As India’s monumental lockdown has failed to curtail the spread of the novel coronavirus in the country, it is faced with a chilling prospect: an epidemiological peak that will reach way beyond our healthcare capacity. But even as facilities are being set up to augment the number of beds and ventilators, an important limiting factor in the equation is the number of healthcare workers. That is, what good are ventilators when you don’t have healers to operate them?
To cope with this shortage, some states like Maharashtra, Haryana and Delhi have planned to recruit medical students. The participation of medical students in this fight against COVID-19 is a contentious issue. On the one hand, a lack of training renders them non-essential to patient care; on the other, clinical training is essential to generate future responders against COVID-19.
Even though the prospect of involving medical students may seem reckless, precedents for their involvement offer some insights on their potential usefulness. During the 1918 Spanish Flu, medical students at the University of Pennsylvania were deployed in direct patient care since most of the trained doctors had been diverted to war. Similarly, during the polio outbreak of 1952 in Denmark, students were tasked with manually ventilating patient. More recently, medical students were recruited in patient care during a massive flood in Kelantan, a rural Malaysian state, in 2014.
These examples tell us that medical students can be an efficient contingency workforce provided we suitably address their lack of training and properly manage any legal and ethical issues. Studies conducted at the University of Alberta and the University of Michigan during the 2009 H1N1 pandemic show that the majority of students (surveyed) preferred to volunteer. So we have the question: how capable and ready are India’s medical students to respond to COVID-19?
The current MBBS curriculum in India lacks a crucial emphasis on disaster management and emergency medicine. In most colleges, training in these areas is confined to one or two isolated sessions on basic life support, and instructors neither assess their outcomes nor reinforce them.
However, this should not preclude medical students from participating in the multifaceted pandemic response. They can perform various ‘small’ tasks in clinical settings, like answering patients’ calls, making discharge summaries, screening for symptoms, counselling relatives, drawing samples and monitoring physical distancing in COVID-19 care centres. These are simple protocol-based tasks with low legal liability and for which students can be trained over one or two days.
Medical students can also take up community-based tasks like contact tracing and isolation, spreading awareness and identifying infection hotspots. Since most students are active on social media, they are ideally suited for spreading awareness and dispelling myths as well.
In the US, students at Harvard Medical School even formed a COVID-19 response team. Using a task force born out of this initiative, they created separate educational modules for doctors and non-expert people. They also created special teams for campaigning, helping medical staff with their daily chores, social work and for indirect patient care. Finally, they launched a mental health initiative to help people cope with these trying times.
The age of medical students is another factor in their favour, vis-à-vis COVID-19 care. Most students fall in the age group 18-25 years, and the COVID-19 mortality in this group is very low; in fact, with the appropriate precautions and protocols, we could expect to ensure zero fatalities among student-responders. This proposal is in stark contrast to the idea of calling upon retired healthcare professionals: though they are likely to be much more experienced, their advanced age and any comorbidities could make them highly susceptible to serious illness, even death. So it would be wiser to limit them to policymaking and decision-making at the moment, and bring the younger staff to the fore.
Now, since students are not employees, they should not be forced to work in this pandemic. Recruitment should strictly be on a voluntary basis, with proper informed consent. Moreover, the law does not allow medical students to prescribe tests or medications, so student volunteers should work together with doctors, with the latter writing prescriptions, etc.
It is possible that a lot of medical students may simply refuse to volunteer. Apart from the natural fear of contracting COVID-19, a fear of causing harm to the patient or transmitting the disease to their families can be potential reasons. Hesitant parents may also struggle to send their children to the frontlines of India’s COVID-19 response. Since most medical colleges have hostel facilities, encouraging students to stay on-campus will only feed the fear of transmitting the disease. We could start by giving students simple, redundant tasks so that they don’t feel hesitant, or guilty if a patient in their care should succumb.
To maximise the benefits and minimise the harm by the involvement of students, the key factor remains the introduction of good training programmes that equip them with sufficient skill and address their concerns.
Manraj Singh Sra and Amulya Gupta are with the All India Institute of Medical Sciences, New Delhi.