The first case of COVID-19 in India, was reported on 30 January 2020. As numbers kept on increasing, on 24 March, the Prime Minister ordered a nationwide lockdown for 21 days, affecting the entire 1.3 billion population of India. On 14 April, the PM extended the nationwide lockdown till 3 May which was followed by two-week extensions starting 3 and 17 May.

Because of the lockdown, there was a significant reduction in the number of transplants. In fact, the transplant program stopped during nationwide lockdown. There were no living donor transplants and there were 5 cases of brain-stem death identified in Mumbai during this period, but none could become donors due to practical problems. These include scarce resources (e.g., beds, operating theatres, medics, and nurses) and a logistical difficulty in ensuring clean and microbiologically safe pathways within hospitals for transplant patients.

As regards, kidney transplant procedures, there was fear among doctors that SARS-CoV-2 infection could be missed in both donors and recipients who are asymptomatic owing to the sensitivity issues with the RT-PCR test. Additionally, in the immediate postoperative period and after hospital discharge, transplanted patients have increased susceptibility to SARS-CoV-2 infection owing to induction therapy and immunosuppressive treatment. Because of this even the patients were reluctant for transplant and particularly kidney transplant patients because they have an alternative in the form of dialysis. Beginning June 1, the lockdown was released. By this time, with better understanding of COVID-19 and availability of antiviral and anti-inflammatory drugs the recovery rate of COVID-19 steadily improved.

Timely case identification” and “proper clinical management”. The recovery rate has been steadily increasing. In my opinion, with proper evaluation of recipient and donor which includes epidemiologic history, clinical history, throat swab for RT PCR and HRCT chest and with proper care in the hospital, kidney transplantation can be performed in the current situation. It is important to discuss with the patient that despite taking all precautionary measures, a small risk of covid infection remains and a dedicated consent form would help patients make well informed decisions. The significant decline in kidney transplantation is due to uncertainty regarding the risk of developing COVID-19 infection and its impact on recipients and also because these patients have an alternative in the form of dialysis.

Nurses are part of one of the biggest segments of the healthcare industry and they play an extremely important role. The right caring for a patient post-treatment is crucial for their recovery, and nurses are well aware of that. They ensure that they provide the patients with everything they need, right from caring to counselling, to ensure their good health and speedy recovery. However, even after knowing everything about health and healthcare, most of these caring angels fail to take care of their own health. 

The healthcare industry is one of the most hazardous environments to work in. Nurses in this industry are constantly exposed to a complex variety of health and safety hazards in the course of their work. Hazards range from biological exposure to disease-causing organisms such as tuberculosis and human immunodeficiency virus (HIV); exposure to chemicals such as glutaraldehyde and ethylene dioxide; risks of needle-stick injuries causing HIV, hepatitis, etc; Long working hours causing musculoskeletal issues; moving heavy patients that may lead to physical discomfort; and prolonged shift work causes stress and adds to the health issues.

In a report published by the WHO, the disease burden caused by percutaneous sharps injuries among healthcare workers was found to be three million per year. Maximum cases of hepatitis B, hepatitis C and HIV among healthcare workers were reported to be due to needle stick injuries. It is very unfortunate that approximately 1000 healthcare workers die annually from occupational HIV, which can and should have been prevented. Despite having the resources and the knowledge, almost 80% of healthcare workers remain unimmunized (against Hepatitis B) in many parts of the world.

In addition to this, nurses have a higher risk of non-communicable diseases such as diabetes, hypertension, and cardiovascular diseases as well. Many nurses are forced to lead an unhealthy lifestyle due to their long shift hours, busy-paced work, and the stress of maintaining a work-life balance. With so many responsibilities, it becomes easy to understand how self-care becomes their last priority.

Maintaining the health of the nurses became all the more difficult during the pandemic with the extreme workload, minimal information about the virus, and the fear of contracting the disease. Therefore, we made certain provisions in the hospital itself. We provided all our nurses and staff members with vitamin C supplements and adequate protein to ensure their immunity is boosted, we gave them constant reminders to drink water and gave them enough breaks between shifts to rest and destress. Bio breaks were given to use the washroom and return with fresh PPEs keeping in mind menstrual hygiene and prevention of UTIs and renal calculi. We also checked their weight regularly to make sure they are well-nourished and also are regularly screened for COVID-19 so that if infected, they can be treated on time. The nurses who had turned positive were provided free and best care to recover.

Apart from that, we also arranged several diversions such as poster competitions, counselling events to take care of nurses’ grievances, and several other provisions were made to ensure that the mental health of the nurses was also taken care of.  

I agree that nursing is a noble profession and that you are expected to keep your patients as the top priority, but it is equally important to take care of yourself because you can look after your patients only when you are fit and healthy. Set aside some time for exercise, take care of your nourishment, take vitamin C and protein supplements to boost your immunity, get enough rest and sleep, practice meditation to maintain good mental health, report to a physician in your hospital if you are feeling uneasy or unwell, ask for help whenever you feel overwhelmed by work and lastly, give yourself the priority and importance you need and deserve.

With the COVID-19 pandemic, we are living through a world crisis that we have never seen in nearly a hundred years.

The enormous scale of the crisis and the impact it has created had already caused a lot of fear, uncertainty and anxiety across the globe. The frontline workers were always at the risk of contracting the virus, despite which they have served us and took care of millions worldwide. When the pandemic started no one knew about it precisely and we were in the same boat too. All the employees and nurses were timorous and terrified but when we gathered them with respective managers and conducted meetings to explain their duty, they came forward. We had taken the initiatives to train them and counsel them about how they have to take care of the patients in the given scenario.

The acceptance of a situation where we had to stand for one another was the utmost priority which the nurses developed. Those times were so hard as there was no transportation for anyone to go to their homes respectively which was a matter of concern. But, we being nurses were only concerned about our duty and responsibility.

Generally, the ICU care unit had always seen the hardest goodbyes and warmest welcomes, but Covid-19 ICU care units were no less of a greater chore. We were running aisles to get the patients what they needed on time each moment. This reminds me of the most challenging day in the covid ICU critical care unit. This was the time when covid cases peaked up, we were accommodating 40-45 patients all at once. Suddenly, we received a call from the emergency room that there were three patients that had to be admitted as early as possible. We panicked as soon as this news was received. They were on mobile ventilators and they had to come all the way to the hospital.

We had assigned two nurses who took care of these covid patients, as our first priority were always them, we were making arrangements for them for a hassle-free admittance. We received the call about their arrival post at 5 pm in the evening and these critical patients arrived at 7 pm. They were in miserable conditions, one patient was unconscious and the other two had major respiratory problems. I remember how their saturation levels were at 80 and it was terrifying to see three patients at once with such ailments.

The doctors along with nurses were on the duty trying to do whatever we could to bring them to normalcy. As the three of them had different conditions, looking after them was a challenge. The frontline leaders faced great difficulty to get the nurses from normal ICU to covid care unit. Arranging manpower was a task for the assistant nursing superintendent. Even though there were such circumstances the nurses always came front to help the patients which were overwhelming.

Nurses are known for their patience levels and self-composed nature, needless to say, that day we experienced it. The nurses were so composed and patient with those patients who happened to recover in later stages. There was less equipment for them so, we immediately contacted the biomedical engineers to provide us with the necessary equipment. They did a very commendable job in coordinating with us at such times.

There is an on-call list for emergencies where the nurses wait at their respective hostels. If there is any need, they attend as soon as possible. Such arrangements play a major role at times where it is the matter of life and death. Post that day, we have taken good care of the mentioned patients and they recovered pretty well.

This experience has been great learning for the nurses as they have dealt with such situations, they are now ready for anything. They have no fear of treating any patient with any kind of ailments. Currently, we have 12 covid patients admitted and the nursing staff is dealing with them extremely responsibly. As they are competent to handle patients, the nurses are getting opportunities in other countries mainly, the Gulf countries and the UK where they are looking for such skilled manforce.

I am very much proud that after such experiences, our nurses are getting the opportunity to excel in their careers. After the patients recovered, their smiles are what we look up to and feel proud of. Even though time has passed such memories stay with us impacting and leave us with great learnings.

I believe that a pandemic had to come to make the world realise what nurses are capable of doing anything and 2020 was the year for nurses. As the patients struggle for their life, we can handle any situation now as we demonstrate care, team spirit and utmost unity. The most challenging day had been the most memorable one too in the times of covid.

Patients and their families undergo a great deal of suffering when diagnosed with a life-threatening disease such as COVID-19. Unlike other chronic diseases, dealing with COVID-19 patients was different and difficult because the disease was unknown to us and we did not have answers to the patients’ questions. The uncertainty of the disease, the fear of illness and death, the stigma, and socioeconomic hardships all made it even more difficult to deal with the situations in the hospital.

At the end-of-life department, we look after patients with advanced, progressive, incurable or life-limiting diseases so that they can live the final few days with their loved ones and make a few extra memories with their families before they die. The process of care and counselling is not limited to the person who is dying but extends to their families, friends, and caregivers as well. Working at the end-of-life department is quite overwhelming. Watching people lose their loved ones is difficult, and it becomes all the more emotionally challenging when it is a COVID-19 patient as no one is allowed near the patient, they are to be isolated and stay alone.

Suffering from a life-threatening disease and being isolated while fighting the battle alone can take a toll on you emotionally and psychologically. Many times, the patients would scream and yell in agony and fear, would abuse the nurses just to vent out. The disappointed nurses would then come to me and tell me how they did not wish to continue working in the COVID wards. In times as such, I would counsel my team members and tell them how the patient is in pain and struggling for life; there isn’t any grudge against the nurses or the authorities, but the fear of losing their lives and leaving their families alone. It was overwhelming for the nurses in the initial months, but now everybody is well acquainted with the situations and knows how to handle things. 

When the pandemic was at its peak and the hospital was full of COVID-19 patients, nurses had to provide care in extreme situations, even in critical care units which were outside the area of their usual practice. None of my nurses backed off from such additional responsibilities. In fact, they spent extra time learning the right ways of doing things to help the patients and their team members, and I am extremely proud of my team.

However, offering clear, accurate and consistent communication to the patients and their families during end-of-life care, in this situation, was challenging. Having access to equipment to provide supportive end-of-life care, was increasingly difficult as demand for supplies increased day-by-day while we approach the height of the pandemic. Creative care planning helped us mitigate some of these challenges along with the determination and diligence of my team.

The initial months, where we had minimal information about the disease, were extremely difficult. We did not have enough PPE kits so we had to use raincoats to protect ourselves. Many of our teammates had contracted the virus and were struggling for life. Doctors had lost hopes with one of them, said she may not recover. This incident was very tough for us to deal with, but thankfully she recovered and has rejoined the team to serve the patients. 

One very disturbing challenge that we had to face during the times of the pandemic peak was the process of disposing of the bodies of those who lost their lives. Normally, when a patient died, the family would be informed and they would take their patient home to do the final rites. But during the pandemic, many patients were abandoned by their families, and in such cases, we had to dispose of the bodies with the help of municipal authorities. In such cases, we would dress the body in a fresh hospital gown, wrap it in a blanket, then cover it with a dead-body bag and hand it to the municipal authorities with utmost dignity.

In cases where the families we not allowed near the patients due to the restrictions, we tried to do some of their final rituals because we understand how difficult it must be for the family to not be able to see their loved ones for the one last time. I along with my team made sure that none of our patients or their families feel they are alone in this or that the patients are being discriminated against because they may not survive. The end-of-life care department is dedicated to support and care for patients, and their families, in their final, most vulnerable times.   

Nursing is called a noble profession for a reason, it is not just about treating a patient, but also giving them comprehensive care and family-like support throughout their recovery process. It is about ensuring that the patients know there’s someone to look after them, a caring professional who will be there to help them throughout. It takes a great deal of perseverance, dedication and commitment to serve as a nurse with the complexity of disease conditions and technological advancements. Earlier what was considered to be an occupation that only involved caring has now changed to become a profession that involves caring as well as curing.  

Nurses have time and again, proved that they are an extremely important fraction of the health sector and full partners to medical professionals. The COVID-19 pandemic was one such chaotic crisis where the nurses shouldered equal responsibilities with doctors playing an extended role and were involved in care-efficient and cost-efficient services. I can vouch that without nurses, the conditions would have been extremely difficult to handle. The abilities of the nurse to carry out various jobs, learn new skills, and adapt to a different environment were the driving forces that kept the hospitals functioning during the pandemic. The pandemic did not only showcase the competency of the nurses but also the importance of them.  

My team of nurses at Gleneagles Hospitals Group worked day in and day out to serve our patients suffering from COVID-19. Within a few days, they were able to learn about the virus and nursing management of patients with COVID-19. They were the most preferred team members for the doctors in planning, diagnosing, treating and evaluating patients’ progress.  They helped several patients recover without any severe complications and lessened the economic burdens on the family and the payors.  Nurses went beyond caring, predicted early warning signs and collaborated with doctors in making the right clinical decision. They followed best practices of care to hasten recovery, and early discharge and prevented readmission by their education and guidance to the patients they cared for. My nurses never missed wearing pleasant smiles behind masks, gentle gestures in a COVID suit, warm touch with gloved hands, and empathetic words heard beyond N95 mask and face shiels. They stood tall in their heroic expression when they assisted patients in non-invasive ventilation, collected samples for COVID test, stood close to the patients while performing aerosol-generating procedures, met the nutritional, hygienic and elimination needs of the patient and assisted in birth and end-of-life care. The nurse was the family of the patient when the visitors were restricted in the COVID ICU and wards. Nurses used all their talents such as singing, praying, reading stories and spiritual books to patients, using humour, motivational small talks and connecting with their loved ones through WhatsApp and online modes to delight patients with COVID-19.  

If you ask me what has led to such drastic and positive changes in the field of nursing, I would say it is the improved standard of education and training, nursing philosophy, vision, mission, values, code of ethics and technological advancements. With improved education, the foundation of knowledge is strengthened making nurses who are capable of learning and adapting new skills without facing any issues. An improved code of ethics gives a sense of security to those entering the profession and attracts more individuals to it. And lastly, technological advancements have made it possible and easier for nurses to help their patients more efficiently and accurately. With all these positive changes I see the future of nursing in India to be bright and progressive. Nursing centres of excellence, global nursing education system, collaborative care, nurse clinicians, robotic nursing, specialization and super specialization in nursing, telenursing, Young Nursing leadership development, nursing research and collaboration, nursing informatics, preventive care and nurses as business leaders are the way forward.  However, there are still certain concerns that need to be addressed.  

There is a massive shortage of nurses in India and the major reason being, the migration of nurses to foreign countries. Indian nurses are highly competent, dedicated and committed and therefore are valued in foreign countries. Nurses from India migrate to a foreign land where they get a higher education, career advancement, lateral entry to medicine, evolve as nurse practitioners, and earn more respect and better compensation than they could in India. Adding to the shortage of nurses is the fact that we Indians think of nursing to be a secondary or inferior profession to medicine. We fail to understand that nursing walks alongside medicine and surgery and that nurses too are highly educated and capable. Behind every successful treatment and surgery, there are a team of nurses whose untiring efforts result in cost-effective and care-efficient services.  For India to become a global leader in the healthcare and medical field, we must appreciate and value our nurses and give them the respect they deserve because, without them, the system will fall apart.  

Lastly, I have a message for all the nurses, the future of nursing in the nation will be bright if only the future of the nation is bright. We are well aware of the equipment we use and the impact them on nature. Syringes, tubes, drains, disposables, PPE kits, surgical masks, etc. When they are disposed of carelessly, can cause severe harm to the environment. Although we cannot stop using them, we can ensure that they are disposed of properly so that no major harm is caused to the environment. Nurse innovators who are interested in product designing are to be encouraged so that they can contribute towards building Greener Healthcare by minimizing Biomedical waste generation, thereby protecting the soil, air and water.  Together, we can make healthcare green and sustainable to give our nation a healthier future. Nurses can make a difference and impact if recognized, respected and rewarded for being a care hero at the bedside and a business hero at the boardroom.  

By Dr Jothi Clara. J. Micheal

Director of Nursing, India Operations Division, IHH Healthcare India (Gleneagles Hospitals Group)

The COVID-19 pandemic has not only changed the lives of those affected by it, but has, in the literal sense, changed the lives of everybody. The way we socialize, the way we see our health, the way we perceive life, has all changed, and perhaps, this change is permanent. It also changed our entire education system. There were no more classrooms anymore where we could interact with our professors and peers to learn. It was all online. The pandemic forced us all to fetch our electronic devices to learn about the virus and how to look after the patients while taking care of ourselves. 

Regular classes were necessary as we knew absolutely nothing about the disease. We had to upgrade our knowledge in order to treat our patients and protect ourselves from contracting the virus. We had to attend several online classes and webinars, and it was difficult to manage time as the nurses had to look after patients too. Therefore, we divided the staff into groups, the on-duty group will look after the patients in their respective shifts and the off-duty group will attend the classes in the meanwhile.

The classes taught us everything. Right from the effects of the virus and how it spreads, to the safety protocols, PPE donning and doffing, and its sequences as per HIC policy to prevent the spread of infection. We were also taught the importance of hand hygiene, the sequence and the right way of doing it, and isolation techniques. It was exciting to learn new information, as we knew with this knowledge we could help thousands of patients and save their lives.  

With the introduction of telenursing, our nurses were connected with patients in the isolation wards where they addressed their concerns, answered their questions, and took updates on their health regularly without having the need to expose themselves to the contaminated wards unless extremely necessary. 

If I were to pinpoint a challenge that we faced with the entire online learning and telenursing approach, it was the rare connectivity and internet inconvenience that we had. And there were a few instances in which some of the team members had difficulties using the video conference applications or login problems. Apart from that, it was all smooth and effective. The ease of having access to a smartphone and such advanced technology, was extremely helpful in managing the whole pandemic situation and keeping the entire staff updated with the latest information about the virus.

To ensure the health of our nurses, we made regular announcements to remind the staff to wash their hands. We also had all the arrangements made to ensure that the nutritional needs of the staff are met. We provided them with good food, protein bars, healthy snacks, energy drinks and everything else they needed to remain active throughout their shifts.

The e-learning approach is extremely different from the traditional classroom-learning approach. However, it is equally effective and came as a savior during the pandemic when group gatherings were prohibited as an attempt to contain the virus. The experience with online learning was different, perceiving information was a little difficult given the unpredictable technical glitches, but with the dedication of our staff-member and their will to spend extra hours in learning along with working full-time shifts, it was all possible. The nurses worked day in and day out to serve the patients along with that, they honed their skills to help those suffering in a better, more efficient way. The hard work and diligence of my team were commendable and I can say that I am extremely proud of each one of them.

The preconceived notion of nursing being a women’s only field is something that I have always found to be inappropriate. To my belief, there is a need for male nurses as they make important contributions to the team, profession and organization as well. They not only help with laborious tasks but also support the team beyond work. I say this because I have seen how helpful male nurses can be, especially during times of crisis. In 2018 when the entire state was hit by the historical Chennai floods and the hospital was submerged 5 feet underwater inside and 8 feet around the hospital. There was no electricity to keep the machines and instruments running. It was crucial to evacuate the patients from the hospital to a safer place. At that time, it was the male nurses who came forward and gave confidence to me as a Director Of Nursing to lead the evacuation. They played a herculean task to ensure safe transportation of patients from the hospital and evacuated them on boats to ensure that they reach a safer place. Only because of the help of male nurses, we could ensure that there were no casualties. The presence of mind of one of our nurses in evacuating a patient saved his life on the boat. If it were someone else, any rescue team, we may have lost the patient on the commute, but because there was a nurse, he could save him. 

Having male nurses in the team has always been seen as a strength. They not only help the female nurses with work, but also offer them emotional support and assistance when anybody misbehaves with them. The concerns of my male team members are not just limited to the hospital. They ensure their female teammates’ safety beyond work as well. They always offer to drop them home after late shifts, just to be sure that all the women of the team have reached homes safely.

I have been in the industry for over 3 decades and I do not consider internal bias or discrimination to be the reason for men not wanting to be a part of the field. As I mentioned earlier, there is no bias within the team but the prejudice of the society. There are no nursing colleges in India that offer an equal or a high number of seats to men. Most of the colleges do not admit men for nursing at all. This is, perhaps, the biggest reason why men do not enter the field because there is no source of knowledge, to begin with. Apart from that, the assumption of this being a women-dominated field, based on the fact that modern nursing was founded by Florence Nightingale, a woman, is also a contributing factor. In addition, the assumptions of low pay and almost no recognition are also certain crucial factors that stop men from entering the nursing niche. But the biggest reason why India suffers from a deficiency of male nurses is the perception of society, relatives and the people around them, towards nursing. Since nursing is struggling to be accepted to be a reputable, gender unbiased career, makes it difficult for men to be a part of it, although there is a great demand and opportunity for growth for men in the field. 

Many of you must think that, how did nursing a field so intimately related to medicine, become a women-dominated profession when women were not allowed to have an education just a few decades ago. The answer is quite interesting. During the wars, it was the men who nursed the injured soldiers, mostly without any formal training in medicine, and women were restricted to play the roles of midwives and child-birthing processes. With time, the demand for men increased in the army and other sectors that needed manpower and muscular strengths. Therefore, the role of caring for the sick came down to most women. In addition, the founder of modern nursing, Florence Nightingale, became the role model for most women to get into nursing and pursue it as a career. Since initially, nursing meant to just take care of the patients and tend to their needs, it did not need high education, unlike today. Therefore, women did not face much resistance and slowly, nursing grew to become a sector that had way more women than men.

Today, nursing is not just meant for caring but also curing and it runs parallel to the medical field and partners in delivering business goals of the organization. Nurses need to be highly educated and trained to provide good care and plan the treatment with the multi-disciplinary team. It is also the first line of care, especially in cases or trauma and accidents, as nurses need to go to the accident site and bring the patient to the hospital in an ambulance. Therefore, we need more men in nursing as it requires a lot of strength to transfer patients, lift them up and do such other laborious tasks.

According to me, the way to put an end to this bias in the eyes of society is by providing equal opportunities to both men to women who desire to enter the field of nursing. Colleges and universities should have an equal number of seats for male aspirants. Hospitals must make it a point to include nurses in governance and development teams, make them a part of hospital planning, include their views in developing policies, etc., it will not only help the hospital run better, but will also help the society understand how nursing is not a female dominant career anymore, it is way more than just helping the doctors. When given importance and respect, and been valued will surely attract more men to the field. Nursing profession needs heterogeneity to run smoothly which creates a huge demand for men in the field. It also provides growth opportunities and is a stable career as nursing is not only limited to the hospitals any more but even to flight nursing, submarine nursing, military nursing, robotic nursing, tele nursing, space nursing, school health nursing and industrial nursing etc... Another reason why I say there is a great demand is that even the male patients are more comfortable when male nurses render personalized care for them, especially when it involves caring for patients with andrological, urological and support activities of daily living. This also protects the right of the female nurses who have been historically subjected to meeting the personal hygienic needs of the male patients.

Nursing is a noble profession and equal opportunities should be provided to both men to women. There should be a gender-sensitive approach including equal opportunities and respect.  In fact, it must be open to all genders and not be limited to a specific gender. The profession requires a great deal of empathy, and according to me, any human being capable of being empathetic towards the pain of others and who is committed to helping others can and should be given the chance to pursue nursing everywhere in this country. Let us bring a new norm of brining more male nurses in nursing and consider involving transgender.  It’s high time we see people as humans first, see their caliber and not judge them or snatch an opportunity away from them just because they were born a certain way. There should be a need to let people grow based on the given opportunities. Let’s make inclusion our mantra and use the strengths of every human being to make this nation a superpower.

The initial months of the COVID-19 pandemic, when we were unaware of the threats that surrounded us, were extremely challenging. The uncertainty of the disease and the lack of information together made an appalling combination that the healthcare professionals had to deal with. The peak of the pandemic was like a nightmare, we did not have enough manpower, information, PPE kits, essential equipment, and other resources to treat the patients and look after them.

At this point, we needed to come up with innovative and creative solutions to treat patients given the complexities of the pandemic. In those tough times, telenursing came as a saviour. It emerged as a critical tool in the fight against COVID-19, helping to ease the burden on healthcare providers by encouraging patients with relatively mild or moderate ailments to get care through telecommunication, from their homes.

Telenursing uses technology to provide nursing care to individuals who are geographically distant from healthcare providers. This was especially beneficial during the peak of the pandemic as the hospitals were crowded with patients who needed serious care. When the concept was introduced to us, most of my team members were excited to learn the new skill of nursing patients digitally. It was truly helpful and saved several patients from unnecessarily visiting the hospital and being exposed to the virus.

When the nurses interact with the patients digitally to figure out if they need to visit the hospital, they ask the patients certain questions about their health. Based on the answers that the patients give, the nurses put them into red, amber, and green groups. Those who fall under the red group need instant medical attention and are asked to visit the hospital, those in the amber group could be assisted by doctors digitally and improve their health, and those in the green group needed no medical assistance and are fine. All the nurses were vigorously trained to assist the patients and take the right call while segregating them into these three groups.

It truly did help in easing the burden on healthcare providers by encouraging patients with mild or moderate symptoms to get digital care. There were more pros than cons and challenges while providing telenursing. If I had to mention some challenges, it would be the few instances where we had connectivity issues and the times when the patients could not use their digital devices well. Other than that, all our nurses are technology-driven and can use telenursing to their best advantage.

Our nurses recognize the value of tele-home care as essential components of telenursing that give patients easy access to high-quality care and eliminate costs and difficulties associated with travel to healthcare facilities. They monitor the patients closely using technology and try to identify the warning signs early, to ensure good health and quality of life for the patient.

Telenursing continues to grow as a valuable method for providing nursing, especially in India. The trend is breaking the tradition for good. According to me, integrating telenursing with POC devices and healthcare mobility solutions will enable healthcare professionals to help more and more patients. Creating a telenursing portal for disease conditions like pre and post-transplant, chronic disease detection and management, long duration of tubed and drains and other rehabilitative services can also be extremely beneficial. Telenursing is cost-effective and time-saving. The COVID-19 pandemic has unfolded this opportunity to us and we should make the best out of it. It has expanded at lightning speed and will continue to grow. The time is not far when telenursing will become a norm and will also be included in the regular curriculum for good.

Despite warnings from viral epidemiologists and scientists, the SARS-CoV-2 pandemic caught most of the world by surprise. Although it has wreaked havoc on communities worldwide, researchers and pharmaceutical companies rose to the challenge, creating vaccines within record-breaking time. However, this accomplishment alone will not suffice to overcome the pandemic. Widespread vaccination is necessary for populations to reach herd immunity, a condition in which a large enough percentage of the population is immune to an infectious disease, thereby providing indirect protection to the entire population. 

When a large percentage of the population is vaccinated against an infectious disease like COVID-19, the risk of infection and transmission is significantly reduced. This means that the population is less likely to experience large-scale outbreaks, allowing life to return to normal. Of course, does not address every concern about the impact of vaccination on immunity.

Does COVID-19 Vaccination Offer Complete Protection against Infection and is it advisable or necessary for you to get vaccinated if you have previously suffered from Covid-19 infection?

At present, India has three COVID-19 vaccines that are approved for use – Covaxin, Covishield, and Sputnik V. All of these are non-replicating vaccines, including inactivated or subunit and nucleic acid vaccines. While Covaxin has been developed indigenously, Covishield is the Indian version of the AstraZeneca-Oxford vaccine, and Sputnik V was developed in Russia. All three vaccines have been found to be effective at preventing COVID-19 infection with high levels of efficacy ranging from 63.09% to 92%. All of the vaccines available in India have undergone numerous phases of trials to ensure their safety and efficacy as pointed out by the Government of India and the Ministry of Health and Family Welfare (MOHFW).

At the same time, you should keep in mind that no vaccine offers 100% protection against infection. However, the risk of infection is considerably lower and the risk of severe COVID-19 infection is even lower. As mentioned earlier, the risk of infection is also reduced as a larger percentage of the population gets vaccinated. All COVID-19 vaccines that are approved for use in India must also be administered in two dosages. This means that you can still get infected before receiving the second dose of the vaccine. This is why it is important to continue to exercise caution even after receiving your first dose.

Is vaccination safe and necessary for those who have been previously infected with COVID-19?

The Government of India and the Ministry of Health and Family Welfare (MOHFW) recommends that all individuals who have previously tested positive for COVID-19 and have fully recovered should receive the vaccine. This will help to strengthen the immune response against the virus as infection with COVID-19 is believed to only provide protection for a limited duration. Moreover, research suggests that people who have been previously infected show a better response to vaccination and may get the same immune benefits from a single dose as most people get from two doses.  It is best to wait for one to two months after recovery from COVID symptoms before seeking vaccination.

Individuals who have recently tested positive or are suspected to have COVID-19 infection should wait for at least two weeks post-recovery to seek vaccination as they could pose a high risk of transmitting the virus to others at the vaccination site.

Can I Resume Normal Activities After Getting Fully Vaccinated?

Eventually, we will all be able to return to normal life after we have been vaccinated. However, this also requires vaccination of a large section of the population to reach herd immunity. While getting vaccinated does provide protection against possible infection and severe COVID-19 symptoms, it does not provide 100% protection. It is also part of our social responsibility to continue complying with precautionary measures including hand-washing, mask-wearing, and social distancing. Doing so will make it easier for us to overcome the pandemic not just as individuals, but as a society.

Vaccination is regarded as the best defence against infection with the SARS-CoV-2 virus, making it especially important for those at a high risk of severe COVID infection. As patients suffering from cardiovascular or heart disease fall into this category, it is advisable for them to get vaccinated as soon as possible to lower the risk of infection.

According to a Cardiological Society of India statement published in the Indian Heart Journal, COVID-19 patients who suffer from cardiovascular disease are at a significantly higher risk of complications and fatalities. Among hospitalized COVID-19 patients, nearly 30% experience cardiac injury and 40% of fatalities are linked to cardiac complications.

This is why you should seek vaccination as soon as possible if you suffer from heart disease. Likewise, it is advisable to get family members who suffer from heart disease vaccinated against COVID-19. At present this is regarded as the most effective strategy for protecting those with heart disease or cardiovascular risk factors from COVID-19 infection.

At the same time, concerns about the safety of COVID-19 vaccination for patients with such preexisting conditions are understandable.

Can Covid vaccines worsen the condition or cause side effects that further jeopardize your health if you are an existing cardiovascular or heart disease patient?

Some heart disease patients and caregivers have concerns about the vaccine itself causing infection. This is not possible with the COVID-19 vaccines that are currently in use as they do not have a live virus and are non-replicating vaccines, including inactivated or subunit and nucleic acid vaccines. However, vaccines can cause mild to moderate side effects as your immune system responds to the vaccine. Such side effects are indicative that the vaccine is working, although everyone responds differently and not everyone will necessarily experience side effects.

Common side effects of COVID-19 vaccination include pain at the site of the injection, lethargy, fatigue, headache, and muscle pain. These side effects are outweighed by the benefits of vaccination because of the risk of severe COVID-19 in heart patients. As pointed out by the World Health Organization, heart patients who also suffer from compromised immunity, are pregnant, or have a history of allergic reactions (particularly to vaccines) should discuss these concerns with their health care provider before getting vaccinated.