Covid-19: Inspection teams flag violations by private hospitals
Private hospitals and nursing homes in the Capital are needlessly testing Covid-19 patients admitted with mild and moderate symptoms, using therapies not on the Union government’s clinical management guidelines, and are only partly complying with infection control protocols, according to an inspection by teams constituted by the Union home ministry, which has suggested a tighter vigil on these facilities.
The teams, formed when Delhi was in its third and most serious wave of infections in November, surveyed 114 privately run health care facilities in the city on November 17 and 18. It presented the findings to the director general of health services (DGHS) under health ministry, and the report is now part of an affidavit by the Centre to the Supreme Court.
The court is hearing a public interest case to evaluate steps taken by the Union and state administrations to control and mitigate the Covid-19 outbreak.
“In the discharge policy prescribed by MoHFW, only severe categories of admitted cases are required to be tested using RT–PCR technique prior to discharge. However, it was noted that all private hospitals inspected were testing every admitted Covid-19 patient using RT– PCR technique prior to discharge,” said the report.
DGHS’s guidelines say that apart from severe cases, patients with moderate or mild symptoms can be discharged after three consecutive days of no fever without the need for an RT-PCR test.
Experts have previously stressed on this point since nucleic acid tests like RT-PCR can throw a positive result if it finds viral fragments. People infected with Covid-19 are typically believed to not be infectious after 10 days.
“Majority of the hospitals inspected were not complying with the Clinical Management Protocol prescribed by MoHFW and using drugs and treatments based on the clinical judgement of respiratory physicians, general physicians working in these hospitals,” said the summary report, citing what they said was regular use of remdesivir and convalescent plasma therapy.
The report added that while these have been prescribed as “investigational therapy (on experimental basis)”, hospitals were using these “routinely”. “Further, these hospitals were found to be using favipiravir, doxycycline, azithromycin, ivermectin in many patients in spite of these drugs not being prescribed in the National Clinical Management Protocol issued by MoHFW (ministry of health and family welfare).”
According to experts, approaches for treatment of Covid-19 are still evolving and most therapies are experimental. “Despite a lot of data from across the world, there are studies saying opposite things about many therapies. In such a scenario, doctors are going by their clinical experience and their institution’s clinical experience on what seems to work and what does not. Even the national protocol is dynamic,” said Dr Harsh Mahajan, senior vice-president, Nathealth, an association of healthcare stakeholders.
“There are new therapies and medicines emerging, evidence on what works and what doesn’t is being published every day. So there should be some leeway for the treating physicians to decide what works and what doesn’t for their patient,” said Dr Arun Gupta, president of the Delhi Medical Council.
According to Dr Samiran Panda, head, epidemiology and communicable diseases, ICMR and a member of the National Task Force (NTF) on Covid-19 Management, the guidance on plasma therapy has been changed to mention caveats but it has not been banned.
“ICMR has made it public that the therapy isn’t of much use based on the evidence that we have, and our revised guidelines were drastically modified for reference of those wanting to administer it. It has not been banned but there are clear cut dos and don’ts mentioned in ICMR advisory,” Panda said.
According to the government’s affidavit, the DGHS has thus recommended a special vigil on private facilities to ensure they are testing and discharging people as per guidelines. “Similarly, to avoid misuse of drugs not recommended by the MoHFW, GOI, a special restrictive order may be considered for issuing,” said the report, urging the Delhi government to consider appointing nodal officers for monitoring the performance of all these hospitals on a day to day basis. The inspectors said they were satisfied with the facilities’ compliance with government’s direction to earmark a certain percentage of ICU beds for Covid-19 patients, displaying data regarding occupancy of the identified beds, and the rate of infections among health care workers.
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