Life During COVID Times: A New Normal

Life during COVID Times: A New Normal?
Dr Sudhir Kumar

COVID-19 caused by SARS CoV2 virus is a pandemic, which started from China in December 2019, and since has rapidly spread to around 200 countries. After China, many European countries such as Italy, Spain and France saw huge numbers of COVID-19 cases and deaths due to it. Currently, USA too is reporting large number of cases and deaths.
The infection was relatively late to arrive in India, sometime in early March 2020. However, since then, the number of infected has been steadily increasing (crossed 75,000 cases and 2600 deaths). Governments swung into action and enforced lockdown (we have just completed 50 days of lockdown).
Routine lives have been disrupted, with people confined mostly to homes except venturing out for essential services (we have seen some relaxation over the past week or so, when industries and businesses were allowed to function with skeletal staff).
Our lives as doctors too have changed. I am a neurologist working at Apollo Hospital in Jubilee Hills, a leading multi-specialty hospital in Hyderabad. Our OPDs are functioning “normally” for the past 10 days. Let me describe this “new normal”. The patient and one attendant (only one attendant is allowed now; in pre-COVID times, it was not unusual to have 3-4 attendants per patient in OPD and dozen or more attendants for a patient admitted in ICU) are checked for fever (with a thermal scanner) at the entrance. Those with fever are asked to report to “Fever Clinic OPD”. If the temperature is normal, patients are allowed in after sanitising hands and with face-masks on. They are also asked to fill a questionnaire that capture details such as presence of symptoms of cough/fever, any recent travel, etc, as a screening tool for COVID. Once the hospital staff declares the patient “safe”, he is allowed to enter the OPD waiting area. In the waiting area, seating is modified to allow social distancing (alternate chairs are kept vacant). Patients are encouraged to come at their scheduled appointment times so as to minimize wait times to see the doctor. In pre-COVID times, it was not unusual to find several “walk-in patients” who would land up without any prior appointments, so that at any given time, 5-6 patients and their attendants could be waiting to get inside my consultation room.
Inside my OPD room also, there are several changes, which have become “normal” now. Patient’s chairs are kept at 1.5 meters distance from my chair across the table to ensure adequate social distancing. The side chair near my right side (which was within 2-3 feet from me) has been removed. I wear an N95 mask (without a valve) throughout the day. The patient and the attendant should have their masks on. Conversation with the patient often involves a few aspects of COVID- such as how they are coping during lockdown… how deadly the virus is… when will it go…and so on. Clinical examination that require touching a patient is avoided, if possible. So, sensory system examination is often skipped. Motor system examination to check for grade 4 or 5 power is also skipped. If examination is performed, I wear gloves, which are single use and discarded after every patient. Wearing gloves in OPD is a “new normal” for me, as we do not usually perform any procedures in OPD. If reflexes are checked, the knee hammer is sanitised after every patient. I attempt to complete the examination as quickly as possible, as it is not possible to maintain safe social distancing while examining a patient. I prefer patient not talking during examination so that aerosol generation is minimised. Prescription is generated on computer. MRI and CT scans are seen on computer (PACS) so that I touch as little things as possible. Shaking hands with patients to greet is a strict no. I can no longer comfort a patient or caregiver by holding their hands or by patting their shoulders. Healing comes through these acts of empathy and compassion too and not merely from medicines. I hope we can go back to the “old normal” where we could hold our patients’ hands again. For follow-up of reports or other minor queries, patients are encouraged to use online consultation option on Apollo 24/7 app. Once the patient leaves, a hospital staff comes in and sanitises the chairs and table (this is done after each patient). This is also a “new normal”.
A few of my patients with cough or fever are denied entry into my OPD, (as per the hospital protocol). I feel bad as those symptoms could be due to infections other then COVID. However, I am able to give opinion after emergency physician or Infectious disease physician sees them.
Driving between home and hospital are a pleasure these days, as traffic is significantly less. Police have stopped me a few times during this commute to check about the reason of my travel. There is a sticker pasted on my car’s windshield “Apollo Hospital On Duty”. However, sometimes they check my ID card to ensure I am not misusing such a sticker.
OPDs are not busy (about 40-50% of usual work load). This is because state and country borders are sealed. Many of my patients come from other states such as Maharashtra, Andhra Pradesh, Karnataka, West Bengal, etc. We also get patients from Middle East and Africa. These patients have been waiting for borders to open and transport to resume so that they can travel to Hyderabad. I have been providing online support, however, this should not become the “new normal”.
On account of lesser workload, I reach home earlier than usual. I discard my hospital clothes and keep them aside for washing. After taking shower, I have more time to spend with kids and parents. I feel sorry for them, as they have been confined to home for more than 50 days. Kids have no school but online classes are on. However, no outdoor games at all. Is this going to be a “new normal” for kids? I hope not…Parents are in the older age group and belong to the high-risk group for acquiring severe disease, so they have strictly remained indoors. No going out for walks or socialising with their friends in the community. I hope this also does not become the “new normal”.
Another change in our daily routine has been a flurry of webinars, where various experts have discussed almost all neurology topics in the past 50 days (I too have been a speaker for some of those webinars). On many days, there are 5-6 webinars in a day, where international and national experts deliver lectures on recent advances in management of various neurological diseases. These webinars were interesting during the initial few days, however, now, webinar fatigue has set in. The enthusiasm to log on to attend virtual webinars has waned over the past 50 days.
A not so hectic work schedule has allowed me some time for singing, one of my hobbies since childhood.
All in all, the situation has not turned out to be as bad as we had imagined. Most of the hospitals are not overwhelmed and our frontline medical workers have handled the workload well. Deaths have been relatively lesser, and I hope it stays that way. I hope the uncertainty ends soon and people can resume their daily activities without fear. Which one is better: the “old normal” or the “new normal”? I would any day pick the “old normal”. However, we do not have a choice for now. It is better we stick to the basics to contain the disease: hand hygiene, using face cover and maintaining social distancing at least for the next several months (until there is a vaccine, or the virus mysteriously disappears in the same manner as it appeared in Wuhan).