Patients can enter OPD blocks at all hospitals in Telangana only after going through a series of screening and after an entry slip is issued by doctors.

NIMS is one of the few non covid19 hospitals still providing outpatient service
Coronavirus Frontline workers Sunday, May 17, 2020 - 19:07

To safeguard the doctors working at Outpatient Department (OPD) sections of all government hospitals in the state, the Telangana Health Department put in place a set of safety precautions, where the patient would be first screened and voluntarily disclose if they suffer from any of the COVID-19 symptoms.

However, many doctors in the frontline at some of these government hospitals do not have faith in the current screening system, as many wonder if the measure adopted is adequate or even foolproof.

The screening measures of OPD patients came in place following a scare at Nizams Institute of Medical Sciences (NIMS), Hyderabad, in April when two resident doctors had to be placed under quarantine after a nephrology patient was suspected of coming in close contact with a COVID-19 patient.

Dr Jay Singh Arora, the convener of the Resident Doctors' Association, was one of the two doctors who was put under quarantine in April. “Fortunately, the patient tested negative; so there was no cause for concern. However, the present screening process has been put in place after much discussions between doctors and the health department officials,” he said.

The current system

In a day, close to 500 patients visit the OPD section at NIMS hospital even during the lockdown and at a time when the number of coronavirus cases in Hyderabad is rising. NIMS is one of the government hospitals in Telangana that still treats non-COVID cases when many private hospitals have essentially stopped OPD services.

When this reporter visited NIMS on Saturday, a queue of roughly 40 people stood in front of the OPD block. Although circles were drawn on the floor to enforce physical distancing, people did not stand in the earmarked spots.

The security personnel tasked with manning the queue were checking the temperature of those standing in the queue. Once screened, the OPD patient has to approach two lab technicians, who will be suited in full protective gear. After asking a series of questions, the lab technicians will issue an entry slip that has to be taken to a room with three doctors. The permission to enter the OPD block is only issued once these doctors sign the entry slip.

“If someone has a temperature of above 100 degrees Fahrenheit or shows signs of COVID-19 like symptoms, we ask them to visit the King Koti government hospital and get tested. On a daily basis, we refer about three to four such persons. This is only to rule out COVID-19,” said Dr Varun, one of the resident doctors manning the screening post at OPD section of NIMS on Saturday.

Why this is inadequate

Dr Jay Singh does not view the present system as adequate. “I was called back on duty and am back working in the screening section. But this system is not foolproof,” he said.

His concern stems from a statement by the Indian Council of Medical Research (ICMR), which said that 80% of COVID-19 cases reported in India are asymptomatic.

According to Dr Jay, many of the patients often do not show COVID-19 symptoms. Even if they have fever, they may have taken paracetamol hours before coming to the OPD, and thus their temperature would seem normal, he added.

If the patient is found to be having a high temperature or exhibits any COVID-19 symptoms, they have to visit the King Koti government hospital to get tested. “The test results may come after two days, and if found negative, they have to go through the hassle of standing in a queue, with their ailments, all over again,” explained Dr Jay.

“Its a time-consuming process and is a hassle for the patient. The success of the present process depends on if the patient voluntarily discloses symptoms, but they are not incentivised to do so,” he added.

To reduce the rush to OPD at NIMS, the hospital management had come out with teleconsultation services but there have been only a few takers so far. “The number of people coming to OPD has seen no change from the pre-COVID-19 period. And there are not many takers for the teleconsulting,” noted Dr Jay.

At Fever Hospital, one of the resident doctors manning the screening post takes two steps back if a patient takes one step towards him.

“This is a hospital where scores of patients with high fever walk in. So the chances of COVID-19 cases among them are high. There are guidelines, too, for who needs to be tested. We admit those with symptoms at our isolation wards and send their samples for testing to King Koti hospital,” said the doctor, adding they send samples of close to 10-15 patients for testing per day.

When asked about risking exposure, the doctor simply replied, “That’s the nature of the job.”

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