Covid: Experts suggest early discharge of stable patients to ease burden on hospitals
New Delhi: With hospitalisations from coronavirus disease (Covid-19) on the rise in Delhi, experts from the All India Institute of Medical Sciences (AIIMS) have suggested early discharge of stable patients who can then continue home isolation.
Doctors from AIIMS, Post Graduate Institute of Medical Sciences-Rohtak, and Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow participated in a discussion on protocols to be followed for home isolation during the National Grand Rounds, a virtual platform for doctors across the country to discuss challenges in Covid-care.
“In one of the cases presented, the patient was discharged early after he stabilised. In places like Delhi, where the number of cases are high, this is a policy we are more aggressively looking at. This will decrease the burden in hospitals and the home isolation will continue as an extension of the hospital service,” said Dr Randeep Guleria, director, AIIMS. He, however, warned that such patients have to carefully monitor their signs and symptoms as there is a possibility that they are brought back to the hospitals with a cytokine storm.
Cytokine storm is a condition where the body’s immune system goes into an overdrive and starts attacking its own tissues and organs.
The case referenced by Dr Guleria was that of a 53-year-old man with controlled diabetes, who had to be admitted to the hospital because his oxygen saturation had dropped to 93%. The normal oxygen saturation is between 95 and 100%.
The patient was given low-flow oxygen and steroids and he stabilised in 72 hours. As he did not have any other symptom, he was advised home isolation.
Currently, nearly 60% of the total active cases or those with the infection in Delhi are in home isolation, 20% admitted to hospitals, with the rest – who did not have proper isolation facilities – being in Covid care centres.
The suggestion by experts was proposed a day after the union health ministry announced that home isolation in Delhi will be augmented to support up to 35,000 to 40,000 people. “The support system needed for patients in home isolation – telemedicine support, pulse oximeter, etc – will be ramped up, as the number of active cases might go up in the future,” NITI Aayog member Dr VK Paul had said during a press briefing on Tuesday.
He had also said that Delhi had dramatically improved when it came to early admissions of patients who needed hospital-based care. “Initially, when the pandemic had started – till about June – nearly 60 to 70% of the deaths in hospitals happened within the first 72 hours. Half of these deaths happened within the first 24-hours of admission. In Delhi, there has been a dramatic change since,” Dr Paul had said.
The necessity of close monitoring and timely shift to the hospital was demonstrated in another case presented during the grand rounds. A 43-year-old man with no comorbidities who was in home isolation noticed that his oxygen saturation had dropped to 86% on the sixth day of symptoms. He had what is called happy hypoxia where patients do not have apparent breathlessness despite low oxygen saturation. In hospital, the doctors found that he had a pulmonary embolism, a clot that blocks the blood vessels in the lungs. The condition can be fatal if not treated in a timely manner.
Patients in home isolation must rush to a hospital if they have any breathing difficulty, drop in oxygen saturation, persistent pain or pressure in chest, confusion, slurred speech, any weakness or numbness, or bluish discolourations, the doctors said.
The doctors also added that antiviral medicine Remdesivir should not be given to patients in home isolation. Doctors advised that drugs such as anti-malarial hydroxychloroquine, anti-parasitic ivermectin, and anti-viral Favipiravir that are thought to prevent viral replication to be given cautiously.
“Remdesivir should not be given to patients in home isolation because it may lead to several complications such as kidney or liver injury. Unfortunately, it has become a common practice among medical professionals in smaller cities. Many are prescribing all three – hydroxychloroquine, ivermectin, and favipiravir – together and sometimes along with steroids. This will cause more harm than good,” said Dr Dhruv Chaudhary, head of pulmonary and critical care medicine at PGIMS Rohtak.