Current COVID-19 Scenario and Suggested steps for Coping – India

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Salient Points

This article reports 2 hospitals in the country, emergency surgical procedures were performed on patients who developed COVID-19 in the post-operative period. This resulted in healthcare personnel getting infected with COVID-19 leading to a lock down and quarantine situation at these hospitals.

They highlighted the possibilities that patients who develop COVID-19 in the postoperative period were

Either

  • infected at the hospital (nosocomial)

or

  • were already infected on admission and have been pre-operatively asymptomatic for COVID-19, or in the incubation period which suggests community level spread.

Hospitals can become a reservoir of the virus and spread to HCP when patients with high viral load are admitted. This may lead to further community spread and to HCPs and hospitals being unavailable for care of patients when the pandemic progresses.

Detailed Summary

Management

  1. Shut down regular OPDs for chronic illness – these individuals are vulnerable and should not be making trips to the hospital. This reduces hospital crowd and avoidable workload.
  2. Mobile based counselling for patients with chronic illness.
  3. Medical emergencies to be catered to by hospitals not frequented by COVID-19 patients.
  4. Home delivery of medications.
  5. Multiple hot-lines manned 24×7 by appropriate medical professionals.
  6. Lab samples to be collected from homes.
  7. Use a syndromic approach to diagnose COVID-19 – using home isolation and prophylactic measures.
  8. PCR or Rapid Testing only for confirming diagnosis when essential for care.
  9. Save resources so they can be put to better use.
  10. Dedicated ambulance services.
  11. Separate emergency facilities for patients with ARDS.
  12. Dedicated respiratory teams should handle these cases, adopting very effective respiratory and universal precautions.
  13. Every Patient coming to the hospital for any emergency should be considered to be potentially infected with SARS-CoV-2.

Surgical procedures must be reserved for emergencies, each patient going for surgery must have a screening PCR on a nasopharyngeal swab and IgM antibody and lab reports to be seen before taking up for surgery. Similar to the system in place for hepatitis B, C and HIV.

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