Telemedicine, instant isolation key to stopping COVID-19 surge: Experts

It would appear that one of the major reasons for the surge in the spread of COVID19 in Mumbai and its sister cities is symptomatic and asymptomatic positive patients visiting laboratories and CT scan centresExperts say the government must restrict such peoplersquos movements by providing mobile units for collection of samples at home and encouraging telemedicine Only patients with a fluctuation in oxygen saturation and other comorbid conditions should be given sent for hospital treatmentDr Santosh Bansode head of department Emergency Medicine at Wockhardt hospital Mumbai Central said ldquoOur ICU and regular COVID beds are full and therersquos a waiting list of over 100 Patients in need of beds are struggling some are struggling to get medicines and some are struggling for oxygen The government and healthcare professionals are trying their best but people continue to suffer We must understand the reasons behind the surgerdquoDr Bansode added ldquoToday anyone experiencing symptoms goes to his doctor first Advised to take medicines and do a COVID and blood test the person goes to labs to give samples By the time the COVID report comes the person comes in contact with several people and unknowingly exposes them to the virusrdquoDoorstep testsDr Bansode said there must be teleconsultations and tests at home Patients must also be screened to determine if they really need hospitalisation Doing this would require standard protocols which must be supervised by experts to avoid unnecessary use of limited medicinesPatients in denialDr Anannya Mukherji professor of Medicine and head of unit Dr D Y Patil Medical College said ldquoPatients are initially almost always in denial Also the middle and uppermiddle class especially prefer to get CT scans which involves more movement People should be made aware of the sixminute walk test and measuring oxygen saturationClear indications should be provided for when an HRCT scan is needed Has the humble chest Xray become completely uselessrdquoldquoFear and the right contacts help patients occupy beds resulting in genuinely needy people not getting them Teleconsultation and very early isolation of symptomatic patients are key to controlling this pandemicrdquo she concludedDr Sandeep Nyayanirgune consulting senior radiologist said ldquoIn case of complaints with the lungs like intermittent cough with or without sputum patients definitely need to be referred to an HRCT commonly used to diagnose lung disease test Patients taking treatment for cough and cold with no relief should be advised isolation first and COVID tests at home and a chest Xray This may help reduce transmissionrdquoDr Nyayanirgune added ldquoThe civic corporation must set up more mobile Xray and sample collection units There should be effective awareness about such units which can be linked through the BMC ward war roomsrdquolsquoGet wellequipped vansrsquoDr Wiqar Shaikh professor of Medicine Grant Medical College and Sir JJ Group of Hospitals said the surge could be attributed to mutations inappropriate COVID behaviour and unsatisfactory performance of vaccines against mutationsDr Shaikh said as soon as someone experiences symptoms a wellequipped van should reach their home for an RTPCR test Several patients are told to undergo a CT scan the machines of which could be superspreaders themselvesldquoWe need to have serious coordination between the central and state governments and cooperation from the population in the coming days or else our country is in real danger of being swamped by COVIDrdquo Dr Shaikh saidSyndromic managementDr Subhash Hira professor of Global Health at the University of WashingtonSeattle USA said ldquoThe Ministry of Health must design syndromic management guidelines for paramedics to identify a few syndromes to screen people for COVID For example three common syndromes are mdash fever diarrhoea and swelling in rms legs or toesfingers These three or more should be tested with a rapid antigen test in mobile health units Antigenpositive patients should be encouraged to isolate at home while those with moderatetosevere illnesses can be referred to local clinics COVID centres and CT scans if required This way only 1520 per cent of antigenpositive patients will be sent to health centres and hospitals Right now patients accompanied by friends and kin at labs and hospitals is a lsquofashionrsquordquo