key: cord-0959865-bh3qbn3q
authors: Bajracharya, Aliza; Gurung, Suja; Munakomi, Sunil
title: Scoping the perplexing effect of the COVID pandemic in Nepal, and the appraisal for precautionary measures from its lurking aftermath
date: 2020-06-11
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.06.027
sha: 8d19cfdbd1d261e350786777580b0f487273d2db
doc_id: 959865
cord_uid: bh3qbn3q

nan

Scoping the perplexing effect of the COVID pandemic in Nepal, and the appraisal for precautionary measures from its lurking aftermath The coronavirus 2019 (COVID-19) pandemic has led to the global health crisis. [1] It is not only challenging the health aspect of the world but is draining the global economy along with the social and political sectors. [2] In the context of Nepal, our country is in the community transmission phase at the moment. Our There is also a lack of adequate medical professionals, staff, and medical supplies such as OT gowns, medicines, spinal instruments, that need to be transferred from the capital city thereby hampering their timely interventions. Amidst the current surge of the disease with this paradoxical lack of resources, currently, we are only able to screen only a few cases each day. This places the whole center at a very high risk of inadvertent transmission of the disease while we focus on the accountability of managing such emergency cases.

Putting patient care as our primary focus and also maintaining COVID protocols, we have segregated the rounds among each neurosurgeon, so as to limit the exposure. We are mostly taking the help from the telemedicine and social network applications to enquire about the neurological status of the patients and their radiological imaging prior to their referral from the peripheral centers, for preparatory knowledge, counseling, and needful preparations.

Nepal has been on the state of lockdown since the last 68 days, which has outturned obvious decrement in the incidence of road traffic accidents. However, but there has been an uprise in fall incidents, physical assaults, sub-acute to chronic subdural hematomas, oncological emergencies with herniation syndrome, and the incidents of hemorrhagic strokes. COVID also has concurrent risks of strokes, encephalitis, and disseminated intravascular coagulation (DIC). It can also complicate post-operative events in our patients. Similarly, this pandemic has caused collateral damage from a panic state fearing COVID. This pandemic has also eclipsed other health issues that shouldn't be neglected. In the midst of the crisis, the other aspect of concern is the lack of adequate training among staff working in isolation and ICU pertaining to COVID 19. There is also a lack of adequate knowledge in proper donning and doffing methods of the PPE's and the proper methods of waste disposal. This might cause more harm and can be paradoxically disastrous for the whole hospital.

Along with this, precautionary measures taken are also dismal. Though tests for patients are done, visitors aren't tested due to the lack of testing kits. Similarly, no measures are taken for handling patients and safeguarding the health workers in outpatient clinics. Likewise, the ambulances that carry patients from the neighboring district are not timely disinfected. This will endanger all the medical teams and other staff involved. So, there is just a thin line between the selfprotection issues and the accountability towards our patients amidst such pandemic.

By far to contain this infection, the government has ensured isolation facilities, quarantined the suspected cases, and contact tracing of the exposed patient, increased the screening tests, but all these steps are at a snail's pace. The isolation facilities provided are not up to the mark, the care standard is unsatisfactory and the quarantine facilities are inadequate. As a result, some of the patients have even started eloping from these centers, endangering the risk of community exposure.

The government has started to seal the hospitals after identification of the positive cases, and all the exposed health team members are kept in quarantine for days.

Although it may appear a rational step to contain the spread, it is not a permanent solution, especially in our context, wherein the shortage of manpower is already a major health issue.

To at least make a start, there needs to be a provision of rapid testing of every high-risk emergency case so as to safeguard the health workers. The referral cases need to have the facility of conducting the test prior to the referral to the center so that it avoids unnecessary delay and the environment of fearful uncertainty while managing them.

In this period of shortage of protective gear, only minimal indispensable personals required in the management need to be employed for the care. The precaution needs to be there for the backup health personnel workforce in cases of accidental exposure and their absenteeism during isolation or treatment.

There is certainly going to be an exponential growth in cases as the influx of migrants is rising every day. The only solution is to ramp up PCR testing and employing strict contact tracing. But we are still crippling on managing PPE, test kits, quarantine, and isolation facilities. The management algorithm is still not well structured. A road map for tackling the issue in a battlefield upfront and in the current environment with limited resources is pivotal. Hub and spoke model can be ideal to run the health care system in this time of crisis. This can magnify efficiencies, effectiveness, and enhance the quality of health services.

The government has been building their plans in moving sand although there is a mammoth task ahead of us in combating the COVID. This is a war with no smoke and we the soldiers with no ammo. There is still no silver lining in the control of this pandemic, and but there needs to some methodology to unravel this health crisis in a justifiable manner. There is a need for some calmness amidst the chaos.

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