Patients without fever or not requiring oxygen support for three days at a stretch will be considered “fit for discharge”, experts overseeing Covid management told state-run medical colleges and hospitals on Monday.
Patients will have to be assessed to see if they need to be admitted to ICUs depending on their oxygen saturation levels. If a patient is responsive, he or she can be treated in a general ward without being shifted to a HDU or an ICU, experts said while laying down a new protocol for treating Covid patients after interacting with senior doctors and officials of state-run tertiary and secondary healthcare institutions.
“The new protocol specifies which Covid patient will be admitted where — either to an ICU, ITU or a Covid ward and how doctors need to assess the requirement,” said Gopal Krishna Dhali, the chairman of the five-member Covid management committee set up by the health department.
“If, for instance, a patient’s oxygen saturation is below 94 per cent he or she can be subjected to 10 litres of oxygen (supply per minute) in a Covid ward instead of an ICU. He or she may be shifted to a HDU (high dependency unit) if the saturation level doesn’t improve. But there is no need to directly admit him or her to an ICU.”
Over the last two weeks, health department officials have observed that a section of patients with mild infection and low oxygen saturation levels were being wheeled directly into ICUs across state and private healthcare facilities.
In most cases, there has been no step-down from ICUs to either HDUs or general wards, health department officials observed while monitoring the condition of Covid patients in hospitals. The tendency has robbed genuine patients from a slot in the ICUs, officials said.
“At RG Kar Medical College and Hospital, for instance, moderately critical patients have been admitted to ICUs when they could have been treated in wards, which are equipped with ventilators,” said a senior official at Swasthya Bhavan. “There has been a general tendency to create hype and avoid responsibilities.”
The expert committee on Monday told hospitals and medical colleges that there was no need to defer surgeries on the pretext of rising Covid cases. Officials were advised to go ahead with emergency operations after taking “due care”.
“Elective surgeries can be deferred but not ones that require immediate intervention,” said a committee member.
The new protocol stresses intensive monitoring of high-risk patients at hospitals including senior citizens with co-morbidities and those undergoing chemotherapy for cancer.
Experts have suggested that such patients should be checked at least four times a day. Any deterioration of their condition will have to be immediately attended to.
“Monitoring doesn’t mean prescribing costly anti-viral medicines or similar drugs. A keen eye on the parametres and necessary intervention can bring about positive changes,” Dhali said.