A person who is sick can’t be refused treatment: Dr Randeep Guleria

Dr Guleria, who also heads the clinical research group within the national task force set up by the Indian Council of Medical Research, said in an interview that routine services in hospitals can resume only after new cases of Covid-19 register a downward trend
Dr Randeep Guleria said with the lockdown gradually being lifted and people mixing with each other, there will be an increase in the number of cases.(HT File)
Dr Randeep Guleria said with the lockdown gradually being lifted and people mixing with each other, there will be an increase in the number of cases.(HT File)
Updated on Jun 03, 2020 06:38 PM IST
Copy Link
Hindustan Times, New Delhi | ByAnonna Dutt

Delhi should not restrict its health services to the state’s residents alone, but look at optimising Covid-19 hospital admissions and encourage the people’s participation to stop further spread of the disease, said Dr Randeep Guleria, professor of pulmonology and director of All India Institute of Medical Sciences. Dr Guleria, who also heads the clinical research group within the national task force set up by the Indian Council of Medical Research, said in an interview that routine services in hospitals can resume only after new cases of Covid-19 register a downward trend. Edited excerpts:

The Delhi government has sought the people’s opinion on whether health services in the state should be restricted to Delhi residents. What is your opinion?

We have to provide every patient the best care we can, how can we turn away someone who is ill just because they have the wrong address? What about people who work in Delhi and live in NCR {National Capital Region} ? Are they Delhi citizens or outsiders? Should they be turned away? Someone who is very sick and needs a test or a bed or a ventilator should not and cannot be refused treatment as long as we have beds. Anyway, I don’t expect the numbers of Covid-19 patients coming to Delhi from other states to be very high as transferring a person who has tested positive to Delhi will not be easy.

How prepared is India for an increase in the number of cases?

With the lockdown gradually being lifted and people mixing with each other, there will be an increase in the number of cases. What will really help is the people’s participation. People have to understand that despite the lockdown being lifted their responsibility in terms of infection control doesn’t come down, actually it increases much more – social distancing, hand washing, wearing a mask in public, avoiding crowded places, high-risk groups not going out unless essential becomes all the more important.

Coronavirus outbreak: Full coverage

But the increasing number of cases means that the hospital admissions will also go up. Luckily, the number of people requiring ventilator support is low and most people get a mild illness. But we will have to look at strategies to optimise hospital admission – can we send people home early with home isolation, can we monitor mild cases at home with healthcare workers speaking to them regularly?

Close to 300 AIIMS staff have tested positive for Covid-19. What can be done to prevent infections within the hospitals and protect health care workers.

Protecting healthcare workers is paramount and we have been working on it aggressively for the last two months. If you look at our data, only about three or four healthcare workers have got the infection from within the hospital. The remaining staff were working in non-Covid areas and got the infection from the community; most of their family members have also tested positive.

Our concern is they should not pass it on to others and create a cluster within the hospital.

For that, we have a hospital infection control team that has been training everyone -- right from the sanitation workers to the faculty -- on infection control measures. We have now designated nodal officers for each area, who make sure the infection control measures are followed. All the staff members who come from outside the campus are screened for fever, cough, cold, and body ache. If they have any of these symptoms, they are asked to go home or get tested.

And, of course, we will have a new normal where all the doctors and staff irrespective of their wards or duty areas will have to protect themselves with N95 masks, gown, or face shield.

Plus, there has to be a low threshold for testing so that even if there is a small suspicion then a test should be done.

When do you expect the non-Covid services to resume?

First, we have to see how the pandemic behaves. Do you manage the non-Covid patients who are relatively stable versus a huge surge of Covid-19 patients that are emergent? Of course, patients who come into the hospital in an emergency or even semi-emergency such as trauma, or in need of dialysis, blood transfusion, or chemotherapy will continue to be managed. However, patients who need, say a knee replacement surgery or gall stone removal or hernia surgery, can wait. If there is a huge surge in cases, you will have to prioritise the beds.

For example, if you look at the situation in Mumbai right now, it will be difficult for any hospital to do anything other than Covid-19 management.

When we started off, there were only about five or ten patients in our trauma centre and another 70 or 80 in Jhajjar. Now, we have close to 550 in Jhajjar and more than 100 patients on high-flow oxygen or ventilation in the trauma centre. We are seeing an increase in the number of moderate and severe cases.

Once there is a downward trend, then with all infection control measures, one can start looking at opening up other services. Plus, right now doing routine procedures would mean us exposing them to the infection.

What is the current treatment protocol for Covid-19 patients?

In patients with severe infection, there are two or three treatments that are being given. Convalescent plasma therapy is used for patients with moderate infection when they are yet to form antibodies. We give them plasma from recovered patients to boost their immunity. To some extent, this does seem to work.

Then, if the patient is in a cytokine storm (an excessive immune response where the immune cells start attacking the body) then we give them anti-inflammatory drugs. A definite antiviral treatment has not been found yet. Remdesevir has shown some benefits, but it does not reduce mortality.

Also, over the last few weeks as the data emerged we have seen that there occurs a hypercoagulable state and there is excessive clotting in the lungs, brain, and other parts of the body. So now, very early on even in mild or moderate disease anti-coagulants are started upfront.

Also, a large number of patients recover with oxygen therapy and supportive treatment. Conscious proving or making the people lie on their stomach helps in oxygenation and they do not need to be put on a ventilator.

Is more testing needed? Does India have the capacity for more testing?

Our testing capacity is going up every day. We had started with 10–20,000 tests a day and now we are consistently doing over 1 lakh tests a day. We are hoping to double it by June 15, we have the capacity.

Having said that, our country is huge and even with all this, you would not be able to test even 5% of the population – which is about 7 crore tests. That is not practical in any part of the world.

So we need to focus on what questions we need to answer – look at how we can do surveillance so that we can pick up cases in cold areas so that they do not spread the disease further, look at hotspots and test people with ILI {influenza-like illness} so that we can isolate them and prevent further transmission and the number of cases come down.

And when we open up the routine services, there will be screening areas through which all the patients will go through and in case they have fever or ILI. Those undergoing surgeries have to be tested to protect healthcare workers as well as prevent poor prognosis. Data suggests that if you operate on a person who has underlying Covid-19 disease the mortality is much higher, even if he is asymptomatic or has mild symptoms.

SHARE THIS ARTICLE ON
Close Story
SHARE
Story Saved
OPEN APP
×
Saved Articles
Following
My Reads
Sign out
New Delhi 0C
Sunday, December 05, 2021