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Covid: experts suggest early discharge of stable patients to ease burden on hospitals – delhi news


New Delhi: With coronavirus (Covid-19) hospitalizations on the rise in Delhi, experts from the Indian Institute of Medical Sciences (AIIMS) have suggested early discharge of stable patients who can then continue home isolation.

Doctors from AIIMS, the Postgraduate Institute of Medical Sciences-Rohtak and the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow participated in a discussion on the protocols to follow for home isolation during the National Grand Rounds, a virtual platform for Doctors across the country discuss the challenges at Covid-Care.

“In one of the cases presented, the patient was discharged shortly after stabilization. In places like Delhi where the caseload is high, this is a policy that we are looking at more aggressively. This will reduce the burden on hospitals and home isolation will continue as an extension of the hospital service, ”said Dr. Randeep Guleria, director of AIIMS. However, he cautioned that these patients should carefully monitor their signs and symptoms, as there is a possibility that they will be rushed back to hospitals with a cytokine storm.

Cytokine storm is a condition in which the body’s immune system speeds up and begins attacking its own tissues and organs.

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The case referred to by Dr. Guleria was that of a 53-year-old man with controlled diabetes, who had to be admitted to the hospital because his oxygen saturation had dropped to 93%. Normal oxygen saturation is between 95 and 100%.

The patient received low-flow oxygen and steroids and was stabilized within 72 hours. As she did not present any other symptoms, home isolation was recommended.

Currently, almost 60% of all active cases or those with the infection in Delhi are in home isolation, 20% admitted to hospitals, and the rest, who did not have adequate isolation facilities, are in care centers. of Covid.

The experts’ suggestion was proposed a day after the union’s Health Ministry announced that home isolation in Delhi will be increased to support between 35,000 and 40,000 people. “The support system needed for patients in home isolation (telemedicine support, pulse oximeter, etc.) will increase, as the number of active cases could increase in the future,” said NITI member Dr. VK Paul Aayog, during a press conference on Tuesday.

He also said that Delhi had dramatically improved when it came to early admissions of patients in need of hospital care. “Initially, when the pandemic began, until approximately June, between 60 and 70% of deaths in hospitals occurred within the first 72 hours. Half of these deaths occurred within the first 24 hours after admission. In Delhi, there has been a dramatic change since then, ”said Dr. Paul.

The need for close surveillance and timely transfer to hospital was demonstrated in another case presented during the big rounds. A 43-year-old man with no comorbidities who was in home isolation noticed that his oxygen saturation had dropped to 86% on the sixth day of symptoms. He had what is called happy hypoxia, in which patients have no apparent dyspnea despite low oxygen saturation. At the hospital, doctors discovered that he had a pulmonary embolism, a clot that blocks the blood vessels in the lungs. The condition can be fatal if it is not treated in a timely manner.

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Patients in home isolation should rush to a hospital if they have any shortness of breath, decreased oxygen saturation, persistent chest pain or pressure, confusion, slurred speech, weakness or numbness or bluish discolorations, the doctors said.

Doctors also added that the antiviral drug Remdesivir should not be given to patients in home isolation. Doctors advised that drugs such as the antimalarial hydroxychloroquine, antiparasitic ivermectin, and antiviral favipiravir, which are believed to prevent viral replication, should be administered with caution.

“Remdesivir should not be given to patients in home isolation because it can lead to various complications, such as kidney or liver damage. Unfortunately, it has become common practice among medical professionals in smaller cities. Many prescribe all three (hydroxychloroquine, ivermectin, and favipiravir) together and sometimes along with steroids. This will do more harm than good, ”said Dr. Dhruv Chaudhary, chief of pulmonary medicine and critical care at PGIMS Rohtak.

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