the condition of patients with Covid is changing very dynamically, which requires a quick change of doses of drugs, and taking the equipment out of the room reduces the likelihood of staff infection. Naturally, the medical staff always had special protective equipment.
All hospitals have revised the criteria for transferring a patient to intensive care. Because this highly specialized bed capacity is limited even in the most advanced hospital system, it was used only for critically ill patients with an optimistic prognosis. The new rules have been adapted exactly to this idea.
New York has revised its legal framework for medical errors. We won’t go into details, but this was a badly needed and timely change.
Another important link in the management of the Covid pandemic is the timely and safe discharge of the patient from the hospital. If there is no home rehabilitation system, discharge is out of time, the patient stays in the hospital longer than necessary. And this, in turn, increases the risks of infectious complications in the patient himself and reduces the number of beds that are so necessary during a pandemic in an already overloaded system.
As far as we know, Georgia does not have a modern system for the rehabilitation of patients and nursing homes that would ensure a safe discharge of the patient. It makes sense to use covid hotels for these purposes. Now what is meant by safe patient discharge? Very often the patient goes a long way to recovery. During this period, he may need oxygen, and the discharge of a patient with a portable oxygen machine will relieve the hospital sector and accelerate his rapid return to normal life rhythm.
It is imperative that a country has clear and detailed guidelines on patient management for all health care facilities in the health care system, while at the same time that the legal framework is flexible to change hospital guidelines to suit individual capacities and conditions. As internal rules change in American hospitals.
It is clear that for the treatment of uninfected patients it is necessary to create covid-free zones. Patients admitted to the emergency department should be promptly evaluated and transferred to such locations if the answer is no.
Covid isn’t going anywhere. There is no vaccine yet; there are no effective cures for it; heavy winter and spring months ahead. Intensive preparation should start today and continue as long as necessary. It should be understood that nothing is impossible.
The correct use of intellectual resources, the appropriate technological and medical base, as well as the correct epidemiological analysis and analysis-based epidemiological solutions, are the keys to successfully combating the pandemic.