How to Combat COVID19 associated Social Stigma!

Dr. M. Wasim Ghori, Medical Director
& Consultant Diabetologist,
Heart & Diabetes Clinics, Mumbai

Dr. M. Wasim Ghori, Medical Director & Consultant Diabetologist, Heart & Diabetes Clinics, Mumbai discusses the need to follow certain protocols that can help overcome the COVID-19 pandemic and not to stigmatise an individual, locality or a community.

From the early days of the HIV epidemic to the current COVID-19 crisis, a major challenge around infectious diseases has been dealing with the deep-seated stigma around affected populations.  Research shows that at the height of the HIV crisis, stigma and misinformation were among key factors that prevented people from seeking testing and care until it was too late.

When an infectious disease outbreak becomes a pandemic as with COVID-19, people are understandably frightened and concerned.  When the outbreak is caused by a new virus, rumours and misinformation run rampant causing fear and anxiety leading to prejudices against people and communities, social isolation and stigma.  Such behaviour may culminate into increased hostility, chaos and unnecessary social disruptions.

Stereotypes quickly arise about people who have or may have the disease.  In the US and Europe, for example, people of Asian descent have been treated with suspicion and blamed for COVID-19, even though they’re no more likely to spread the virus than is the general population.  Also, some people worry that individuals who have recently completed quarantine have COVID-19 and are contagious, but there is no current evidence to suggest that’s the case.

Cases have been reported of people affected with COVID-19 as well as healthcare workers, sanitary workers and police who are in the frontline for management of the outbreak, facing discrimination on account of heightened fear and misinformation about infection.  Even those who have recovered from COVID-19 face such discrimination.  Further, certain communities and areas are being labelled purely based on false reports floating in social media and elsewhere.    There is an urgent need to counter such prejudices and to rise as a community that is empowered with health literacy and responds appropriately in the face of this adversity.

In this regard, all responsible citizens are advised to understand that:

• Although COVID-19 is a highly contagious disease which spreads fast and can infect any one of us, we can protect ourselves through physical distancing, washing our hands regularly and following sneezing / coughing etiquettes.

• Despite all precautions, if anybody catches the infection, it is not their fault. In situation of distress, the patient and the family need support and co-operation. It must be noted that the condition is curable and most people recover from it.

• Healthcare workers including doctors, nurses, allied and healthcare professionals are rendering their services tirelessly to provide care and medical / clinical support in this situation of crisis. Sanitary workers and police are also doing selfless service and playing critical roles in addressing the challenge of COVID-19. They all deserve our support, praise and appreciation.

• All those directly involved in the management of COVID-19 are equipped with appropriate protective equipment to keep them safe from the infection.

• Targeting essential services providers and their families will weaken our fight against COVID-19 and can prove grievously detrimental for the entire nation.

How stigma affects groups that experience it?

• Stigma can make people feel isolated and even abandoned. They may feel depressed, hurt and angry when friends and others in their community avoid them for fear of getting COVID-19.

• Perhaps more concerning, stigma harms people’s health and well-being in many ways. Stigmatised groups may often be deprived of the resources they need to care for themselves and their families during a pandemic.

Why stigma hurts everyone?

• Research from past epidemics has shown that stigma undermines efforts to test for and treat disease.

• People who are worried about being shunned or worse may be less likely to get tested or seek medical care, which increases infection risks for them and for others.

What you can DO to reduce COVID-19 stigma?

Education is one way to fight stigma. It helps dispel harmful stereotypes. You can help reduce stigma by:

• Getting the facts about COVID-19 from reputable sources such as Ministry of Health and Family Welfare, Govt of India, Centers for Disease Control and Prevention (CDC) and World Health Organisation (WHO) and share them with your family and friends.

• Cross check any information related to CoVID-19 from reliable sources before forwarding any messages on social media.

• Speaking up if you hear or see inaccurate statements about COVID-19 and certain people or groups.

• Reaching out to people who may feel stigmatised. Ask how you can help. Listen to them and show that you understand and support them.

• Showing support for healthcare workers and others who are caring for people with COVID-19. Thank them for their work and share positive messages on social media.

• Showing support for and thanking all who continue their essential jobs to help you and your community, such as police officers, bus drivers, grocery store clerks, food bank workers and delivery people.

• Share positive stories of those who have recovered from COVID-19.

What you can AVOID to reduce COVID-19 stigma?

• Never spread names or identity of those affected or under quarantine or their locality on the social media.

• Avoid spreading fear and panic.

• Do not target healthcare and sanitary workers or police. They are there to help you.

• Do not label any community or area for spread of COVID-19.

• We need to move from the language of fear and paranoia to one of empathy. We can stop using terms such as ‘infected’ and ‘carrier’ and switch to ‘affected’ or ‘acquired’. This reminds people that patients and those at risk are people just like us.

• Avoid addressing those under treatment as COVID victims. Address them as ‘People recovering from COVID’.

Remember, everyone is in this together. The COVID-19 pandemic will be over sooner if fears and rumours are replaced by facts, proper action and a show of support for one another.

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Why should your Laboratory be Accredited and How?

Mr. Prashanth Kumar

Let me begin with, what is Laboratory Accreditation?  Everyone who already knows please excuse.  This article is for those who are looking for quick information on the process and for them who are novices and budding in their career.

Laboratory Accreditation (ISO 15189) is an internationally accepted framework for increasing test quality and bringing down the frequency of laboratory errors.  It determines the technical competence to perform specific types of testing, measurement and calibration.  The process evaluates the laboratory's quality, performance, reliability and efficiency.

Why is it necessary?  Accreditation stimulates higher standards of quality within laboratories, thereby leading to more consistent, reliable test data, thus contributing to more effective health and safety regulation and to products of more consistent quality.  It gives confidence to the management and identifies the opportunities for improvement Certainly it gives you more business opportunities as well!

Nowadays, when it comes to customers, an accredited laboratory inspires confidence.  Look at it from a customer's perspective.  The thought process is similar to ours when it totals to a decision making on a purchase.  Why do we choose a branded product over a local one?  Do we trust tap water or Bottled water?

As more and more laboratories are becoming accredited, it results in more and more competition in quality.  The end result has been improving the overall quality of care in healthcare facilities like specialty areas, accreditation programs, etc.  This has assisted in ensuring that patients receive consistent, excellent care throughout the installation.

What is the process to obtain accreditation?

Many of you would be thinking of getting your laboratory /hospital accredited. I will brief you in a simple manner. Before you begin, you need to identify the scope of accreditation and training of employees and make the tests ready for accreditation and evaluating IQC (Internal Quality Control) / PT  (Proficiency Testing) results, CAPA (Corrective Action - Preventive Action), conducting an internal audit, MRM (Medical Record Management), etc.

a.  This is nothing but identifying the readiness of the departments, tests, etc. which you intend to apply for. 

b.  Next, is the application filing and appropriate payment.

c.  Thirdly, the application is reviewed by the body, either there will be no inadequacies in the quality manual or else CAB needs to present satisfactory corrective action.

d.  Fourth, is a pre-assessment visit (Optional for NABL and not applicable to QAI) of the CAB by a lead assessor appointed by the accreditation body.

e.  The fifth is the final audit - either it is cleared successfully without Non-conformities or else after satisfactory corrective action by the CAB, the audit report will be discussed in the technical committee and the certificate is issued. 

The accreditation cycle is of 2 years. The Accreditation body will conduct a desktop audit to verify the compliance annually.  Re-accreditation happens after 2 years and the laboratory has to apply 6 months prior to the validity completion date.

As an experienced person in this field, some of the areas I suggest to take care while applying for accreditation are as follows:

a)  Calibrated equipment with traceability certificates

b)  Method validation/verification

c)  Temperature/ humidity monitoring,

d)  %CV estimation for quantitative testing,

e)  Standardised technical SOPs and quality SOPs

f)  Document control

g)  Proficiency testing

h)  Internal quality control

i)  Trend analysis, setting lab mean,

j)  Set up quality indicators and monitor regularly, and

k)  Onboard training of technicians.

Many labs fail to qualify while applying for renewal of accreditation, Why?

• Lack of commitment from management and staff
• Unqualified employees (untrained)
• Local equipment loyalty (improper equipment)
• Non-monitoring of IQC/Proficiency testing (it could be because of lack of knowledge to do so)
• Unable to set the lab mean properly (many labs change the lab mean to pass the QC on a regular basis!!)
• Improper documentation
• Lack of SOPs to proceed
• Lack of leadership, etc.

Quality is not a day’s result; it is a continuous improvement process.  You build it slowly, continuously and steadily.

A simple tip to keep the success continuing is CONTINUAL MONITORING OF QUALITY SYSTEM. 

It can be simply explained by the values of Medihelps:

> TRUST

> TECHNOLOGY

> TEAMWORK

> TRANSPARENCY; &

> TIME BOUNDNESS.

This article has been contributed by Mr. Prashanth Kumar, who is an expert in the field of Quality Management and Laboratory Operations with over 20 years of experience. His expertise in the accreditation process is commendable both as a NABL auditor and as an independent advisor.  Mr. Kumar is based in Bengalaru.

He has previously served as an accreditation Officer at NABL, during which he had completed the transition of the standard from ISO/IEC 17025 to ISO 15189 for Medical Laboratories in India.  He is also a qualified Auditor for ISO 15189. Furthermore, he has completed training for the implementation of Hospital Accreditation standards by NABH.

He has worked with many organizations, including startups and well-established ones to put their quality system in place.  He has as well worked with Quest Diagnostics India, where he met the major purpose in preparing for CAP and NABL Accreditation and successfully finished the process within 7 months. 

His strong knowledge and expertise have assisted many laboratories to fit themselves and become competent at a very fast pace, thereby equipping themselves to clear the audits without many non-conformities. He is also an advisor for many top leading laboratories and hospitals for their quality management and laboratory operations.

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