Major government COVID-19 hospitals in Chennai are witnessing clusters among their medical staff. On January 5, Stanley Medical College reported around 27 COVID-19 cases among its medical students, after they returned from a tour. Earlier in December, 39 staff members at the Rajiv Gandhi Government General Hospital (RGGGH), including doctors and nurses, contracted COVID-19, after a diabetes patient who underwent surgery at the hospital tested positive for the coronavirus. More recently, 25 doctors at the Government Kilpauk Medical College reportedly tested positive for the virus between January 1 and 6, according to Edexlive. A similar situation has arisen in Delhi and Mumbai, where scores of doctors nurses are contracting COVID-19, raising concerns over a crisis of hospitals becoming understaffed as the third wave intensifies.
On January 5, the Union Health Ministry reduced the duration of required home isolation of COVID-19 patients from 10 days to seven days from testing positive, provided there is no fever for three successive days. According to Dr E Theranirajan, dean of RGGGH, a pilot study conducted at the hospital among COVID-19 patients, whose samples had the S-gene dropout (indicative of Omicron), found that they had turned non-infective within five days.
“So five days of isolation is likely enough, but since government guidelines say seven days, we are following that,” Theranirajan said. With hospital clusters likely to force huge numbers of doctors and nurses to be away for days, leaving health care facilities with a sparse workforce, experts suggest avoiding clusters with strict precautions.
Dr K Kolandaswamy, former Director of Public Health in Tamil Nadu, says that hospitals being high-risk places for infection, comprehensive measures must be taken, especially to ensure ventilation. “We don’t see major clusters in medical camps etc. Clusters occur in hospitals because there are too many people, there’s overcrowding and too many visitors with no control. Clusters are bound to occur unless proper measures are taken.”
According to Kolandaswamy’ recommendations for hospital infection control, apart from the usual precautions of masking, handwashing, distancing and disinfection of surfaces, adequate ventilation must be provided, especially in all patient-care areas. Specifically, he stresses the minimum hourly average ventilation rate, or the rate at which fresh air from outside flows into the room, must be 160 litres per second per patient in the case of natural ventilation, down to 60 litres per second per patient for general wards and outpatient departments, and 2.5 litres per second per cubic metre for corridors and other transient spaces.
If natural ventilation (open doors and windows) is insufficient, he recommends exhaust fans, mechanical fans, or air filtration systems to increase ventilation rates in rooms with COVID-19 patients.
He also recommends avoiding the use of broomsticks to prevent dust generation; instead, switch to wet mopping or vacuum cleaners. Hospitals are advised to limit visitors unless absolutely necessary. Staff members are advised to avoid using elevators, and also stagger the schedules of consultation timings and other services, as well as lunch and coffee breaks.
For instance, the Dean of Coimbatore Medical College Hospital (CMCH), Dr A Nirmala, says that the institute’s students have been advised to take their food to their rooms instead of the dining hall when possible. “Our dining halls and rooms are well ventilated. Students have also been asked to keep the windows open and take necessary precautions,” she says.
Moreover, medical and paramedical staff have been instructed to be extra careful in handling patients, she says. “Whenever a patient enters, students and hospital staff have to have a high index of suspicion that they may be COVID-19 positive, and they have to follow appropriate behaviour.”
The Tamil Nadu government issued new guidelines for triage and treatment of COVID-19 patients. This is to prevent patients who could be treated under home isolation from reaching major health care facilities, and save hospital resources to treat serious COVID-19 cases. According to these guidelines, double vaccinated or asymptomatic individuals will be advised to undergo home isolation or be referred to COVID Care Centres (CCCs).
“If they have any queries, they will be asked to contact the medical officer through teleconsultation,” says Theranirajan. Unvaccinated individuals and those with comorbidities will be admitted in CCCs, while pregnant women and lactating mothers and elderly persons above 60 years of age would be referred to COVID-19 hospitals.
Hospitals have continued to follow the Health Ministry guidelines of treating patients with less than 93% SpO2 level as having moderate disease and admitting them. “If they have a respiratory rate of 24 to 30 (breaths per minute), we transfer them to CCCs. If it’s above 30, we admit them to the hospital,” Theranirajan said. The patient’s age and comorbidities will also be considered, as per the guidelines.
Many patients at Apollo have also been kept under home isolation or at COVID-19 isolation facilities at hotels, with teleconsultation or telemonitoring, according to Dr K Hari Prasad, President of Apollo Group of Hospitals. Stressing the need to quarantine infected persons to prevent further spread, he says that home isolation is likely to be the mode of management for a vast majority of people in the third wave. “Since vaccination rates are better compared to the previous wave, we expect fewer people to be hospitalised,” he says.
While the previous waves saw a rapid rise in hospitalisations, overburdening health workers, the number of hospitalisations, so far, have remained low, notes Dr Hari Prasad. “We aren’t seeing the kind of panic we saw in previous waves. People believe this is a milder variant that does not cause serious disease. It’s good that there is no panic, but a lot of people are also ignoring precautions that could lead to further spread,” he cautions.