Severe chaos over mild patients after new SOP
Delhi has 163 ambulances on special “corona duty” that requires its staff to be in full personal protective equipment (PPE) and follow special sanitisation procedures.Updated: Jun 24, 2020, 05:03 IST
The old system of assessing coronavirus disease (Covid-19) patients at their residence to determine if they are fit for home isolation must be brought back, the Delhi government said in a letter to Lieutenant Governor Anil Baijal on Tuesday, reiterating the practical difficulties in a new protocol that senior as well as grassroots health staff separately said was virtually impossible to implement.
The administration on Monday formalised the new health assessments protocol that says every new Covid-19 patient must visit a government facility, a process that requires special ambulances and increased deployment of medical staff, and raises the risk of infection among anyone who is involved in the exercise.
“There is a lot of panic among people because of the new guidelines. Earlier, they tried to stop home isolation and a consensus on continuing it was reached after a lot of dialogue. Now, [there is] this new guideline… Why should a Covid-19 patient be made to stand in a queue at a quarantine centre? I have written to the L-G to continue with the earlier system of the medical team visiting the home of coronavirus patients instead,” said Delhi’s deputy chief minister Manish Sisodia at a press briefing.
On Tuesday, Delhi recorded its largest single-day spike of Covid-19 cases so far with 3,947 people testing positive. While at least some of these were possibly through antigen tests at a health facility, a large proportion are likely to have been identified through RT-PCR tests carried out by labs. These results usually come a day or more later, and it is these people who need to be taken to a facility, according to the rule put into force on Monday.
The guidelines were first suggested by the L-G-led Delhi Disaster Management Authority (DDMA) over the weekend. According to these rules, a doctor at a Covid-19 Care Centre (CCC) will check severity of symptoms of each patient and, from health history of any comorbid condition, determine if they can be allowed to recover at home.
A separate team will carry out house checks to see whether there is a stand-alone room and bathroom that a Covid-19 patient needs for home isolation so that other members of the family are not infected.
The new rules led to such chaos that at least three of the 11 districts of Delhi have not been able to adopt the protocol since they have too many new cases to handle, officials from these districts told HT on Tuesday on the condition of anonymity.
“Currently, around 3,000 people on an average are testing Covid-19 positive in Delhi per day through swab tests. If they have to be taken to CCCs, the government will have to arrange 3,000 trips of ambulances in addition to the distress calls that they are presently catering to. This seems impossible at this juncture. So, we have no alternatives but to continue with the old method for now until further orders are received,” said one of the three district magistrates, asking not to be named.
Delhi has 163 ambulances on special “corona duty” that requires its staff to be in full personal protective equipment (PPE) and follow special sanitisation procedures. Given the strength of the fleet, each ambulance will need to carry out more than 18 trips in 24 hours if all of these patients are to be taken to these centres as per protocol.
“Coronavirus patients will have to go to the quarantine centres and stand in long queues, which will aggravate their illness and pass it on to others. How will they reach the centres? Ambulances should be kept for taking severe patients to hospitals rather than transporting people with mild symptoms to these centres,” said Sisodia.
“I am hopeful that the L-G will soon call a meeting of the state disaster management authority to change this decision and resolve the problems of the patient,” he added.
The LG’s office did not respond to requests for a comment on Sisodia’s letter.
The letter follows a protracted row between the L-G’s office and the Delhi government, triggered by an order on Friday that virtually scrapped the practice of home isolation. The order was reversed a day later, but the DDMA – the nodal agency for Covid-19 response measures that is led by the L-G – introduced the mandatory assessments.
A second area of confrontation was on the choice of an agency that is meant to carry out followup checks with people in home isolation. The Friday order scrapped the arrangement with Portea Medical and, according to Monday’s guidelines, the task can now involve medical students or be outsourced. Officials said the process of outsourcing will require new tendering.
The tussle has led to a situation where many patients were moved to CCCs and are not requesting to be allowed to go back.
“I feel weak and breathless. I thought I’d be kept under observation. But the doctor only checks up on me over the phone. The facility is good, but I think I would have taken better care of myself at home, as there is no special medical treatment for this,” said 35-year-old Anita from the Terapanth Bhawan CCC in Chattarpur.
A majority of the CCCs lack air conditioning and some – particularly the ones setup in schools – require residents to use common lavatories.