Bengaluru: Indian Institute of Science Bangalore's Professor A.G. Ramakrishnan from Department of Electrical Engineering IISc has presented a paper on redesigning of COVID-19 ICUs to save the lives of Corona Warriors.
Reporter: Currently the design of most of the ICUs is not suited for treating the highly infectious patients of COVID-19. Why do you think so?
Professor Ramakrishnan: ICUs were originally designed to isolate a sensitive patient recovering from a surgery or some other condition from possible infections from outside. The air inside the closed ICU is maintained as infection-free and the hospital staff suspect that anyone entering the ICU might bring in infection and risk to the patient. However, when COVID-19 patients are being treated, the patient is fully infected and is exhaling the virus all the time. So, when such a patient is kept inside a closed room such as an ICU with recirculating A/C, slowly the entire air inside the ICU is filled with viral load. Since the A/C also does not filter the virus, the viral load slowly increases with time and this is detrimental to the health of the patients, doctors, nurses and every other health workers. So, now we need to protect the doctors and nurses working in the ICU from the enormous infection arising from the patients under treatment. In fact, in most hospitals, the same centralized A/C cools the other wards and ICUs also, and hence the infection can easily spread to other patients and doctors not dealing with COVID-19 patients too.
In short, neither the doctors nor the patients get filtered air to breathe.
Reporter: What are the alternatives?
Professor Ramakrishnan: Use a completely ventilated building for keeping COVID-19 patients. Airconditioning is not at all needed. Arrange for powerful fans on one entrance, which pump in fresh air into the building (hall or ICU) and exhaust fans on the other end that sucks out the air forcefully from the building. This ensures that the virus exhaled by the patients is continuously removed from the building by a continuous, unidirectional flow of air through the room. If there are no other buildings, then pass the outlet air of the ICU through disinfecting solutions to make sure that the air is completely free of the virus before it is recirculated through the ICU. If A/C cannot be eliminated, then it is absolutely necessary to isolate the A/C for the rest of the hospital from the A/C for the COVID-19 ward. This will protect the other patients in the hospital from the viral load coming through the A/C from the COVID-19 ICU or ward. Read: Southampton team developing prototype protective equipment for frontline healthcare staff.
The doctors and nurses in the ICU can be given modified special protective equipment that supplies virus-filtered air and facilitates them to breathe easily and comfortably. The novel Coronavirus cannot enter through the intact skin. So, there is no need to have the plastic PPE that doctors and nurses are forced (OR choose) to wear. In some cases, they are asked to use diapers, because they cannot use the toilets with cumbersome PPEs on. The current PPE used was designed for the Ebola virus and there is no need for the plastic gown for the rest of the body, which creates excessive heat, humidity and discomfort. Accordingly, except for wearing a comfortable, fully closed, face cover with filtered air, they can just wear a normal dress and leave everything into a washing machine, take a hot water shower with soap, wear a new set of clothes and go home or go to their resting area after their duty for the day. The doctors and nurses must be rotated every few hours, so that they can relax for some time and get mentally and physically rejuvenated, before again continuing their duty. During this time, they must be given refreshing nutritious juices or hot soups; light exercise, yoga and or pranayama; listen to relaxing music, etc. Utilize the expertise of elderly specialists (carrying higher personal risk) through remote (internet-based) consultation and do not give them duty, where they directly interact with the COVID-19 patients.
Reporter: You also suggest that soothing music be played for patients. Has this been implemented abroad? if so any positive effects from this?
Professor Ramakrishnan: For everything, we need not look to the west. Actually, the mortality rate of COVID-19 patients (number of patients dying as a ratio of the number of patients infected or the number of deaths per million population) is much higher in most developed European countries and USA, compared to India. Stress-induced hyperglycemia (an increase of blood glucose level due to excessive fear) is known to health researchers. Most patients admitted for major surgeries get affected by this and their blood sugar level increases, which is sometimes mistaken as diabetes. In many ICUs, only thin screens separate different patients. So, whenever a patient wakes up and looks around in an ICU, he sees other patients with different tubes fitted into the body and some of them dying also. All of this increase the stress level of the patients and stress also reduces the immunity of the body. So, anything that relaxes the mind is potentially useful. Also, I have given a reference to a research study that has observed the benefits of music listening on healthcare workers with respect to burnout symptoms, stress reduction as well as surgical efficiency:
Read: Systematic review of interventions for reducing occupational stress in health care workers
Reporter: How did you formulate the suggestions for the redesign of ICUs?
Professor Ramakrishnan: By talking to (i) several doctors about the current situation, how they feel with the N-95 masks, whether they have fear and tension, what the nature of the airconditioning in the ICU is, etc. (ii) refrigeration and airconditioning engineers about their recommendations for filtering the Coronavirus from the circulating air, (iii) by reading a lot of related material, (iv) by going through a number of YouTube videos of physicians attending to COVID-19 patients around the world, (v) by studying reports such as “Indian society of critical care medicine experts committee consensus statement on ICU planning and designing, 2020” and that of Indian society of heating, refrigerating and air conditioning engineers (ISHRAE) and (vi) a number of research papers related closely or peripherally to the issue under consideration.
Reporter: How cost-effective it is?
Professor Ramakrishnan: It will be very cost-effective to create new ICUs dedicated to COVID-19 by converting large, well-ventilated halls. On the other hand, if a current airconditioned ICU with false roofing and no windows needs to be converted, then it may involve higher expenditure.
Reporter: Have you or IISc given these papers to the Government?
Professor Ramakrishnan: No. You can help me do so to the Ministry of Health, Government of India, and ICMR and/or AIMMS. Can you suggest who is the best person, who might read this and take interest in implementing the same? And what is the best mode to contact them? Email or letter or social media, etc.
A few months before, when I first wrote the initial draft of this article, I shared it on the Twitter accounts of many newspapers’ science correspondents and health ministers of most states in India and also several other countries. I did not get a single reply or enquiry from anyone of them. I got the best paper award from the IEEE Humanitarian Technology Conference for this paper, and when I shared it on Twitter, Facebook and also LinkedIn, none of the media contacted me. However, when it was shared on the official Twitter and Facebook pages of IISc, several media people are curious to know what my suggestions are. However, no doctors or hospital administrators or Government health administrators have contacted me so far.
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