On Sunday night, a 65-year-old resident from Nayagaon in Punjab with symptoms of severe acute respiratory distress (SARD) tested positive for COVID-19 at the Post-Graduate Institute of Medical Education and Research (PGIMER). The patient, who has no relevant travel history or history of contact with another positive case, was placed in the emergency ward and was in contact with at least 36 medical professionals, some of whom were not equipped with proper protective gear, before he tested positive for COVID-19 and was placed in the Communicable Disease (CD) Isolation ward of PGIMER.
Lack of protocol in isolating SARD patients
Although the Indian Council for Medical Research (ICMR) has broadened testing criteria to those with severe respiratory distress, the hospital does not have a set protocol in place wherein a patient with SARD is immediately isolated and tested for the disease. Hence, the 65-year old patient remained in contact with not just unassuming medical staff but also other patients admitted to the emergency ward at PGIMER. The patient was also tested for swine flu before being tested for COVID-19. “Since he did not have a travel history or relevant contact history, he was placed in a general ward like any other patient. Only when he wasn’t responding to regular treatment was he tested for the disease,” said a source from the hospital.
31 staff members home quarantined
“A team from community medicine has identified 36 members of the staff who were exposed to the patient before he was tested for the disease,” an official source said. This comprises five doctors, 22 members of nursing staff and nine members of sanitation staff and hospital attendants. Most of the staff members have been asked to home quarantine while three resident doctors have been placed in a quarantine ward at PGIMER. Out of these contacts, many did not have the protective equipment necessary to safely handle COVID-19 patients. “One anesthesia resident had a PPE but not a hazmat suit. Another medicine resident who was incubating the patient did nit even have a PPE,” the source said. None of these staff members has been tested yet since they are asymptomatic.
“There was a lot of chaos and everyone was shocked because many residents were in direct contact with him in the medicine emergency ward before he was shifted to the screening ward 22,” said Uttam Thakur, president of the Association of Resident Doctors at PGIMER. Though most of the staff working with suspected cases are provided with some form of personal protective equipment, the equipment provided to the rest of the staff is not adequate to guarantee protection from infection. Prior to being admitted to PGIMER, the patient was examined at the Government Multi- Specialty Hospital in Sector 16 as well, where he was exposed to a range of ill-equipped medical staff as well. Sixteen members of staff from GMSH-16 who were directly exposed to the patient have also been quarantined.
Thakur claims that though there is no shortage of equipment for those in the screening and isolation ward at the hospital, he does acknowledge that staff stationed everywhere else in the hospital has limited access to such equipment. On several occasions, members of hospital administration and Director Jagat Ram have claimed that not all healthcare staff requires personal protective equipment, but only those who are directly in contact with patients in screening and isolation wards. However, with potential cases cropping up in general wards, all hospital staff can be potentially exposed to the pandemic.
Nursing staff, attendants and guards vulnerable
“Now that a positive case without any travel history and contact with other positive cases has surfaced, who potentially exposed many unprotected healthcare staff to the disease as well, the administration will be compelled to take action. But before this, we have always been worried about suspected cases being in general wards around staff who don’t have PPE or N 95 masks,” said a nurse posted in the emergency ward. Since potential cases do not always land directly in screening or isolation wards, healthcare staff from all functioning emergency wards of the hospital have voiced concern.
Prior to this incident, a video had gone viral of a surgeon from PGIMER refusing to operate on a patient with history of international travel without an N95 mask. The video shows the surgeon demanding an N95 mask for himself and two nursing staff members who were to assist him during the surgery.
Far from having access to N95 masks, most staff, especially those lower down the hierarchy like cleaning staff, security guards and attendants, either wear a hand-stitched cloth mask or wrap a piece of cloth around their face to remain protected. “Despite the fact that these members of staff can also potentially be in contact with everyone, they are not provided adequate protective gear. They say the WHO guidelines only ask for staff directly dealing with COVID-19 patient to have N95. How do we know who is infected and who is not?” said the nurse from the emergency.
“We have to make do with whatever we have for now,” said a member of the cleaning staff who has been reusing the same cloth mask for the past 10 days.
ICMR guidelines on rationing PPE kits
The latest standard operating procedure issued by the Indian Council for Medical Research acknowledges that India is in the stage of community and local transmission of COVID-19. It adds that any medical workers handling patients with severe acute respiratory illness is in high risk for contracting the infection and should be provided with a full PPE kit. However, this procedure has not yet been followed at government hospitals across the city and SARI patients have been placed in general emergency wards and handled by medical staff without full protective equipment.
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