CMAAO COVID Guidelines for doctors

CMAAO COVID Guidelines for doctors



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


1. A significant epidemic will require healthcare professionals to be flexible in what they do

2. Be prepared to work outside your usual area of expertise in the increasingly likely scenario of widespread community transmission of COVID-19.

3. In the event of a significant epidemic, primary and secondary care "will be put under extreme pressure". This would "inevitably be exacerbated by staff shortages due to sickness or caring responsibilities" and would represent a "challenge" for the profession.

4. It may entail working in unfamiliar circumstances or surroundings or working in clinical areas outside of their usual practice for the benefit of patients and the population as a whole."

5. Consider every patient coming to hospital as COVID positive and water surgical mask all the time.

6. As much as possible give tele or video consultation appointments and consultations.

7. Pass on a SMS to all your patients not to visit the hospital with fever and cough. They should come on teleconsultation.

8. All patients with cough and fever if enters a hospitals should be given a surgical mask at the reception, should get priority without line in getting lab or imaging tests.


9. All reusable equipments stethoscopes, bp instruments etc should be frequently sanitised.

10. Minimise paper work as much as possible.

11. Learn the correct method of using and disposing surgical masks

12. Update MOH guidelines on a daily basis.

Courts should make guidelines and leave it to the medical boards and not handle the cases themselves?

Dr KK Aggarwal & Advocate Ira Gupta

Now and then women approach the courts for termination for pregnancy on medical grounds. Instead of approaching the courts, the government should come out with clear cut guidelines, based on which the medical board can take a decision in such cases.

Like in MCI ethics regulation 6.7 “ …the question of withdrawing supporting devices to sustain cardio-pulmonary function even after brain death, shall be decided only by a team of doctors and not merely by the treating physician alone…”

The following two cases illustrate this.

Terminations under 20 weeks isn’t our business: High Court

Unwanted pregnancies under 20 weeks can be medically terminated by doctors directly, and the woman need not be referred to medical board nor be asked to approach courts for remedy, the Madras high court has said. The court also said doctors & police officials need to be sensitized to the issues surrounding unwanted pregnancies as they often misconstrue the provisions of Termination of Pregnancy Act.

Coming to the rescue of a woman who wanted to terminate her eight-week-old fetus forced on her by a man known to her, Justice Anand Venkatesh said if a criminal case is pending, samples will be taken for DNA test of both mother & the conceptus (fetus & placenta).

In all cases, where a victim girl suffers an unwanted pregnancy & where the length of pregnancy does not exceed 20 weeks, the victim girl need not be referred to the medical board & the termination of pregnancy can be done as per the provisions of Act. The victim girl should not be unnecessarily made to knock the doors of this court.

Madras High Court allows termination of 26-week pregnancy

The Madras high court has allowed the termination of a woman’s 26-week pregnancy after medical tests revealed that the fetus had health complications and the child would require multiple and extensive surgeries with a remote chance of survival.

The Trichy woman moved the court seeking permission to terminate the pregnancy after the legally permissible gestation time of 20 weeks. Scan reports during the 18th week of her pregnancy revealed that the fetus seemed to have dilated ventricles — a brain condition.

The court, subsequently directed her to appear for a medical examination at the Tuticorin Government Medical College Hospital, where a medical board comprising a paediatrician, neurosurgeon, neurologist, cardiologist & obstetrician assessed her previous medical reports & subjected her to various tests & filed a report before the court.

The medical board was of the unanimous opinion that the woman should be allowed to abort the fetus. The bench cited the medical expert’s opinion & said, “Even if the child in the womb is born, its survival will be medically remote as it has to confront numerous surgeries, which cannot assure its longevity.” In such circumstances, if the pregnancy is not ordered to be terminated, the woman would be subjected to mental trauma & hardship, the court ruled.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Guidelines may underestimate the harms of statins: Follow person-centric approach

A new modelling study involving persons aged 40 to 75 years with no history of cardiovascular disease (CVD) suggests that 10-year risk thresholds used in current guidelines to prescribe statins for primary prevention of CVD are probably substantially too low.

A new study published online Dec 3, 2018 in the Annals of Internal Medicine has suggested that instead of 7.5% to 10% 10-year risks one should use 14% risk thresholds where the benefits of statins exceed the harms.

Using an approach originally developed by the National Cancer Institute to look at tamoxifen for breast cancer prevention, the investigators show that statins provide net benefits at higher 10-year risks for CVD than are reflected in most current guidelines; 14% for men aged 40 to 44 years. The risk threshold, however, increased to 21% for aged 70 to 75. For women, the risk thresholds were higher at 17% and 22%, respectively. Individuals, who were at high risk for CVD (>21%) were likely to benefit from statins, regardless of sex or age.

Among the four commonly used statins, atorvastatin was found to have the most favorable benefit–harm balance, followed by rosuvastatin, especially for younger adults with low or medium CVD risk.

New research and/or guidelines are suggestions and recommendations, which are definitely evidence-based. While they do standardize treatment for any given condition, they are not without their limitations. They cannot be generalized as each patient is different and hence treatment has to be individualized.

Also, western data cannot be extrapolated to our Indian settings.

Do not follow guidelines blindly and give statins to every case with 10-year risk of heart disease of more than 10%.

Instead every case should be individualized based on age  and other factors.

The individual risk for CVD events should be calculated before prescribing statins. This will result in individual patient harm reduction in CVD risk.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA