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Have to deal with every patient as potential COVID case: Telangana DME

Written by Rahul V Pisharody
| Hyderabad |

Updated: June 6, 2020 6:13:15 pm

Director of Medical Education, Telangana, K Ramesh Reddy. (Photo: Twitter/ K Ramesh Reddy)

From 1,592 positive cases in Telangana on May 18, the state’s tally as of June 5 stands at 3,290. As the number of fatalities due to COVID-19 in Telangana stands at 113 as of June 5, with the 100-figure mark having breached the previous day, it is interesting to note that 79 of these deaths were reported in the last 19 days.

While 28 deaths were reported during the 60 days between March 2 and April 30, the next 17 days between May 1 and May 17 witnessed six deaths. The sudden rise in the death rate has been observed since May 18. It was around the same time, the total number of positive cases too witnessed a sudden spike.

According to the daily medical bulletin issued by the office of Director of Health and Family Welfare, relaxation of the lockdown since May 16 is the major reason behind this jump in cases and fatalities. “People are traveling across the state and some of them are not following the basic preventive measures like wearing a mask, maintaining safe physical distance, and overcrowding. There has been a surge in the number of cases since the relaxation of lockdown,” it said. However, the number of COVID tests conducted in the state remains a convenient secret with even the health minister maintaining that over 30,000 tests are conducted so far.

In a telephonic conversation with, Director of Medical Education, Telangana, K Ramesh Reddy said a majority of the mortalities are among the senior citizens and it is also the responsibility of families to safeguard their elderly from getting exposed to the virus infection. The state, meanwhile, has increased the number of beds with oxygen supply gearing up for a possible spike in cases in the coming days. Regarding more and more doctors and
medical staff testing positive for the disease, the DME said every patient reaching a hospital for any treatment should be treated as a possible COVID suspect and all due precautions should be taken. Here are the excerpts.

A sudden spike in COVID casualties has been witnessed in Telangana in the last 18 days. A majority of them are said to be senior citizens. What are the reasons?

Because of the comorbidities, they are more prone to the virus and would succumb even in case of a slight infection. The course of infection in a healthy individual is different from a diseased individual. If the viral load is very high in a healthy individual, then corona has different effects. Not only does it affect the lungs, but also blood vessels and intestines. So, multiple presentations are there for corona. We don’t know what type of effect it is causing in the elderly. Now the most dreaded one suspected is that it would clog the minor blood vessels in the lungs, and this will not allow oxygen to carry. So even if there is oxygenation of the lungs, further carrying of oxygen into the body will not occur. That is one of the bad features now.

What makes them more prone to COVID?

Anyone above the age of 60 years is vulnerable. The elderly will have some or the other disease in the body. It may be hypertension, diabetes, etc. It may not be serious. In the case of diabetes, the blood sugars will be under control but even if there is any mild infection, the blood sugars will be uncontrollable. It is a natural phenomenon. We see that routinely. So an ordinary diabetic person is affected by, for example, a urinary tract infection, then it becomes uncontrollable. That kind of feature will help the virus to propagate further inside the body. If the individual is above 65 and is hail and healthy, it may not cause any damage.

In such a scenario, what kind of steps are taken to save the lives of the elderly who are infected by the virus?

More than 50 percent of the mortalities are senior citizens. We have been telling time and again that all the elderly people should remain confined to their houses and not get exposed to the virus. It is very important. We are appealing to the family members who go out to work to isolate themselves from senior citizens because they are
very prone to the infection. A younger person in the family who goes out to work could be an asymptomatic carrier. In higher age group, they may not withstand a multi-organ failure. It is the responsibility of the family to safeguard the health of their elderly. If done properly, there will be a significant drop in mortality.

Now that you say elderly persons are at grave risk of losing their lives, is the state prepared with enough ICU beds and ventilators?

The SOP for any infected person will be the same. Depending on their other comorbidities, they would be attended to. If he has a cardiac, renal, or any other problems, those will be attended to. Once he gets infected and has renal failure, suddenly the blood serum creatinine levels will shoot. In the normal course, it would not have been damaging to him. That is why these people must be safeguarded. We have a sufficient number of ventilators which are distributed across hospitals in the state, for example, Gandhi hospital has 230, Osmania General Hospital has 85, and so on. As per international literature, ventilator care is not mandatory in many of these cases. Now they say ventilators are not required in every case. The main thing is the oxygen supply.

How is the State prepared to deal with the rising number of COVID cases?

We have made elaborate arrangements for oxygen supply and they are now being extended to districts also. In the Gandhi hospital, we have 1500 beds with oxygen supply. There are 1000 oxygen beds in TIMS, 350 at King Koti hospital, 100 at the Chest Hospital. Even in district hospitals, we are extensively laying oxygen lines. Because that is one of the mainstays of treatment in COVID cases. Even if the number of cases shoots tomorrow, at the district level and circle levels also we are providing oxygen beds for taking care of patients. The basic idea is that oxygen saturation should not fall below 95 percent. That is very critical. If it comes below and oxygen is given, slowly they will
come out of the crisis.

With more and more doctors and medical staff in non-COVID hospitals testing positive for coronavirus, there are apprehensions among the medical community. What do you have to say about that?

We have started fever clinics in all the hospitals. The basic idea is that most COVID cases present influenza-like-illnesses (ILI) symptoms along with fever. Those cases are advised to be taken to separate clinics so that they don’t mingle with other patients. That is going to be the target group. If someone has symptoms, they are admitted into the isolation ward and test them. That is how you are supposed to pick cases from society. We are doing it already. Whoever is having the suspicion, their samples are taken for testing. The next thing is that these cases come to casualty, medical OPs, pulmonology OPs, or ICUs. In these areas, adequate PPEs, N95 masks are available for a long time. So wherever needed we are asking everyone to liberally use them and take care of the staff, including the class 4 employees working there. No one should get infected. All individuals have to scrupulously follow the guidelines.

A patient coming to the cardiology or orthopedic department may not show symptoms, but could be asymptomatic. Some of the doctors infected are in these departments.

See, everyone should wear an N95 mask and we have supplied it to all staff. The MOHFW has given all the necessary guidelines. If you wear an N95, you won’t be at risk of infection. We are asking everyone at OP ward to wear face shields, too. The virus is there in society and these are the only measures we can take. And treat every patient as a potential COVID suspect. Insist on the patient wearing a mask. Mask has been made mandatory for everyone, not only a doctor. Adequate amounts of hand sanitisers are available. Ask them (patients) to clean their hands before entering inside. If all preventive measures are taken and we can cut down the infection at a significant rate.

Are you saying all patients entering a hospital for medical care to be considered as a potential COVID positive?

We should consider everyone (all patients) to be a suspected case of coronavirus and take all preventive measures. He should wear a mask, and clean hands with sanitisers. Paramedics have to wear a mask and gloves. We have given adequate masks and PPE kits to every hospital all over the state. These measures have to be followed
scrupulously. If despite that some get infected, that is a different issue. We have to take this very seriously and follow very effectively. I think hospital staff and other patients will also be protected.

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