Why Are Hospitals Insisting on Testing All Patients for COVID-19?

Why Are Hospitals Insisting on Testing All Patients for COVID-19?

Published10 Jun 2020, 09:02 AM IST
Fit
5 min read

Why are doctors prescribing COVID-19 tests for patients coming in for non-COVID services?

When the Delhi government decided to only test symptomatic people for COVID-19, medical practitioners reacted with extreme apprehension. While this policy would have had some obvious and direct outcomes for COVID containment, it would also have greatly affected access to non-COVID health facilities for patients requiring these other services.

Even though the Delhi Lt Governor Anil Baijal overturned the government’s revised order, this whole debate raised some important questions: How does a restricted testing policy affect non-COVID services?

Why Are Hospitals Insisting for COVID Tests for All?

In an interview with FIT, Dr Naresh Trehan, chairman and managing director of Medanta-The Medicity spoke about opening up hospitals for elective surgeries and why that would need for patients to be tested for COVID-19.

He said, “Nobody knows who could be a silent carrier of the disease. If you don’t know that, there is no fool-proof way of protecting yourself and others from the virus. So, it is for the protection of everybody that this protocol has been made.”

Notably, such a protocol is not applicable for emergency services and treatments; those patients would have to be attended to immediately without waiting for a COVID test.

But for elective surgeries - surgeries which can be scheduled in advance but are not necessarily optional - doctors consider a test important. In fact, it has been estimated that worldwide, around 28.4 million elective operations were cancelled due to disruption caused by COVID-19. This could either have been due to converting hospitals into full-fledged COVID designated facilities, or because of unavailability of sufficient tests, or because of the underlying risk of performing surgeries on COVID-positive patients; which brings us to the next crucial argument.

COVID-19 Patients At Higher Risk of Dying From Any Surgery: The Lancet

COVID-19 patients may be at a higher risk of dying if they undergo any surgery - even minor or elective surgery.

This finding came from a new global study published in The Lancet on the risks of postoperative death for COVID-19 patients by experts at the University of Birmingham-led NIHR Global Research Health Unit on Global Surgery who examined data for 1,128 patients from 235 hospitals.

What does this imply? If patients are operated upon without knowing their COVID status, those who are, indeed, positive, would have been put at a 20% higher risk of death.

Dr Sushant Wadhera, Advanced Laparoscopic and Bariatric surgeon in Delhi, had written a letter to the Delhi government to highlight this issue. Till the time of writing this report, he had not received a response. Speaking to FIT, he said, “It feels like the government is doing this to suppress the numbers.”

Remember, for a routine surgery like a gall bladder removal, the risk is as low as 0.01%, which multiplies significantly for a COVID patient. “Now if I do not know your COVID status, I will not take the risk.”

Why the Surgeries Cannot be Delayed Indefinitely

An estimated 505,800 non-emergency surgeries, 51,100 cancer surgeries, and 27,700 obstetric surgeries could have been delayed across India during the three-month period before and after the peak of the viral outbreak, Mint reported on May 18, 2020.

The number of operations cancelled in India is estimated at 48,728 per week or about 585,000 over 12 weeks, as per a report published in the British Journal of Surgery on May 12, 2020.

Dr Sushant Wadhera said that at the beginning of the coronavirus outbreak in India, it was understandable to postpone elective surgeries as mass-testing may not have been possible then. “But after three months, that reason is simply inexcusable.”

“Moreover, it needs to be understood that a COVID-positive patient is a risk for all lives working around him/her. The surgeon, the surgical staff and every other person in the operation theatre.”

He adds that for emergency procedures that cannot be denied right now, an entire safety protocol has to be followed by the staff. They need to wear the full PPE gear, the Operation Theatre is sealed for a day, and the attendants should ideally go into quarantine and get tested.

He added that as the country opens up, people would want to get on with their lives. “It is their right to get treated for whatever pain they are suffering from. If anything obstructs that, it needs to be reconsidered. Some of these health problems are progressive, i.e. they worsen with time. Not treating them soon can reduce a person’s chances of survival in the longer run as well. Testing must be allowed, and smaller and medium-sized hospitals must be made available for non-COVID services. This is not the only disease we are dealing with. For COVID, the formula is simple: Test more, save more.”

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(This story was auto-published from a syndicated feed. No part of the story has been edited by The Quint.)

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