14 April,2021 06:10 AM IST | Mumbai | Vinod Kumar Menon
Civic health workers test people arriving from the ferry at Gateway of India. Pic/Ashish Raje
It would appear that one of the major reasons for the surge in the spread of COVID-19 in Mumbai and its sister cities is symptomatic and asymptomatic positive patients visiting laboratories and CT scan centres.
Experts say the government must restrict such people's movements by providing mobile units for collection of samples at home and encouraging telemedicine. Only patients with a fluctuation in oxygen saturation and other comorbid conditions should be given sent for hospital treatment.
Dr Santosh Bansode, head of department, Emergency Medicine at Wockhardt hospital, Mumbai Central, said, "Our ICU and regular COVID beds are full and there's a waiting list of over 100. Patients in need of beds are struggling, some are struggling to get medicines and some are struggling for oxygen. The government and healthcare professionals are trying their best but people continue to suffer. We must understand the reasons behind the surge."
Dr Bansode added, "Today, anyone experiencing symptoms goes to his doctor first. Advised to take medicines and do a COVID and blood test, the person goes to labs to give samples. By the time the COVID report comes, the person comes in contact with several people and unknowingly exposes them to the virus."
Dr Bansode said there must be teleconsultations and tests at home. Patients must also be screened to determine if they really need hospitalisation. Doing this would require standard protocols which must be supervised by experts to avoid unnecessary use of limited medicines.
Dr Anannya Mukherji, professor of Medicine and head of unit, Dr D Y Patil Medical College, said. "Patients are initially almost always in denial. Also, the middle and upper-middle class especially prefer to get CT scans, which involves more movement. People should be made aware of the six-minute walk test and measuring oxygen saturation.
Clear indications should be provided for when an HRCT scan is needed. Has the humble chest X-ray become completely useless?"
"Fear and the right contacts help patients occupy beds, resulting in genuinely needy people not getting them. Teleconsultation and very early isolation of symptomatic patients are key to controlling this pandemic," she concluded.
Dr Sandeep Nyayanirgune, consulting senior radiologist said, "In case of complaints with the lungs like intermittent cough, with or without sputum, patients definitely need to be referred to an HRCT (commonly used to diagnose lung disease) test. Patients taking treatment for cough and cold with no relief should be advised isolation first and COVID tests at home and a chest X-ray. This may help reduce transmission."
Dr Nyayanirgune added, "The civic corporation must set up more mobile X-ray and sample collection units. There should be effective awareness about such units, which can be linked through the BMC ward war rooms."
Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and Sir JJ Group of Hospitals said the surge could be attributed to mutations, inappropriate COVID behaviour and unsatisfactory performance of vaccines against mutations.
Dr Shaikh said as soon as someone experiences symptoms, a well-equipped van should reach their home for an RT-PCR test. Several patients are told to undergo a CT scan, the machines of which could be super-spreaders themselves.
"We need to have serious coordination between the central and state governments and cooperation from the population in the coming days or else our country is in real danger of being swamped by COVID," Dr Shaikh said.
Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle, USA, said, "The Ministry of Health must design syndromic management guidelines for paramedics to identify a few syndromes to screen people for COVID. For example, three common syndromes are - fever, diarrhoea and swelling in rms, legs or toes/fingers. These three or more should be tested with a rapid antigen test in mobile health units. Antigen-positive patients should be encouraged to isolate at home, while those with moderate-to-severe illnesses can be referred to local clinics, COVID centres and CT scans if required. This way, only 15-20 per cent of antigen-positive patients will be sent to health centres and hospitals. Right now, patients accompanied by friends and kin at labs and hospitals is a âfashion'."
