Starting Tuesday, almost the whole of India will be under a near-complete lockdown to contain the spread of the novel coronavirus. But Rajasthan’s Bhilwara district had shut down and sealed its boundaries on March 20 itself when six medical practitioners – three doctors and three support staff – from a private hospital tested positive for the virus. The source of the infection is yet to be ascertained.
According to a report in BBC Hindi, there were more than 600 people admitted in the hospital at that time. In addition, more than 5,000 people had been treated at the hospital’s outpatient department in the two weeks leading to the discovery.
Bhilwada’s drastic decision to shut down, much before the rest of the country, was driven by the fear that all of these people could be possible carriers of the virus.
Hospitals becoming the node of coronavirus infections is not unheard of: in Italy, a Covid19 patient is alleged to have infected as many as eight people in a hospital, many of them health workers.
Italian Prime Minister Giuseppe Conte later accused the hospital of not following procedures.
While it is not yet clear what exactly happened in the hospital in Bhilwara, the incident could be a timely warning for the rest of the country, particularly as the government ropes in the private sector in the battle against the virus that has killed thousands across the world.
Advisories and orders
On March 20, the Union government issued an advisory stating that “no suspected Covid 19 patient should be turned away from any hospital”. As precautionary measures, the government asked hospitals to set aside “some beds” and to set up “isolation facilities”.
“All hospitals should mobilise additional resources including masks, gloves and personal protection equipment,” the advisory added.
That apart, the government also advised hospitals to discourage outdoor patients coming in for routine consultations. For patients who came in irrespective, the government asked for the those exhibiting flu-like symptoms to be segregated.
Several states followed suit issuing their own orders, largely mirroring the Centre’s guidelines.
The state’s directive to private hospitals broadly covers the same grounds. These instructions apply to government hospitals too, said Akhilesh Tripathi, deputy director at the state’s health and family welfare department.
“Also, we have said that PPE [personal protection equipment] must be worn optimally,” said Tripathi. “And, of course, proper sanitisation. These two are very important things.”
Tamil Nadu has gone a step further. It has instructed for a rotation policy to be adopted in the state’s government hospitals treating Covid-19 patients: one-third of all medical officers must self-quarantine themselves at home, according to a state government notification.
Karnataka has invoked the Epidemic Diseases Act while passing an order that makes it mandatory for hospitals to keep suspected coronavirus patients in isolation.
The state, which has not seen any confirmed case yet, has also asked private hospitals to keep isolation wards ready as per their capabilities.
But getting an isolation ward up and running in such a short span of time is easier said than done, say doctors in smaller private hospitals. Such wards are crucial to not letting the virus spread within a medical facility.
Ramesh Somayaji, a doctor and owner of the Bangalore-based Rajshekar Multispecialty Hospital, said his hospital was in the process of preparing an isolation ward. The facility is expected to be ready by Wednesday, said Somayaji.
Until then, Somayaji said he had no choice but to refer suspected coronavirus patients to government facilities. “We have put up a board outside asking people with respiratory symptoms and travel history to identify themselves,” he said. “We only let in people inside the hospital who are not running a temperature.”
Lack of equipment
Somayaji said his hospital, a 48-bedded facility would not be able to treat Covid-19 patients even after the isolation facility was ready as the hospital did not have enough ventilators. “We can keep people who test negative,” he said.
Apart from ventilators, Somayaji said there was a shortage of personal protection equipment and the government did not provide any either. “That is why we could not start so far and we can only begin on Wednesday,” he said. “Now, we have purchased some with our own money, which is obviously okay.”
Exclusive Covid 19 hospitals, dedicated wings
Somayaji, who is the joint secretary of Private Hospitals and Nursing Homes Association of Bengaluru, said private medical facilities in the city were in talks with the government to turn the 2,500-bed Bangalore Medical College into a Covid-19 only facility. The rationale behind it was to prevent the spread of infections within hospitals. “We are there to help, we can take in the non-Covid patients there into our hospitals and also provide doctors who can treat Covid patients there,” he said.
On March 22, Balram Bhargava, director general of the Indian Council of Medical Research, seemed to suggest something similar. “We are making preparations in all states such that Covid hospitals are segregated,” he said.
However, there is no official notice to that effect yet.
On the same day during a high-level meeting, cabinet secretary Rajiv Gauba reportedly asked for private hospitals to be instructed to set up dedicated wings for Covid-19 patients.
However, a doctor employed at a leading private hospital in Mumbai, the only city where non-government facilities have been green-lighted to treat confirmed cases, said it was unlikely. “The best hospitals can do is to maintain some distance,” he said. “Full wings are not possible with current occupancy numbers.”
Public health experts said hospital turning into hotspots was the “nightmare we are all worried about”. “Health workers could become an even graver risk than the patient,” said Poonam Muttreja, executive director at the Population Foundation of India.
Strict protocols borrowed from learnings all over the word need to be put in place immediately, said Muttreja. “It is important that the public should also know these protocols, so that they can complain if these guidelines are not being followed and there is some accountability.”
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