In Maharashtra, COVID-19 admission protocols in hospitals had not adapted to the new realities of the disease until a union government directive cleared the air.
Pune: Earlier this month, Ms Deo* (name changed to protect privacy) from Latur, Maharashtra wanted to get her 73-year-old father admitted to the government hospital there. He exhibited several of the COVID-19 symptoms though his RAT (Rapid Antigen Test) came out negative. However, his HRCT (High-Resolution Computed Tomography) score was 11, indicating a high degree of infection of the lungs.
The Civil Hospital Latur declined to admit him saying they required a positive test result. Meanwhile, Ms Deo took her father to a private hospital where he was tested again, but this time an RT-PCR (Reverse Transcription- Polymerase Chain Reaction) test was administered. He tested positive and the patient was finally shifted to the Civil Hospital. The whole ordeal cost the family three days and more than Rs 25,000.
The old protocol in government hospitals of insisting on a positive test result before admitting suspected COVID-19 patients was delaying treatment and may even be costing lives. The second wave of infections has somewhat been attributed to a more dangerous mutant variant B.1.617, the so-called ‘double mutant strain’ which is known to throw up false negatives. Considering this, doctors have been recommending an HRCT to get a clearer diagnosis. But anecdotal evidence in several instances suggests that hospital protocols in Pune hadn't caught on.
Infectious Disease Specialist Dr Amit Dravid said that there are now increasing cases in which RT-PCR and antigen tests are negative but lung infection scores more than 6. Such patients should be treated as covid-positive but government protocol doesn’t accommodate this, he had said. Delays in treatment caused due to this may risk the condition of the patient.
Like in the case of 40-year-old Dinakar*. With an HRCT score of 13 but a negative RT-PCR test, he was forced to get himself admitted at a private hospital when he was denied admission in a state-run hospital. When the private hospital started running low on oxygen, he was forced to shift. He was once again rejected from the government hospital for the same reason and he had to try at yet another private hospital. All the while, his condition kept worsening.
In another instance, when 31-year-old daily-wage labourer Sunil* started exhibiting COVID-19 symptoms, he wanted to get admitted right away, partly in order to protect his pregnant wife. While his RT-PCR test said he was negative, his HRCT score was at a worrisome 16. When he called the Pune Municipal Corporation COVID-19 war room, he didn’t get a proper response. They said they would call him back and he never heard back from them. When he called them again 15 hours later, the operator told him that he wouldn't be admitted to a government hospital without a positive RT-PCR test. Sunil then decided to search for a bed in a private hospital, rushing between Hadapsar, Wagholi and Deccan. By the time he finally got a bed, his wife was distraught.
Dipti Jadhav, a social activist, said that they had been encountering many such cases in the past few weeks where HRCT scores are more than 10, but public hospitals deny admissions on account of negative RT-PCR or Antigen tests. People then had no option but to go knocking on private hospitals. Not only does this process take a lot more time, risking the patient slipping into a critical condition, but the hospital bills also run in lakhs. “Why are we still following outdated protocols?” she had asked.
Until a union government directive dated May 9, there hadn't seemed to be a consensus within the state public healthcare system about how to deal with such cases. Dr Dnaneshwar Mote, a member of the state’s COVID-19 task force, said that there are three methods of detecting the virus - RT-PCR, RAT and now HRCT. If RT-PCR and Antigen tests are negative and the lung infection score gleaned through a CT scan is at least 6, the patient is treated as corona positive. “This is the protocol that we asked government medical staff to follow. If this is being violated somewhere, we will correct it as early as possible,” he had said.
While Pune’s District Health Officer Dr Bhagwan Pawar admitted that such was the directive from the state, he added that the lungs could be infected for other reasons like pneumonia, so a positive RT-PCR or Antigen test is a must. Meanwhile, Dr Rohidas Borase from Sassoon Hospital claimed to allow admission of such cases, citing there were no problems with the protocol.
Dr Manoj Khomane, a medical officer in Baramati tehsil in Pune district, said that 10% of beds in Covid hospitals and care centres should be reserved for SARI (Severe Acute Respiratory Infection), emergency and Covid-suspected patients. “Such beds should be allocated to the patients whose coronavirus tests are negative but lungs are infected. In my experience, the test results for such kinds of patients turn up positive after two or three days. So government hospitals should not reject them,” he had said.
To ensure this, the Union Ministry of Health released a “revised national policy for admission of Covid patients to various categories of Covid facilities” that said, “a suspect case shall be admitted to the suspect ward of CCC (Covid Care Center), DCHC (Dedicated Covid Health Centre) or DHC (Dedicated Covid Hospital] as the case may be.”
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