Are crowded OPDs in Hyderabad govt hospitals turning into COVID-19 ‘hotspots’?

Several junior doctors said that it was difficult to maintain crowds and identify asymptomatic people who could be carrying the virus in OPDs in government hospitals.
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There is a constant flurry of activity as one enters the Outpatient Block of the state-run Osmania General Hospital (OGH) in Hyderabad. Right at the end of a dimly-lit corridor near the entrance, doctors and nurses are seen moving in and out.

'COVID-19', a piece of paper stuck on the door declares. This is one of the hospitals where people from across Telangana, who show symptoms like cold, cough, fever etc are admitted, before they are tested for the coronavirus.

Inside the ward, doctors, nurses and ward boys can be seen moving around, but so can attendants of patients, who insist on entering the ward. Many of them are seen crowding around a desk at the entrance of the ward, while some are seated next to a bed where a patient is lying down. People move closely and can't help brushing past each other. Some of the patients here could be COVID-19 positive, but physical distancing is nowhere in sight.

And this is what has created apprehension among the medical community, especially since seven Post Graduate (PG) medical students from Hyderabad's Osmania Medical College (OMC) have tested positive for the coronavirus. The cases came to light after a woman gynaecology PG medico tested positive earlier this week, while discharging duties at the Government Maternity Hospital in Petlaburj. Her roommate also tested positive.

With Telangana's COVID-19 tally rising each day, there is a fear among a section of doctors that government hospitals in the city could be turning into hotspots.

"We have a tough time controlling the attenders. Many times they are rude to us and want to accompany the patients inside the ward as well, even if we are isolating them. Every day, we see heated discussions here," says a security guard posted at the ward's entrance at OGH.   

"We have been seeing a lot of crowds over the last few days to the OPD ward and maintaining physical distancing is very difficult as everyone seems to be in a hurry to get their patients checked first," he added. 

In Fever Hospital, a 'coronavirus helpdesk' has been set up near the entrance, but when TNM visited on Monday afternoon, there was no one at the desk. 

No way to identify asymptomatic carriers

Several junior doctors say that the Out-Patient Wards (OPD) where they were assigned duties, in hospitals like OGH, Fever Hospital, Government Maternity Hospital and Niloufer Hospital, were becoming hotspots for the disease as it was difficult to identify asymptomatic people who could be carrying the virus. 

They point out that most patients at the district-level are referred to government hospitals in Hyderabad.  

"In Petlaburj for example, since it's a maternity hospital treating women and children, people are very emotional. There are often four or five people who come with the patient. There is no control on how many people can enter the wards," says Dr KUN Vishnu from the Telangana Junior Doctors Association (TJUDA). 

"We don't know how many are asymptomatic carriers among them. If a doctor gets infected, then they treat so many patients and the risk of the coronavirus spreading across the state is more," he adds.

Some feel that the hike in numbers is because Gandhi Hospital in Hyderabad has been exclusively allocated to COVID-19 treatment.

"Some ventilators will need to be shifted but if they are able to gradually move treatment of patients to the newly-constructed Telangana Institute of Medical Sciences and Research (TIMS) at Gachibowli, then Gandhi Hospital can be freed up and the load of patients at other hospitals will greatly decrease," a junior doctor who doesn’t want to be named, says. 

Docs in OPDs demand PPE kits

Usually, doctors working in OPDs get an N-95 mask and gloves, but with the recent cases coming to light, demand has been growing for full body Personal Protective Equipment (PPE) kits.

"PPE is required because it is spreading through physical contact. When we go back to hostels, we are infecting our colleagues. If we're going home, we're infecting family members," says Vishnu 

"I see it as my duty to continue treating patients even if it means I can get infected, but my family did not sign up for this. None of this is intentional and it can be prevented easily," he adds. 

Many also demand that the rotational duty system which was in place during the initial days of the outbreak, should be resumed again. Under the system, doctors would work for 10 to 12 days, which would be followed by quarantine for five or six days. 

"This gives the doctors some rest and also makes it easy to report themselves if they start showing symptoms. They should be given accomodation outside hospitals, in hotels or in a government-run centre," Vishnu says.

"If they want us to continue working like this, they should at least routinely test healthcare workers and not wait till they start showing symptoms. This way, the spread can be curbed to a large extent," he adds.

At present, the Telangana government has decided to conduct COVID-19 tests on all 280 PG medicos residing in the hostels on the OMC campus. Two hostels have turned into containment zones and college authorities hope to complete the testing in two days.

Personnel from the Health Department and Greater Hyderabad Municipal Corporation (GHMC) have also begun intense disinfection of hostels.

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