As Covid-19 cases rise, government plans to place patients in all hospitals, but public health experts say it could be trickyDoctors warn against repeating Italy’s mistake and suggest that authorities convert some community and private hospitals into dedicated coronavirus hospitals instead.
At least two patients died in the last two days in Birgunj after hospitals refused to admit them. The patients in search of treatment were a 22-year-old woman, Bishnu Lama of Chhapakaiya, who was suffering from respiratory complications, and 64-year-old fever patient Chalitra Mahato of Shripur of Parsa.
They were taken to several hospitals seeking treatment but could not be admitted because some hospitals had halted all services due to Covid-19 infection among health workers and others were fully occupied. Some of the health facilities were reluctant to take patients for fear of infection to other patients.
“We are not in a position to resume our general services, as most of the health workers have been infected. Others have been quarantined,” Dr Madan Upadhyay, medical superintendent at Narayani Hospital, told the Post over the phone. “We have been forced to use our infected health workers to attend to Covid-19 patients.”
As of Monday, 46 health workers including doctors and nurses of Narayani Hospital have tested positive for Covid-19, which is around 15 percent of the total staff at the hospital.
An irate group of locals on Sunday vandalised Narayani hospital's emergency ward for refusing to admit a patient.
Public health experts have long warned of such a scenario, saying that the authorities must make distinctions while allocating hospitals for coronavirus patients and patients of other diseases.
As Covid-19 cases continue to rise at an alarming rate throughout the country, the Ministry of Health and Population has decided to direct all community and private hospitals to reserve 20 percent beds for coronavirus patients. The directive comes amid authorities’ warnings that government hospitals are already full and that they lack beds to admit new patients.
“We hope that the new decision will be helpful in accommodating new coronavirus patients,” Dr Sameer Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post.
Doctors, however, say the way the cases are rising, it’s a tricky situation.
While Covid-19 patients need to be provided with beds, it’s difficult to say adjusting them in private and community hospitals will be a wise decision, according to them.
“We had objected to the decision some five months ago,” Dr Lochan Karki, chairman of Nepal Medical Association, the umbrella organisation of medical doctors, told the Post. “We will repeat the mistake that Italy made.”
Italy admitted patients infected with Covid-19 in hospitals across northern Italy, the hardest hit region in Europe in March and April. It also told patients with mild systems to self-isolate at home resulting in the spread of the coronavirus among family members.
As of Monday, 23,310 persons have been infected with coronavirus across the country of which 1,178 have been infected in Kathmandu Valley. On Monday 338 people tested positive for the infection, 44 were from the Valley. The Covid-19 death toll so far stands at 79, with eight in Kathmandu Valley, according to the Health Ministry.
Dozens of infected people are currently at their homes in Kathmandu Valley as well as in Birgunj due to lack of beds in state-run hospitals, according to officials at Epidemiology and Disease Control Division.
Doctors say there is a risk of more health workers getting infected if general hospitals are used to treat the coronavirus patients. This will also raise the risk of the rapid community transfer of the virus, according to them.
Over 350 health workers including 60 doctors, over 100 nurses and around 200 paramedics and lab technicians and others working on the frontline have already tested positive for the virus, according to the Health Ministry. Hundreds of health workers, who came in close contact with their infected colleagues, have been sent to quarantine, forcing health facilities to shut down services.
Due to closure of services in general hospitals, patients of other diseases have been deprived of treatment.
On Saturday, an anesthesiologist at Narayani Hospital in Birgunj, who was in isolation after testing positive for Covid-19 inserted a breathing tube into another patient infected with coronavirus, whose condition was critical and needed ventilator support, according to Upadhyay, the medical superintendent.
Even the infected nursing staff who are in isolation are serving infected people in isolation, he said.
An additional 40 percent of health workers of the hospital, who came in close contact with those infected health workers, have been sent to isolation, which forced the hospital administration to shut down all services.
“We are neither learning from our own mistakes nor from that of others,” said Dr Karki. “Most of the private hospitals are operating in residential buildings and cannot even provide personal protective equipment to their health workers since they are too costly for them. Dealing with Covid-19 cases is not as easy as the Health Ministry thinks it is.”
Besides, most of the private hospitals have given unpaid leave to their health care workers, after the government imposed lockdown on July 21 since fewer patients came and they could not be paid, according to Kumar Thapa, former chairman of the Association of Private Health Institution of Nepal Association and owner of a private hospital in Lalitpur.
“Most of our member hospitals are not in a position to handle Covid-19 cases, as it is too sensitive, risky and costly,” Thapa told the Post.“We cannot say no to the government but we wonder if the government has thought about the possible consequences of the decision.”
There are around 350 private hospitals and around two dozen community hospitals across the country of which around 75 private hospitals and a dozen community hospitals are in Kathmandu Valley, according to the Association of Private Health Institutions of Nepal.
Eighteen hospitals in Kathmandu Valley have offered the government to convert their hospitals as Covid designated hospitals, according to Thapa.
“Using all private hospitals for treatment of Covid-19 patients cannot be imagined,” Dr Bhim Acharya, former director at the Epidemiology and Disease Control Division, told the Post. “The ad-hoc decision of the Health Ministry cannot solve problems but instead could spell more disaster. Success in the fight against the coronavirus depends upon the success in saving frontline health workers.”
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19?
Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19?
Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from?
The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territories around the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe?
The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.