(With regular inputs from Dr Monica Vasudev)

Did Indian Government ask hospitals to stop functioning during lockdown

“As per Order No. F.51/DGHS/PH-IV/COVID-19/2020/M/prsecyhfw/2916-3015 dated 20.03.2020 {uploaded on Delhi Govt. Website http://www.health.delhigovt.nic.in/ (Coronavirus updated)}, all MSs/ Directors/ MDs/ HODs of Government of NCT of Delhi Hospitals were directed vide Point 17 to ensure that hospitals should suspend non-essential elective surgery for the time being to ensure bed availability for COVID-19 patients.

This Directorate vide Corrigendum No. F.23/Misc./COVID-19/DGHS/NHC/2019/Pt.IV/4613-20 dated 06.04.2020 has designated only 03 (three) private hospitals, as COVID-19 designated hospitals, either wholly or partly.

Further, this Directorate vide Order No. F.23/Misc./COVID-19/DGHS/NHC/2019/Pt.IV/4730-4733 dated 09.04.2020 had informed Director/ Medical Director/ Medical Superintendent/ Keeper of all registered nursing homes/ private hospitals in NCT of Delhi regarding the availability of Govt. Order on the above mentioned website.

Furthermore, this Directorate vide Order No. F.23/Misc./COVID-19/ DGHS/ NHC/ 2019/ Pt.IV/4865-4869  dated 15.04.2020 had directed all Director/ Medical Director/ Medical Superintendent/ Keeper of all registered nursing homes/ private hospitals in NCT of Delhi  to refrain from violating Clause 14.2 of the Schedule appended to Rule 14 of Delhi Nursing Homes Registration (Amendment) Rules, 2011.

*It is reiterated that this Directorate has not issued any order to private hospitals for suspending non-essential elective surgery.*

Action will be taken against hospitals if they turn away patients: Harsh Vardhanhttps://timesofindia.indiatimes.com/india/action-will-be-taken-against-hospitals-if-they-turn-away-patients-harsh-vardhan/articleshow/75215412.cms?utm_medium=referral&utm_campaign=iOSapp&utm_source=WhatsApp.com

TB notification has gone down instead of going up in India

I had expected that COVID cough will pick up all cases of hidden TB in the country and especially MDR-TB.

I also thought that COVID policy will be applied to TB and all TB ad MDR-TB cases will be isolated and kept in hospitals till they are tested negative.

I even wrote to PM about that way back in late January. I suggested that COVID program should be merged with RNTCP program and Swatchh Bharat program.

But, we are seeing the opposite. The Nikshay, the official database for TB across the country, between February 14 and 29 showed notification of 1,14,460 TB cases. Of these, 83,697 were from the government sector, the rest from private hospitals.

However, for the entire three-week lockdown period, the total number of notifications is only 34,566. It’s disturbing, worrying and may end up into another public health emergency.

Recently, I saw a statement of the HM that polio workers will be involved in COVID fight. I hope this does not hamper the polio work.

I expect post-COVID, we will have less cases of measles and chicken pox - both droplet nuclei infections; less cases of diarrhea, typhoid and jaundice due to hand washing campaign.

Excuse: Active case finding campaign for TB deferred and field workers deployed for COVID work. The OPDs in government hospitals are not functioning, private clinics have closed down. Even patients who are symptomatic cannot access facilities.

People who are on treatment, I hope, are getting medicines.

Should doctors see ILI patients without PPEs

It’s like police going without a bullet proof jacket in a planned raid; army going without arms for the fight and fire fighter entering a fire without firefighting equipment.

Prevalence of COVID

In Santa Clara County, researchers from Stanford University conducted the first large-scale community-based COVID-19 prevalence study in a large US county.

A small blood sample was collected and tested for SARS-CoV-2 antibodies using Premier Biotechs serology test. Of the 3330 people tested, 50 were positive for COVID-19 via either IgG or IgM antibodies in the sample.

Unadjusted, the seroprevalence in the County was 1.5%. The population prevalence ranged from 2.49% to 4.16%.

This suggests that 48,000 to 81,000 people were infected in Santa Clara County in early April, a 50- to 85-fold increase over the confirmed 956 cases. This corresponds to an infection fatality rate of 0.12% to 0.2%, well below most estimated fatality rates, which range from 4.3% in the US to 13% in Italy. 

Our earlier stand is becoming true

1. Mortality 1% of symptomatic cases
2. There are 50 asymptomatic cases to one symptomatic case

COVID era new hospitals design

1. Modern hospitals do not have the flexibility to accommodate a sudden rise in patients.  Beds are being set up in lobbies, conference rooms, and in cafeterias or any space that is available. Tents are being installed on hospital grounds and negotiations are being done for the use of additional space inside nursing homes, assisted living facilities, hotels, religious centers, and colleges.
2. Future hospitals should have more flexibility for pandemics every five or 10 years. There is a need to be able to expand and contract.
3. The wards should have open windows for fresh air and sunlight with high standards of cleanliness.  The unintentional replication of the Nightingale ward (six feet distance) could be effective for handling mild COVID-19 cases, which can be safely isolated together in groups.
4. The emphasis on cutting costs, hospitals near residence or in residence should be done away with.
5. Need for touch-free control for lighting, temperature, and other functions, to help avoid spreading diseases on these highly touched surfaces.
6. Materials that are less hospitable to microbes, such as copper, may limit the risk of surface transmission.
7. Eliminate window curtains as they can become easily contaminated, by installing windows made of e-switchable privacy glass, also known as e-glass or smart glass. It can switch between translucent and opaque and is easy to clean.
8. Designs that help patients stay connected to friends and family by incorporating widely available technologies such as video chat and virtual reality headsets.
9. Do more for healthcare workers. Hospitals have worked on eliminating sleeping quarters for hospital staff and reducing the number and size of break rooms and rest areas. The current pandemic has highlighted the need for giving healthcare workers a place to rest in between the shifts, especially when there are reports of nurses and physicians sleeping in camper vehicles and avoiding their homes to protect their families from possible infection.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA