Sunday, March 15, 2020

Can we afford mistakes and violations of government policies at the present containment phase of the COVID 19?

Can we afford mistakes and violations of government policies at the present containment phase of the COVID 19?

Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA

Mumbai's Hinduja Hospital on Friday quarantined 82 staff members who were in close contact with the patient, and their 14 relatives a day after a 64-year-old patient was diagnosed with the coronavirus. The patient, who had travelled to Dubai, was admitted to the private hospital on March 8, after he complained of uneasiness. As his condition didn’t improve after two days of treatment and he started showing symptoms of coronavirus with fever, cold and breathlessness, the hospital informed the civic body. On March 12, his samples tested positive for the virus (India TV News). While the "high risk" contacts have been kept under isolation and are being observed, the "low risk" contacts have been sent for home quarantine. The high-risk contacts are the doctors and support staff who were directly involved in the treatment of the patient, the low-risk ones are those who came in contact with the high-risk contacts (Mumbai Mirror).

1.     Why was he admitted in a private hospital when he had returned from COVID affected country and had cough and fever. It is against the government protocol.
2.     If doctors and staff were quarantined means the hospital was not ready to treat such patients. In today’s date al hospital must treat every patient every patient with fever and cough as corona liken illness unless proved otherwise. That mean the hospital was not taking standard precautions.

Delhi Death: A 64-year-old woman died in Delhi RML hospital and here also she was shifted from a private hospital where she was put on ventilator without corona precautions. Before getting admitted we do not know how many people might have got effected.

Agra case: A 25-year-old Agra woman whose husband, a Google employee tested positive for novel coronavirus in Bengaluru earlier this week, also tested positive on Friday. The woman, who recently returned from her honeymoon in Italy and was put under quarantine after her husband showed symptoms of the disease, escaped from Bengaluru on March 8, took a a flight to New Delhi and travelled to Agra to be with her parents.  The administration faced resistance when they visited the house where was found staying with eight other family members and could only move them to isolation wards after the district magistrate intervention.

Karnataka Death: Earlier this week, the first death due to corona occurred in Kalburgi, Karnataka, when a 76-year-old man passed away. He had visited from Saudi Arabia from January 29 to February 29. He was asymptomatic on his return, but later developed symptoms of fever and cough. One private doctor visited him at his home and treated him there. On 9th March, when symptoms became severe, he was shifted to a private hospital in Kalaburagi, where he was provisionally diagnosed as 'mid-zone viral pneumonia' and 'suspected Covid-19. But, without waiting for the test results, the attendees insisted, and the patient was discharged against medical advice and the attendees took him to a private hospital in Hyderabad. He was again brought back to Kalburgi but died.

This is not in line with the protocol established by the Health Ministry, Government of India for management of suspected or confirmed Covid-19 cases.

Private hospitals cannot and should not admit and treat corona patients on their own. At present, only hospitals (with isolation wards) designated by the Ministry of Health can treat patients with suspected or confirmed Covid-19 infection. Similarly, only government-designated labs are allowed to test for the new corona virus.

All government and private hospitals should have flu corners to screen suspected cases of COVID-19. Whenever a suspected case arrives at a hospital, a self-declared undertaking should be taken right at the entry, so that proper protocol should be followed. A history of recent travel to Covid-19 affected countries strongly raises suspicion of the patient being infected with Covid-19.

The hospital should call the state nodal officer at the help line number (+91-11-23978046) or email ( Helpline Numbers of States & Union Territories are also available from Health Ministry website. The government body will make arrangements to pick up the patient and treat him/her at the designated hospital.

In the current scenario, every case with cough and fever should be considered as Covid-19 unless proved otherwise. 

The government should be informed, and universal precautions should be immediately implemented.

Singapore has made available masks in large numbers to health care workers and made it compulsory to wear a mask. As a result, not a single health care worker has developed the infection as of date in Singapore.

These aforementioned cases indicate that government directives were not followed or have not percolated down.

Admitting a corona patient in a private hospital (Hinduja hospital) or allowing the patient to move between hospitals, as happened in the case in Kalburgi is shocking.

Such mistakes can cause havoc in the community.

It’s like missing a crucial catch in the World Cup, which could change the course of the game.

At present, India is in the containment or preparedness phase. Missing cases or not informing the government can well lead to community spread, which would then become a real emergency.

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