Qualification & Affiliation-M.B.B.S., Bihar Health Services, Government of Bihar, IndiaThe current ongoing coronavirus pandemic caused by SARS-CoV-2/covid-19/novel coronavirus is an acute infectious communicable disease spreading mainly via respiratory, eye, mouth and other possible routes from person to person as well as through contact with infected non living objects. Added to previous global burden of NCDs (non communicable diseases) & other communicable diseases this new pandemic burden of covid-19 pandemic have put a stress on already overstressed health system of India particularly poor states like Bihar.11Kumar P. What Impact Have SARS-CoV-2/Covid-19 Pandemic on the Reproductive and Child Health Programme of Bihar in India over the 3 months after nationwide Lock down announcement in March 2020? How SARS-CoV-2 Pandemic era does influence RCH Programme? Immunisation, Maternal Health, Family Planning, Research Square, 2021 DOI: 10.21203/rs.3.rs-348841/v4. The delivery of health services is of utmost importance and prime concern in India particularly poor states like Bihar due to high population load with limited resources, poor infrastructure and huge demand on healthcare system. The Healthcare workers (HCWs) are particularly vulnerable group hence this topic needs essential attention and protection.22https://www.researchsquare.com/article/rs-360551/v1The SARS-CoV-2 pandemic had presented a challenge even for developed healthcare systems around the world.33https://europepmc.org/article/ppr/ppr304897 A sense of fear gripped the whole world due to pandemic and India is not an exception. The scarce healthcare resources including manpower, infrastructure, transportation (ambulance services) etc. have been largely deployed to tackle the situation of pandemic of Covid-19. This shift & covid-19 pandemic has tremendous and detrimental effects on HCWs. The healthcare workers of India as well as Bihar are getting frequently infected leading to death of thousands of healthcare workers till date . Although there are several guidelines issued for precaution and safety at workplace by WHO (world Health Organization) & several accredited organizations but a protective and supportive approach from local management and governance is need of the hour . It seems that there is failure of protective and preventive measures at workplace documented and evidenced by several deaths of healthcare workers. Consequently it is apparent from above scenario to ensure the health and safety of healthcare workers in order to control the outbreak and decrease panic and fear among healthcare workers. In this article I am sharing methods and various ways for protecting healthcare workers (HCWs) while having hospital duties as well as policy makers and management people can also find this article useful while making policies for protecting and safeguarding HCWs. This article aims to reduce incidence/prevalence as well as mortality and morbidity of HCWs in Bihar by suggesting important precautions, preventive measures and other facts to be adopted by healthcare workers at workplace as well as drawing attention of policy maker, important stakeholders and management people to provide protection to HCWs.Healthcare workers (HCWs), covid-19 infection, safety, pandemicBackground: The case fatality rate among doctors due to Covid-19 infection is far more in Bihar says IMA (Indian Medical Association) official “Doctors account for 0.5 per cent of the total deaths in India due to Covid-19. However, in Bihar, the percentage of doctors’ death is 4.75 per cent, which is nine times more than the national average,” said senior vice-president of IMA-Bihar Dr Ajay Kumar. “In other states, doctors doing duty in Covid-19 wards are quarantined for 15 days after 15 days of continuous work. This arrangement is not followed in Bihar, as a result of which our doctors remain exposed to Covid-19 patients far longer than in other states. In fact, in Bihar, doctors are working continuously at a stretch since mid-March2020, without even an off day,” said Dr Kumar. Protective gears available here are questionable .44https://www.hindustantimes.com/india-news/death-rate-among-doctors-due-to-covid-far-more-in-bihar-says-ima-official/story-I6hRm0eoJAVXMWSgcyu8zN.htmlThere is a growing concern and sense of fear among healthcare workers of Bihar erupting from the news regarding daily death of HCWs due to covid-19 infections acquired at workplace, violence & struggle at workplace, scarcity and supply of inferior quality PPE55https://www.telegraphindia.com/india/bihar-doctor-deaths-blamed-on-inferior-ppe/cid/1788730 see figure 3 a doctor (author himself) working in Bihar using bedcover as PPE kit for protection due to scarcity of PPE kit. The healthcare workers are under undue stress due to several factors added to this which may affect mental health as well as physical and social health status of care providers. On March 11, 2020, the World Health Organization announced covid-19 as a pandemic and within no time infection first discovered in china (december2019), Hubei province reached India in January 2020. The health work force in Bihar is struggling since then with strict regulation and legal bindings as well as scare resources added with regular death of workers and patients creating stress and panic. In the current year 2021 and last year 2020 healthcare workers have had a high rate of infection hence for safety of healthcare workers it’s important to ensure that procedures, equipment and training are fully protective. At the same time long term, nursing, and resident care providers should have guidance for long term care, nursing homes, assisted patient living facilities and other resident care facilities such as ICU/covid-19 wards for protective measures to reduce the high incidence and prevalence of covid-19 cases and deaths of workers. Emergency services must have critical infrastructure to be able to function properly including law enforcement, fire and violence safety etc. This time last year in 2020 India was under lockdown phase, many theories about India’s surprisingly low rates of Sars-CoV-2 infection included variety of factors including hot weather, natural immunity, heard immunity, robust health system, highly qualified doctors and the country’s high proportion of young people; some also attributed it to the country’s harsh lockdown. India was doing so well that in megacities like Mumbai and Delhi, officials had begun dismantling temporary COVID-19 facilities. Comparing it to current scenario in April 2021, cases and deaths are soaring. The shortage of beds and space is so acute that people are dying in car parks and other places while waiting to be admitted in hospitals. Daily rates are currently over 300,000, the world’s highest-ever daily infection rate. The SARS-CoV-2/COVID-19 pandemic is still going on and globally as well as in India particularly healthcare system is overstressed with this new burden added with previous NCD(non communicable diseases) & CD(communicable diseases). The First human case of this global pandemic was reported from Wuhan city of China in December 2019. The first case of COVID-19 in India was found in January 2020. Today India is having more than 3 lakh cases per day and thousands of deaths daily due to this pandemic. The situation is very worse as compared to previous year and is worsening day by day due to several factors.66https://covidscholar.org/article/608d13484e85066fbf2f1797Objective and Goals: The key objectives and goals are to increase safety and healthy lifestyle adoption among healthcare workers & providers to reduce mortality and morbidity. Creating awareness & providing training to health care workers for infection control, protective measures, home care, long term care, clinical care etc. The government and policy makers should ensure making and enforcement of safety/preventive/protective protocols to ensure safety at workplace by reducing exposure to SARS-CoV-2 infection sources by using PPE & WASH measures etc. The health department should provide training for Capacity building & awareness among healthcare workers to protect themselves & Creating awareness particularly about good nutrition and sleep which often remain neglected.Establishment of Central advisory committee and research wing at state level to keep health workers updated about latest information and guidelines of treatment as these things are changing continuously & almost daily with new findings. Use of reliable and highly accredited sources such as WHO, ICMR, MoHFW, CDC , peer reviewed publications of reputed science journals etc. for providing information to healthcare workers can be utilized to explain basic factsheet of covid-19 virus and disease through IEC etc., incubation period & transmission through droplet, aerosol, contact and other possible routes (stool etc). Risk assessment of workplace should be carried out by analyzing various parameters related to infection & Stepwise approach instead of high technical letters to demonstrate steps of worker protection in real scenario by experts giving clear description and vision on worker protection and IPC (infection prevention and control).Special capacity building & training of healthcare workers involved particularly in invasive and aerosol generating procedures to protect themselves as well as training of healthcare workers for using PPE , respirators, ventilators etc as well as regarding decontamination of medical and surgical equipments. Health promotion and motivation of healthcare workers by traditional yoga, moral and financial support as well as providing working environment with adequate rest hours to ensure good health added with entertainment programs to divert anxiety.
