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[Blog] Covid-19 - Open letter to the Minister of Health : Only herd immunity will probably tame this virus

Consultant en médicine Interne et d’endocrinologie au London NW University Healthcare, le Dr Rajiv Seechun a adressé une lettre au ministre de la Santé, Kailesh Jagutpal, la semaine dernière. Il met l’accent sur la communication, le professionnalisme et l’altruisme qui sont importants dans cette lutte contre le Covid-19. Il parle aussi de l’immunité collective qui pourrait « dompter le virus. »

« Je suis certain que votre département travaille déjà sur un plan d’action pour faire face à la vague de patients qui vont inonder le service médical. C’est une situation très dynamique et il n’y a pas de façon de faire qui soit parfait », écrit le docteur Rajiv Seechun.

Pour le consultant en médecine interne et d’endocrinologie, une bonne communication, le professionnalisme, l’altruisme et la capacité de s’adapter aux changements, sont des atouts de taille. Il souligne aussi que malgré le ‘contact tracing’, il y a une forte chance que la pandémie de Covid-19 continuera à se propager. « Après tout, il est fort probable que l’immunité collective (herd immunity) domptera le virus », estime le Dr Rajiv Seechun.

Qu’est-ce l’immunité collective ? Selon le médecin, c’est un terme médical utilisé pour décrire le fait d’immuniser la majeure partie d’une population contre un virus/une bactérie(vaccin) ou si l’infection a contaminé une grande partie de la population mondiale comme c’est le cas actuellement malgré les mesures préventives.  Ainsi, si une majeure partie de la population est immunisée, le virus ou la bactérie qui a besoin d’un hôte (les êtres humains pour survivre et se transmettre à la personne suivante) ne pourra pas se reproduire et se propager.

Lire ci-dessous la lettre dans son intégralité :

Taming this virus

Dear Hon. Kailesh,

Covid -19 has landed in Mauritius. I am certain your department is working on a plan of action to face the wave of patients that will flood the medical services. It is a very dynamic situation and there may not be a perfect way of doing things. However, good communication, professionalism, altruism and ability to adapt to changes will be key to optimise the care. Despite contact tracing and isolation there is a very high chance the epidemic will spread. After all, only herd immunity will probably tame this virus. Herd immunity here refers to mass vaccination or a situation whereby a big enough proportion of the population worldwide is affected by the virus despite all measures taken and NOT the voluntary act of infecting patients.

Below are some points to bear in mind:

1. Keep the population updated on a daily basis and communicate all the relevant facts to reassure and avoid panic. Be candid. There is enough data out there from China and Italy to make some educated inferences. The majority of patients will be fine. Target those who are at risk and encourage strict isolation to break the chain of transmission.

2. Ensure that people with mild symptoms stay at home rather than rushing to the AE.

3. Encourage virtual assessment/consultation, if possible, to ensure those needing hospitalisation get prompt treatment and those well enough stay at home.

4. Cancel all non-urgent outpatients and non-urgent surgical procedures NOW. Non urgent dental procedures are hopefully banned now, I presume.

5. Ensure your staff is well protected and well managed. Medical staff can be, and is a vector of this virus, if necessary, precautions not taken. Ensure they familiarise themselves with fluid resistant surgical facemasks, filtering face piece respirators, etc. Ensure staff are trained to handle aerosol generating procedures. Your staff should be trained, by now, to handle and dispose of PPE, safely

6. Try train all your staff how to use CPAP/BiPAP/NIV devices on the ward.

7. ALL your registered doctors (including those in the private sector) will need to be summoned to work in the hospital if crisis level is reached. Hence, start training these doctors if needed. Private doctors should avoid visiting patients with flu like symptoms, unless using PPE, as this will be a recipe for disaster.

8. Train your staff how to proceed with cardiac resuscitation on a Covid+ patient to minimise infection. Bag and mask ventilation may need to be avoided if intubation facilities are available.

9. Difficult and ethical decisions will need to be taken. This has to be done by experienced and senior team members. Start training your staff, from now, to make this decision early on to improve efficiency and judicious use of resources. For example: there is no justification to send somebody, irrespective of age, with multiple comorbidities in ITU and deny a young fit patient from an ITU bed.

10. By now, I expect you have a strategy to upscale the testing, the number of isolation rooms and asked all private stakeholders to play their patriotic role in the interest of the nation.

COMMUNICATE, COMMUNICATE AND COMMUNICATE

Yours sincerely,

Dr Rajiv Seechurn

Consultant Internal Medicine/ Endocrinology

London NW University Healthcare
 

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