COVID-19: Management flaws hamper treatment

COVID and non-COVID patients are not being separated in hospitals. Due to infrastructural inadequacies, negligence of the authorities and lack of training, patients are not being properly separated in 47 per cent of the hospitals.

Experts say these flaws in the management of COVID-19 treatment are one of the reasons that the risk of virus transmission in hospitals is not lessening.

This separating of patients is termed as triage and is a scientific method of patient management. The objective is to bring patients under medical treatment as soon as possible.

Triage has been highlighted during the ongoing pandemic as a means to prevent transmission of the virus. There are directives to adopt this method of separating COVID and non-COVID patients, but many hospitals are not following these directives.

President of Bangladesh Medical and Dental Council and convenor of the National Technical Advisory Committee for Coronavirus, Mohammad Shahidullah, speaking to Prothom Alo, said, “COVID and non-COVID patients will come to hospital for treatment. If all the patients are kept together, the transmission will increase. The patients must be separated at the very entrance of the hospital.”

Ever since the outbreak of coronavirus, the number of patients has dropped in government and private hospitals, clinics and physicians’ private chambers. People are getting infected at hospitals. Many physicians and nurses are also getting infected while treating general patients.

Chief Scientific Officer of the government Institute of Epidemiology, Disease Control and Research (IEDCR), ASM Alamgir, told Prothom Alo, “Many physicians, nurses and health workers would have been protected from the virus if the triage method was enforced.”

There is no available data on how many non-COVID patients have been infected by coronavirus at hospitals so far. Bangladesh Medical Association (BMA) said that till Thursday, 5,419 health workers had contracted coronavirus. This included 1,868 physicians, 1,491 nurses and 2,060 other health workers.

According to BMA, a percentage of them have been infected while treating COVID patients. Another percentage has been infected by unknowingly treating general patients who were actually COVID patients.

Sorting patients is one of the methods highlighted by the World Health Organisation (WHO) in the prevention of the virus transmission. The eight-member public health advisory committee of the Directorate of Health Services (DGHS) had recommended the adoption of triage, but this method has not been applied properly nationwide.

Physicians and researchers of China’s Zaozhuang University of Medicine, based on their treatment of coronavirus patients in China, have prepared the ‘Handbook on COVID-19 Prevention and Treatment’. It says that a hospital must have three designated areas for: those infected with coronavirus, suspected coronavirus cases, and non-COVID patients. These three areas must be clearly demarcated.

After initial screening at the hospital, the patients will be sent to the respective areas. The screening must be done in the shortest time possible. The handbook details the issues of managing the three areas and the protection of the health workers. But government officials and public health experts say that this will not be possible in Bangladesh as it is in China.

However, DGHS’ public health advisory committee in April had submitted details in writing to the directorate about how the task of sorting patients is to be carried out. It said that this patient sorting was to be done at the entrance to the hospital. The committee recommended that red, green and yellow areas be designated for COVID patients, non-COVID patients and suspected cases respectively.

Director (Hospitals) of DGHS, Aminul Hasan, speaking to Prothom Alo, said that physicians at all levels including the district and upazila hospitals, had been given virtual training in this regard. Handbooks had also been sent to all the hospitals.

According to DGHS, 53 per cent of the hospitals have actually received the handbooks, while 47 per cent have not.

Director of Shaheed Suhrawardy Medical College Hospital, Uttam Barua, told Prothom Alo, the patients were being segregated after initial screening. People with COVID-19 symptoms were being sent to a separate outpatient department. They were tested there again and then either admitted or being told to take treatment at home. Non-COVID persons were sent to another outpatient department where they were checked. It was a bit complicated when it came to suspected cases. They were being kept in separate wards, tested as soon as possible and then action is taken accordingly.

This system has been in place at this hospital since 27 June. The patient sorting task is conducted by two physicians in the morning, two in the afternoon and one at night, said the hospital director.

He said, around 4,000 to 4,500 patients would come to the outpatient department before, now only 150 to 200 come.

Next to this hospital are the National Cardiovascular Institute and the National Kidney Institute. These two specialised hospitals face difficulty in separating patients.

A professor of the kidney institute, on condition of anonymity, told Prothom Alo that it takes time to conduct tests on complicated patients. Their relatives wander around the hospital and sit on other patients’ beds. Even if the patients are separated, their relatives create risks of infection.

A medical officer of an upazila health complex in Khulna said that the ticket-sellers in the outpatient department ask the patients if they have fever, coughs or sore throats. There is no such thing as triage in this hospital. There has been no training about this either.

The infrastructure of the upazila, district and sadar hospitals is not the same as that of the medical college hospitals or the specialised hospitals. It would be difficult to adopt a uniform method to sort patients.

An infectious disease expert of the country, on condition of anonymity, told Prothom Alo, it is important to understand the science of the matter, to be sincere and use practical sense. If a hospital has two buildings, these can be used for two purposes. If there is only one building, the different floors can be used to curb the risk. If there is a lack of space, tents can be set up on the premises to separate the patients.

Experts say if the general people came to know that hospitals had this system of sorting patients to curb risks, they would come more readily to hospitals. Patients should not get admitted without triage, but it is not clear how the hospitals are actually practicing this.

Public health expert and former chief scientific officer of IEDCR, Mushtaq Hossain, speaking to Prothom Alo, said. “Many hospital managers do not understand the importance of triage. Prevention and control of the virus will not be possible if this method is overlooked.”

This report appeared in the print and online editions of Prothom Alo and has been rewritten in English by Ayesha Kabir