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During Covid-19 lockdown, Delhi hospitals see double the usual alcohol withdrawal cases
Coronavirus Update: To tide over the problem of alcohol withdrawal during the lockdown, AIIMS has designed a nearly three-hour-long training session for all doctors, available free of cost on the website of NDDTC.
The number of people with severe alcohol withdrawal symptoms in emergency department of Delhi hospitals has doubled during the lockdown, according to doctors -- and, they are coming in with severe symptoms.
“There has been at least a 50% increase in the number of patients coming in with severe alcohol withdrawal symptoms to the hospital emergency. Earlier we would see only about one or maybe two patients a day; now we are getting at least three or four patients every day in the emergency,” said Dr Nimesh Desai, director, Institute of Human Behaviour and Allied Sciences, the only stand-alone mental health hospital in Delhi.
The hospital would usually see patients with substance-use disorders in its out-patient clinics, however, to maintain social distance the OPDs were closed. Around 1,000 to 1,500 patients visited these clinics every day. The hospital has started teleconsultation on the number – 9868396824 – where patients can get their prescriptions.
A similar increase was also noted at the main emergency department of the All India Institute of Medical Sciences (AIIMS).
“We are getting double the cases in the emergency department of our main AIIMS campus and these are patients with severe alcohol withdrawal symptoms like delirium tremens or shaking, hallucinations, and confusion caused due to such withdrawal. Severe withdrawal can be fatal too as it can cause seizures,” said Dr Ravindra Rao, additional professor of psychiatry at the National Drug Dependence and Treatment Centre (NDDTC) of AIIMS.
The main centre of NDDTC in Ghaziabad was also shut down.
“No new cases are being taken in. And that is a problem. People are landing up in the hospital emergency with acute alcohol withdrawal symptoms because of two reasons: One, the lockdown has impacted the availability of alcohol and two, it has also restricted the movement of people and health care services. So, people wait longer and then end up in the emergency department with severe symptoms,” said Dr Rao. The psychiatrists on duty respond to such cases, who are then admitted for follow-ups.
Safdarjung hospital has a limited psychiatry OPD running and has also seen an increase in the number of cases of alcohol withdrawal. “Yes, there has been a surge in cases of people with alcohol and drug withdrawal coming to the emergency department. However, I will not be able to quantify it without going through the admission data,” said Dr Rajesh Rastogi, senior consultant at the hospital’s psychiatry department.
To tide over the problem during the lockdown, AIIMS has designed a nearly three-hour-long training session for all doctors, available free of cost on the website of NDDTC.
“Unfortunately, the thing is that most of the doctors are not trained in management of withdrawal symptoms. Not just for the lockdown, but otherwise too. Many patients might have gone to their neighbourhood doctors before landing up at the hospital emergency. As a stop-gap measure once we started receiving these reports, we developed an online training module which is freely accessible to all,” said Dr Rao.
The doctors say not all who drink daily are likely to experience withdrawal.
“Not everyone who drinks daily will experience withdrawal, only those who are dependent on the substance will. We decide whether a person is dependent based on whether they have developed a tolerance, they experience cravings, they take a lot of time out to satisfy these cravings, and they continue to consume the substance even after they have developed physical problems such as liver disease,” said Dr Rastogi.
These people have to keep a watch on their symptoms. Sleeping difficulties, anxiety, palpitations, and shaking of the hands are all symptoms that you need to go to a doctor.
“If the patients come in within 24 to 48 hours of stopping alcohol, then the symptoms are mild to moderate. The severe symptoms start after two to three days of stopping the alcohol. If the patient has severe withdrawal, they require medication -- diazepam – taken every day. But in severe cases we have to inject the medicine in high doses,” said Dr Rao.
Mild cravings can be managed at home, the doctor says.
“If people have mild symptoms– it comes in waves – and people can control it by focussing on other activities such as listening to music, watching movies. It is extremely important to remain engaged; people might be irritable because of the lockdown and the cravings will add to it,” said Dr Rao.
