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Opinion

Covid-19: inspection teams point to violations by private hospitals

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Private hospitals and nursing homes in the capital are unnecessarily testing Covid-19 patients admitted with mild and moderate symptoms, using therapies that are not in the Union government clinical management guidelines, and are only partially complying with infection control protocols, according to an inspection of the teams set up by the Ministry of the Interior of the Union, which has suggested a stricter surveillance in these facilities.

The teams, formed when Delhi was in its third and worst wave of infections in November, surveyed 114 private health facilities in the city on November 17 and 18. They presented the findings to the director general of health services (DGHS) at the Ministry of Health, and the report is now part of an affidavit from the Center to the Supreme Court.

The court is hearing a public interest case to assess the measures taken by the Union and state administrations to control and mitigate the Covid-19 outbreak.

“In the discharge policy prescribed by the MoHFW, only serious categories of admitted cases should be tested by RT-PCR before discharge. However, it was noted that all inspected private hospitals were testing all admitted patients with Covid-19 using the RT-PCR technique prior to discharge, ”the report said.

DGHS guidelines say that, aside from severe cases, patients with moderate or mild symptoms can be discharged after three consecutive days without fever without the need for an RT-PCR test.

Experts have previously emphasized this point, as nucleic acid tests such as RT-PCR can give a positive result if viral fragments are found. People infected with Covid-19 are generally believed to be non-infectious after 10 days.

“Most of the hospitals inspected did not comply with the Clinical Management Protocol prescribed by the MoHFW and used drugs and treatments based on the clinical judgment of respiratory physicians, general practitioners working in these hospitals,” the summary report said, citing what they said was regular. use of remdesivir and convalescent plasma therapy.

The report added that while these have been prescribed as “investigational therapy (on an experimental basis),” they were being used “routinely” by hospitals. “In addition, these hospitals were found to use favipiravir, doxycycline, azithromycin, ivermectin in many patients, despite the fact that these drugs are not prescribed in the National Protocol for Clinical Management issued by MoHFW (Ministry of Health and Family Welfare).”

According to experts, approaches to treating Covid-19 are still evolving and most therapies are experimental. “Despite the vast amount of data from around the world, there are studies saying opposite things about many therapies. In such a scenario, clinicians are guided by their clinical experience and their institution’s clinical experience on what seems to work and what doesn’t. Even the national protocol is dynamic, ”said Dr. Harsh Mahajan, senior vice president of Nathealth, an association of health care stakeholders.

“New therapies and drugs are emerging, the evidence of what works and what doesn’t is published every day. Therefore, treating physicians should have some leeway to decide what works and what does not work for their patient, ”said Dr. Arun Gupta, President of the Delhi Medical Council.

According to Dr. Samiran Panda, Director of Epidemiology and Communicable Diseases, ICMR and a member of the National Task Force (NTF) on the management of Covid-19, the guidance on plasma therapy has been changed to mention warnings, but not It has forbidden.

“ICMR has made it public that therapy is not very helpful based on the evidence we have, and our revised guidelines have been drastically modified for reference for those who wish to administer it. It has not been banned, but the dos and don’ts are clearly mentioned in the ICMR notice, “said Panda.

According to the government affidavit, the DGHS recommended a special vigil at private facilities to ensure they are screening and discharging people according to guidelines. “Similarly, to avoid misuse of drugs not recommended by the MoHFW, GOI, the issuance of a special restrictive order may be considered,” the report said, urging the Delhi government to consider appointing nodal officers to monitor the performance of all these hospitals on a day-to-day basis. Inspectors said they were satisfied with the facilities’ compliance with the government’s direction to allocate a certain percentage of ICU beds to Covid-19 patients, showing data on the occupancy of identified beds and the rate of infections among workers. Of the health.

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