SINCE A 65-year-old patient from Punjab’s Nayagaon exposed at least 36 members of medical staff in the Post-Graduate Institute of Medical Education and Research (PGIMER), with one staff member already testing positive for the disease, residents posted in the screening ward of the Government Medical College and Hospital claim that deciding who would be tested for the disease and who is not has become an onerous task, clouded with uncertainty and ethical considerations.
“With most other diseases, protocols are set, but with COVID-19 they are forever evolving and uncertainty is a given. Though things are a little clearer now, the screening process has mostly been a messy and mismanaged affair,” claims a resident from the ENT department posted on a night shift at the COVID-19 screening ward of GMCH-32. The resident, worn out from the physical and mental toll her night shifts have taken on her, adds: “I wish there were a way to just clearly know who is a possible suspect and who isn’t, but now we are in a stage where everything is too unclear, and deciding whether someone needs to be tested or not is becoming more challenging.”
While India was in the earlier stages of the pandemic, the Indian Council for Medical research had mandated that only those with relevant travel history and history of contact with positive patient be observed and tested if symptoms develop. This criterion was later expanded to include patients with severe acute respiratory disease (SARD) and healthcare workers who have been in direct contact with COVID-19 patients and developed symptoms of the disease.
At GMCH-32, a standard operating procedure was developed according to which only people with relevant contact or travel history and patients. Patients with SARD symptoms were to be tested only when healthcare workers check the patient for all other possible conditions and ailments. “But more recently, since the whole panic around the Nayagaon patient exposing healthcare staff and not being tested for more than a week despite severe symptoms, every one has pulled up their socks. Now they are asking us to look out for anyone with relevant symptoms,” says a nurse posted in the screening ward.
Since the criteria for testing has expanded to any patient with appropriate symptoms, the doctors are having a hard time deciding whether a patient should be recommended for testing. “There are patients who have been admitted to regular emergency wards when they could have potentially been COVID-19 positive, but they were not tested because they did not fit the earlier criteria for the virus. But just in case they are positive, they could have already exposed the virus to so many other healthcare workers and fellow patients,” says the resident from the screening ward.
As for now, the medical staff at the screening ward is following a new guideline where the doctors test oxygen levels of the patient when and if they complain of breathing problems. “Finding it hard to breath is one of the major symptoms of the disease. Often people with a cough come and complain they can’t breathe, but that’s because they cough a lot, not necessarily because their airways are restricted because of infection. So there are some nuanced differences that we can account for at times,” says the resident from the screening ward.
“Another issue is that due to the paranoia and anxiety around the disease, people with a lot of minor ailments also are coming to the hospital to get themselves screened. This way even if they are completely healthy, they risk getting infection from the hospital,” says Dr Vinci, a resident from the ENT department, who has been involved in collecting nose and throat swabs of suspected patients at the hospital. “I would really advise everyone with minor ailments to stay at home and call the hospital if they have any worries rather than coming in here in person,” she adds.
At times, it is clear that the patient is not at risk and it’s easy to dismiss them, but at other you second guess, you wonder if you should recommend them for testing. If not now, what if they do develop stronger symptoms later, and in the meanwhile infect so many more. All these considerations haunt you before you make that decision,” adds the resident from the screening ward.
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