Thomas Mathew: “The situation is serious but panic is not a solution.”

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Covid and its consequences – hospitalisation and at times death – still monopolise the headline. We talk to Thomas Mathew, Chief Operating Officer of Wellkin about how the private clinics are contributing to alleviating the pressure on the public health service and the type of care they are offering.

Last time we spoke, you were in discussions with the government to obtain the permit to admit Covid-19 patients. I understand you have now obtained that permit. How is the situation looking?
We indeed obtained the approval of the Ministry of Health and started treatment of Covid-19 patients requiring intensive care in the first week of November. Things are going well. We have the appropriate infrastructure to provide testing, vaccination and treatment for critical care. Since then, we have had high occupancy in our Covid Isolation Unit and isolation wing.

What is the protocol set up for Covid patients?
There are clinical as well as operational protocols. These have been drafted after extensive discussions with clinical experts, senior managers and advisory from the Ministry of Health. As the pandemic evolves globally, newer guidelines are being introduced, and we are regularly updating our protocols based on recommendations from expert bodies like the World Health Organization, Centers for Disease Control and Prevention and the Ministry of Health, amongst others.

Concretely, what do you do when a patient walks in showing symptoms of Covid-19?
If someone walks in with the symptoms you stated, the patient is referred to the Emergency Triage, which is separated from the main building to perform an RT-PCR test. In case the RT-PCR test is positive, one of our doctors will examine him/her and will determine if s/he needs admission. The patient has the choice to receive treatment at Wellkin Hospital or in any other approved healthcare facility.

If the person opts to be treated at Wellkin, what happens then?
If treatment is received at Wellkin Hospital, then the patient will be transferred by a dedicated ambulance to the Covid Isolation Unit (intensive care unit for Covid-19 patients) or Isolation Wing (special care) depending on their health conditions as advised by the doctors.

There is currently an increasing demand for hospital beds among Covid-19 patients. Are you coping with the demand?
We started with five beds in the Covid Isolation Unit and six additional beds in the Isolation Wing for patients who are in a moderate to relatively stable condition. We are closely monitoring the situation and may expand the capacity within our limitations, to manage the situation to the best of our abilities.

How many more beds are you thinking of adding to the current 11 that you have all in all?
So far, we are unable to comment on the number of additional beds as it depends on a number of parameters, namely appropriate infrastructure and human resources.

Covid and its consequences – hospitalisation and at times death – still monopolise the headline. We talk to Thomas Mathew, Chief Operating Officer of Wellkin about how the private clinics are contributing to alleviating the pressure on the public health service and the type of care they are offering.

From within hospitals, we hear the echo of medical staff shortages. Did you manage to import doctors and nurses or you are digging in the stock available in the public hospitals?
Most countries are facing similar conditions during surge periods. We have been able to recruit specialised nurses from abroad, which has been extremely helpful to start the operations in the Covid Isolation Unit and Isolation Wing. We are also exploring options of onboarding specialised medical officers from abroad to support the new requirements.

How many nurses have you been able to recruit?
Twelve nurses.

From which countries?
From India.

Apart from ventilators, oxygen etc., is there any medication administered to the patients?
Treatment and management of Covid-19 patients depends on the severity of the infection and existing illness and comorbidities. Several targeted therapies have been tried worldwide under Emergency Usage Authorisation, including some antivirals and monoclonal antibodies. While oxygen delivery remains the mainstay of management of hospitalised patients in moderate to severe illness, there are several other supportive measures considered which include steroids, anticoagulants, IV fluids among others. Broadly speaking, depending upon the patient’s oxygen requirements and their lungs status, oxygen delivery may be achieved through simple masks, high-flow oxygen equipment, non-invasive ventilation and invasive mechanical ventilation. Co-management of underlying illnesses and comorbidities is also an important aspect to be considered when administering treatment.

“We have been able to recruit specialised nurses from abroad, which has been extremely helpful to start the operations in the Covid Isolation Unit and Isolation Wing.”

Research into Covid medication is progressing at a dizzying speed and the wildest claims are being put forward only to find out that they are at times overstated. How are you keeping up to date with this?
We have set up an internal Clinical Expert Panel which discusses all developments on the drugs and therapeutic aspects and makes recommendations. All drugs that are used have to be approved by the relevant authorities.

What anti-virals are you using more specifically?
For the moment, we are using Remdesivir.

There is a lag between ordering medication and obtaining it. Are there times when there is a shortage in the country that affects the procedure?
Due to the global demand for some recommended drugs, we do face some delays in the delivery. However, we have been able to forecast the requirements of some essential items, and these are available as per current consumption trends. We are continuously exploring options for quicker delivery of some key recommended drugs.

Many people are in a state of panic while the authorities are saying everything is under control. From your vantage point, how serious is the situation?
The situation is serious but panic is not a solution. It is important that we break the chain of Covid-19 infection to relieve the strain on hospitals and for this, we need the collaboration of each and everyone.  One cannot stress enough the importance of strictly observing safety measures and all recommended norms of social distancing. We believe that both private and government facilities should continue to collaborate on this subject and explore opportunities for the expansion of Covid-19 facilities.

Are your doctors advising people to be cautious, to stay home as far as possible or not to panic?
Our doctors have been at the forefront of not only the clinical management of Covid-19 patients now but also creating awareness since the beginning of the pandemic. We have been sensitising people on appropriate mask, hand hygiene, physical distancing, and self-isolation in case of getting infected or being in direct contact with someone infected, as well as maintaining a healthy lifestyle to boost the immune system. Today, it is important to inform the population of the risk of the underlying health conditions like non-communicable diseases posed by the risks of Covid-19 and our doctors continue to remind our patients about the importance of a healthy lifestyle.

Is private health care in the case of Covid covered by insurance or do patients have to fork out of their own pockets?
We have been in communication with all the leading insurance companies and some of these have signified their intention to consider paying for Covid treatment. We understand that they are working to formalise it at their end. While it is still being formalised at their end, we would advise the patient to check their policy with their respective insurance companies.

So the patients hospitalised at Wellkin right now have to pay the full bill themselves?
Not all of them. There has been insurance coverage for some patients.

For some? Depending on what?
Depending on the patient’s insurance policy. That’s why we call on all patients to check with their insurer to see what coverage they have.

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