More on Covid-19

NEW DELHI: A debate is raging among doctors on whether or not to test all patients coming to hospitals for Covid-19. Meanwhile, there has already been more than one report of a patient dying while waiting for the test results, and not from the coronavirus After a private hospital chain decided that it would insist on Covid-19 tests before admitting patients, to protect its staff from possible infection, the Delhi government last week issued an order stating that strict action will be taken against any private hospital or nursing home denying emergency care and that patients seeking treatment were not obliged to submit a Covid-19 negative report for treatment.In Tamil Nadu, too, the director of medical services has warned that if a hospital or clinic denied services, action will be taken under the Clinical Establishments Act, which could include closure of the establishment. However, most states are yet to issue any policy direction on this issue.When about 20 big and small private hospitals and nursing homes were shut down in Mumbai after many health workers tested positive, many doctors in different cities argued that it might be more sensible to insist on the test than end up having to shut down operations, which would affect other patients too.But the other side of the debate points out that this not only adds to costs for patients, it could also mean potentially life-threatening delays while the results of tests are awaited, sometimes for up to 48 hours.In Jharkhand , for instance, a 61-year old woman who needed dialysis died while the hospital waited for her test results to determine whether she should be in the Covid-19 ward or the general ward. Similarly, a 14-year old in the state died at a private hospital, which demanded a coronavirus negative certificate before administering dialysis. With just one testing centre in Ranchi, there was a long waiting period that proved lethal.Doctors in Mumbai claimed they insist on a Covid-negative report only for patients undergoing dialysis and radiotherapy. "Even that seems impractical, because patients may get a false negative result if they are in the early stages of the infection," said Dr Prince Surana, who owns three hospitals across Mumbai.Joy Chakraborthy, COO of Mumbai's Hinduja Hospital, said the group is not making the test mandatory for patients. "However, our nurses and other staff use personal protection equipment such as N95 masks while attending to emergency patients.""In emergency care, we are taking all precaution as if the patient is Covid positive. However, in the case of urgent surgeries or procedures like obstetric or cancer surgeries where we can afford to wait, we send samples for testing as results are available within 24 hours," said a senior consultant in a private hospital in Haryana. Though OPDs opened on Monday in Haryana, they are functional outside the hospital premises to reduce the risk.Reports of doctors insisting on Covid test are coming in from many states, including Rajasthan, West Bengal and Jharkhand. In Odisha, too, many private hospitals such as Apollo Hospital, AMRI Hospital and Kalinga Institute of Medical Sciences have made Covid tests mandatory. "Any patient coming to hospital is being tested for Covid-19 before being shifted to a ward from the emergency isolation room," said an AMRI spokesperson. "For OPD care, you don’t need a test. However, before any intervention procedure, such as a surgery, dialysis or chemotherapy, all patients should undergo a Covid test. Otherwise, many healthcare professionals will turn positive and the system may collapse," said Ghanashyam Biswas , a medical oncologist in Sparsh Hospital , Bhubaneswar. "Tests for Hepatitis B, Hepatitis C and HIV are mandatory for any intervention. Now Covid test should be add to these. It is also in patients’ interest because a Covid-19 positive may be at higher risk of complications," he said.In Uttar Pradesh, making Covid testing mandatory for treating any disease is not practical, said Dr P K Gupta of UP IMA. There is hardly any infrastructure for Covid testing in the private sector with very few private labs getting approval to do the test. However, in the government sector in UP, any patient in need of emergency surgery is first tested for Covid.In Bihar, a majority of private establishments have solved the problem by simply not running OPDs or undertaking any institutional deliveries after hearing about doctors getting infected. The situation compelled the state’s principal secretary (health), Sanjay Kumar, to tweet about the "almost complete withdrawal" of the private sector and point out that "even regular services have become unavailable".With no clear instructions from governments on how to address the safety of healthcare workers while also ensuring patients do not face crippling costs or dangerous delays in procedures, hospitals are finding their own answers.(with inputs from state correspondents)