key: cord-0852899-oj6ebqlr authors: Ambulkar, Reshma; Rana, Pankaj Singh; Starr, Nichole; Moore, Jolene title: Perioperative health care provider safety and resource availability during the COVID-19 pandemic in India and other low middle-income countries date: 2022-03-24 journal: Indian J Anaesth DOI: 10.4103/ija.ija_888_21 sha: 664977e105087ea54c54ba2ad6f546031b002170 doc_id: 852899 cord_uid: oj6ebqlr nan The World Health Organization (WHO) declared coronavirus disease (COVID)-19 a pandemic in March 2020, affecting most countries worldwide. [1] High-income countries (HICs) like Australia, France, Switzerland, the United Kingdom (UK), the United States of America (USA) and Portugal were better equipped to slow the spread of the virus by imposing lockdown and scaling up preventive, diagnostic and treatment modalities in a well-developed health care system. In contrast, many lower-middle-income countries (LMICs), including India, were less well equipped, which has had devastating effects on these countries' economies and healthcare systems. [2, 3] Regardless of income status, safeguarding frontline healthcare workers (HCWs) for the ongoing provision of essential health services, including surgery, became a key priority in ensuring a functioning health system. [4, 5] To safeguard HCWs, personal protective equipment (PPE) must be available with appropriate training and safety protocols effectively implemented. We conducted a global survey of surgical facilities and perioperative providers to assess the availability of pulse oximeters for patient monitoring, and PPE for safety processes for preventing the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the perioperative setting, in collaboration with Lifebox Foundation, the UK, Smile Train, New York, the USA, Jhpiego, Baltimore, the USA. Online cross-sectional surveys (Annexure 1) were created and to ensure cross-disciplinary and broad geographic input and content validity, the questionnaires were developed by representatives from anaesthesia, surgery and nursing disciplines from Ethiopia, India, Cambodia, Nigeria, Rwanda, the USA and the UK. The online surveys were translated into nine languages (English, Bahasa, French, Spanish, Khmer, Mandarin, Portuguese, Vietnamese, Hindi), and responses were collected from October 1 to November 1, 2020 with all data being anonymised via Survey Monkey. This survey is a secondary analysis of a previously published survey on perioperative provided safety in low-and middle-income countries. [6] Quantitative data were analysed in Stata v15.1 using descriptive statistics and chi-square and t-tests, with alpha set at 0.05. Qualitative data were initially coded by three research team members, then the second group of three authors applied codes in a blinded manner from the codebook and determined inter-rater reliability. The group iteratively reviewed and reached a consensus on discordantly coded excerpts until code themes were finalised. Primary outcomes were provider reported PPE availability, COVID-19-related training and protocol usage, surgical facility COVID-19 testing and pulse oximeter availability as reported by a facility respondent. Ethical approval was obtained from Boston Children's Hospital. As this was safety data collection and analysis, no other country's ethical approval was taken. We received 127 facility survey responses (administrators) and 277 individual perioperative providers' (anaesthetists, surgeons, nurses) responses from 20 LMICs. Of these, 45 (35.4%) facilities and 120 (43.3%) provider responses were from India. The availability of essential PPE (N95 masks, gown, eye protection and gloves) across India was found to be higher as compared to other countries in the same income group [ Table 1 ]. N95 masks were available in 102 (85%) facilities in India vs 85 (54.1%, P < 0.001) in the other grouped LMICs. Approximately 60% of providers in India reported reusing N95 respirators after decontamination; most of these providers were using the 'wait and reuse' method. Surgeries were scaled down in many of the facilities, including 57 (70%) of facilities in other LMICs as compared to 36 (80%, P = 0.24) in India. COVID-19 pandemic caused large-scale outbreaks in many LMICs including India causing economic and social disruption. With a population of around 1.4 billion, India's response to COVID-19 has a direct impact that has affected the world economy. India has vulnerabilities typical of LMICs: That of an overburdened healthcare system, lack of uniform access to healthcare facilities, illiteracy and higher unemployment rates. This survey suggests that India was relatively better resourced than other LMICs with regards to the availability of PPE and training, pulse oximetry availability, and COVID-19 protocols and checklists. [7] [8] [9] Despite these resources, India was not prepared to address the surge of cases of the second wave because of the large population which led to higher caseload and mortality. This may be related to people letting down their guard, vaccine hesitancy and widespread viral transmission at social and religious gatherings. [10, 11] The risk of HCWs becoming infected while caring for COVID-19 positive patients in the OT is disproportionately high in LMICs including India, with the increased transmissibility and vaccine resistance of the Omicron variant intensifying these risks. Allaying the anxiety and uncertainties among perioperative HCWs is also essential. Most of the HCW concerns relate to becoming infected or infecting loved ones and the subsequent consequences. These anxieties should be addressed by providing support for emotional and psychological needs, [12, 13] providing PPEs, vaccinating HCWs and their family members and providing timely healthcare access. India as compared to other LMICs has done well in fighting the COVID-19 pandemic with its available resources. The ongoing protection with PPE and training of HCWs is paramount to prevent their infection and allow the ongoing provision of essential surgical services, which remain a critical part of the healthcare system. The results of this survey can be used to identify areas of need and inform strategies to safeguard healthcare providers as the pandemic rages on. HCWs in India and elsewhere must have the appropriate masks, other PPE, safer reuse strategies in times of PPE shortage, in addition to receiving training and implementing safety protocols in the OT to protect themselves. LMIC resilience and preparedness to fight the next wave of COVID-19 will be crucial in order to mitigate the further loss of life. 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Second wave of COVID-19 in India: Dissection of the causes and lessons learnt COVID-19 vaccination hesitancy in India: State of the nation and priorities for research Psychosocial support for healthcare workers during the COVID-19 pandemic The mental health of healthcare workers in the COVID-19 pandemic: A systematic review We would like to acknowledge John E. Varallo, Adesoji O. Ademuyiwa, Nina Capo-Chichi, JC Allen Ingabire, Harrell Shreckengost. Katie Fernandez Dr. Faye Evans Dr. T. Weiser and Sophallyda Krouch for their contributions to language translations, survey distribution and data collection.Financial support and sponsorship Nil. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.