Test all patients getting hospital admissions for Covid-19: Centre to states
All patients visiting hospitals in and around containment zones identified by the local authorities will be considered “suspected cases of Covid-19” and those getting admitted will undergo mandatory diagnostic tests for the coronavirus disease irrespective of symptoms, according to a central advisory on Tuesday.
In a first, the Union health ministry advisory also advocated a clear demarcation between outpatient departments (OPDs) and wards, and asked doctors to stick to the same federal guidelines they follow in the treatment of Covid-19 patients even while attending to OPD patients.
According to a ministry official, the advisory sent to state governments is aimed at preventing the spread of the deadly infection in health facilities, especially in light of the emergence of a few such cases in parts of the country.
“There is a detailed guideline by the ministry on how to prevent hospital-acquired infection. But there have been cases where hospitals have reported the spread of infection and even shut down in some cases, probably because they got patients who had Covid-19 even though their symptoms weren’t pronounced enough…The new advisory is asking them to treat all patients as suspected Covid-19 cases, and take required safety measures,” the senior health ministry official who did not want to be named, said.
For example, the paediatric intensive care unit of central Delhi’s Lady Hardinge Medical College emerged as a hotbed of infections last week, with 12 health care workers testing positive for Covid-19. Two babies in the ward -- a 45-day-old and a 10-month-old --- got infected. The 45-day-old baby died on Saturday morning.
Since March 2, when the first infection was reported in Delhi, at least 80 health care workers and doctors have been infected in the national capital.
“Hospitals are likely to become high-risk areas. This is because doctors are not testing everyone; that is not possible,” said SK Sarin, director at the Institute of Liver and Biliary Sciences (ILBS)
“…if the population has a large number of those who have no symptoms, and if they get into the hospitals, doctors and nurses will get infected and then pass it on to others – colleagues, families and patients,” Sarin, who is the chairperson of a five-member committee that advises the Delhi chief minister on Covid-19, said, explaining the challenges health care workers and facilities are facing.
According to the Indian Council of Medical Research (ICMR) – the country’s apex health research body – about 69% of those infected by the Sars-CoV-2 virus, which causes Covid-19, either have no symptoms or very mild symptoms.
The central advisory came on the day all of Delhi’s 11 district magistrates as well as deputy commissioners of police, among other officials, held talks with lieutenant governor Anil Baijal and Delhi CM Arvind Kejriwal via video conferencing. Some of them raised issues faced by front-line workers.
“The increase in the number of health care workers, those posted at hospitals and their contacts testing positive is a cause of concern. It might be that adequate measures for protection from the infection are not being taken by hospital authorities, including those which are not treating Covid-19 cases. There is an urgent need to fix these lapses,” said a district magistrate, requesting anonymity.
A statement issued by the Delhi LG’s office said the city-state’s health department had been directed to take all precautionary measures.
Under the central advisory, those who get admitted in hospitals will have to undergo the RT-PCR (reverse transcriptase polymerase chain reaction test, which is a confirmatory test to detect Covid-19. The results take about five-six hours.
“RT-PCR is the gold standard as far as case confirmation is concerned, and results from rapid tests (or antibody tests) are still not foolproof, especially for early diagnosis…And the hospital staff has been directed to particularly keep an eye on patients for any development of unexplained fever, cough or respiratory illness (symptoms of the disease),” the official added.
If a patient tests positive, all those who have had contact with him/her will be put on anti-malaria drug hydroxychloroquine, which is considered a prophylaxis – a treatment to prevent a disease, according to ICMR guidelines. The government, however, has said the drug has to be taken under strict medical supervision as it could have serious side-effects, especially in those having underlying health conditions such as heart and kidney ailments.
Each hospital in the country, be it a dedicated Covid-19 or non-Covid-19 facility, was earlier directed to have a Hospital Infection Control Committee (HICC), which will be responsible for coming up with an effective mechanism for reporting the onset of symptoms suggestive of Covid-19 in health care workers.
This includes surveillance for fever, cough and breathing difficulty, among others, either through self-reporting or active and passive screening at the beginning of shifts.
“Whenever a non-Covid-19 patient or any healthcare workers is suspected to have Covid-19-like symptoms, or tests positive for Covid-19, the HICC will come into action, investigate the matter and suggest further course of action… rapid isolation, contact listing and tracking disinfection will follow, with no need to shut down the whole facility,” the advisory said.
It said if the primary source of an infection could not be established and if a hospital continued reporting a large number of cases among patients and health care workers, the facility should be converted to a dedicated Covid-19 hospital and the local health department must be notified.
“In terms of precautions, we are treating new patients as if they were Covid-19 positive even while conducting emergency surgeries. We are sanitising our operation theatres post surgeries, and our staff are wearing personal protection equipment (PPE) and taking other necessary precautions. All admitted patients are being tested irrespective of the Covid-19 symptoms…Same goes for patients who are frequent visitors such as those undergoing chemo, dialysis and so on; they are also being tested,” said a spokesperson for Max Healthcare.