COVID-19: Nationwide OPD entry and hospital guidelines the need of the hour

Just in the last week, we have witnessed widespread Coronavirus contamination cases in several major government and private hospitals in three states - UP, Rajasthan and Maharashtra - due to free access to OPDs without screening, or confusing guidelines for recognising Coronavirus symptoms. In each case, infected patients were treated for normal illnesses, and in two cases the alert was sounded only after the patients’ deaths. This exposed vast numbers of scarce medical staff as well as patients to infection. We need immediate nationwide guidelines to prevent this.

On March 30, a 25-year old man from Basti was found to be infected after he died in Gorakhpur's BRD Hospital, one of the city’s largest hospitals. In the process, he had exposed both hospital staff and other patients, all of whom are now under quarantine. He had recognisable symptoms, but since he had no “travel history”, the hospital staff assumed he was not infected.

The same happened on April 1 at PBM hospital in Bikaner, Rajasthan. A 60-year-old woman, first admitted to a private hospital, was then referred the government’s PBM Hospital. She was first taken to the emergency ICU, then shifted to the general ward, then to the Swine flu ward, and then to the isolation ward for Coronavirus suspects. Within a day she died. Along the trail, dozens and dozens of hospital staff and other patients were exposed in both hospitals and have had to be in quarantined.

At Wockhardt and Jaslok hospitals in Mumbai, two patients, one admitted for a heart attack the other for cancer, tested positive for Coronavirus. Several attending nurses also tested positive. Although it is being assumed that these patients infected the staff, the opposite may also be true, that the infection passed from staff to patient, since one patient developed symptoms only after 4 days of hospitalisation.

This cannot go on. We need clear nationwide guidelines and several measures as below:

First, all hospitals (government and private) should be mandated to set up a facility to screen OPD patients via a window-protected interview, before being allowed into the hospital. This facility could even be set up outside the main hospital entrance. Those reporting any suspicious symptoms (even the mildest) should be redirected to where they can be tested for COVID-19. Open walk-in access to OPDs should be banned.

Second, all hospital staff should undergo the anti-body test, and only those with anti-bodies (and hence with some immunity) should serve in ICUs and in Coronavirus wards. An antibody test is a simple blood test, easy to administer, and can tell us within minutes if someone has already had COVID-19. Ideally, a PCR confirmatory test should follow to confirm that the person is virus free. Given scarcity of testing kits, medical staff should be prioritised in such testing, to protect both themselves and their patients from infection.

Third, there is need for a widespread awareness campaigns to make doctors and nurses fully cognizant of the wide range of COVID-19 symptoms, including mild ones.

Fourth, patients should not be shifted from hospital to hospital or ward to ward. Anyone undergoing serious hospital procedures should first be tested for COVID-19.

These are extraordinary times and need strong guidelines for hospitals, which for many, are the last port of call.

(The writer is Professor of Development Economics and Environment, University of Manchester, UK)