Dr Anup R Warrier is the lead for infectious diseases, infection control and antimicrobial stewardship for the India units of Aster DM Healthcare. He warns infection prevention will continue to remain neglected until fresh concepts and incentive models are introduced into healthcare planning. Edited excerpts of an interview with FM

 Frontline casualty rates appear to be quite high with the new coronavirus infection, not only in India, but across many parts of the world, including China, UK, US etc. Apart from inadequate availability of PPEs, some experts say that insufficient data on the transmission dynamics of the novel pathogen might be contributing to this. What is your comment?

 Various factors contribute to the enhanced transmission of COVID. As with many respiratory viruses, the most important aspects of transmission are: aerosol-generating procedures being performed on the patient, such as nebulisations; prolonged sharing of closed or poorly ventilated spaces where limited airborne transmission can occur, and limited knowledge about efficiency and contribution of fomite transmission in this outbreak. While in healthcare facilities, AGP and poor ventilation could be significant, prolonged sharing of crowded public spaces and fomites might be significant in the community. The fact that asymptomatic and early symptomatic patients are efficient transmitters of COVID is of concern.

 Considering the pace of infectiousness, novel coronavirus seems to have no parallel, at least in near history. The transmission modes of the pathogen are also unclear. Besides, the virus can stay endemic here as a big challenge in the coming days. In such a scenario, how should hospitals, with patients who are more vulnerable, get ready?

 Unless the global community and healthcare leaders and the government undergo major conceptual changes in delivering healthcare, we will continue to be susceptible and vulnerable. 

For hospitals, design and construction needs to ensure adequate ventilation in all areas that are more likely to facilitate airborne infections. All design workflows and procedures should be planned to avoid crowds. Adding infection prevention interventions like enhanced environmental cleaning and appropriate PPE into the costing strategies becomes an essential part of business continuity planning.

As far as the public is concerned, serious behaviour changes focusing on physical distancing and avoiding crowding, cough etiquette, hand hygiene and universal mask use at least for one more year [has to be observed]. General hygiene measures at home should suffice. 

 Research on infectious diseases gets a lower priority in comparison with lifestyle-related diseases including cancers. This is probably one of the contributing reasons why the scientific community is groping in the dark to offer a clue to stop the unprecedented spread of novel coronavirus. Your views? 

 Research and investment are proportional to the return on investment. Though much more common than NCDs, ROI (return of investment) in infectious disease has been poor. Only at the government level can this be boosted, either by direct investment or by policy and incentives to private industry. Infection prevention has been a neglected story, seen as an ‘unnecessary cost’ – and will remain so until there is a serious change in the overall reimbursement models and cost models for delivering healthcare. Spending loads on environmental and hand disinfection, PPE, adequate HVAC systems, molecular diagnostics and sequencing technologies etc are “not cost- effective” under present price points in delivering healthcare for infectious diseases.  

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