Why Are Hospitals Insisting on Testing All Patients for COVID-19?
Why is it so important for tests to be conducted for patients needing admission or treatment for non-COVID services?
Why are doctors prescribing COVID-19 tests for patients coming in for non-COVID services?
When the Delhi government decided to only test symptomatic people for COVID-19, medical practitioners reacted with extreme apprehension. While this policy would have had some obvious and direct outcomes for COVID containment, it would also have greatly affected access to non-COVID health facilities for patients requiring these other services.
Even though the Delhi Lt Governor Anil Baijal overturned the government’s revised order, this whole debate raised some important questions: How does a restricted testing policy affect non-COVID services?
Why Are Hospitals Insisting for COVID Tests for All?
In an interview with FIT, Dr Naresh Trehan, chairman and managing director of Medanta-The Medicity spoke about opening up hospitals for elective surgeries and why that would need for patients to be tested for COVID-19.
He said, “Nobody knows who could be a silent carrier of the disease. If you don’t know that, there is no fool-proof way of protecting yourself and others from the virus. So, it is for the protection of everybody that this protocol has been made.”
“When patients come in, we put them in a yellow zone. If they are not tested already, they are put in individual rooms and we conduct tests right away. We are finding faster ways of doing it so that they are not inconvenienced. As soon as they test negative, we shift them to the regular wards and carry on with the procedure. Yes, it could be a little bit of a stretch for people, but at the same time, it is for their safety.”Dr Naresh Trehan
Notably, such a protocol is not applicable for emergency services and treatments; those patients would have to be attended to immediately without waiting for a COVID test.
But for elective surgeries - surgeries which can be scheduled in advance but are not necessarily optional - doctors consider a test important. In fact, it has been estimated that worldwide, around 28.4 million elective operations were cancelled due to disruption caused by COVID-19. This could either have been due to converting hospitals into full-fledged COVID designated facilities, or because of unavailability of sufficient tests, or because of the underlying risk of performing surgeries on COVID-positive patients; which brings us to the next crucial argument.
COVID-19 Patients At Higher Risk of Dying From Any Surgery: The Lancet
COVID-19 patients may be at a higher risk of dying if they undergo any surgery - even minor or elective surgery.
This finding came from a new global study published in The Lancet on the risks of postoperative death for COVID-19 patients by experts at the University of Birmingham-led NIHR Global Research Health Unit on Global Surgery who examined data for 1,128 patients from 235 hospitals.
“We would normally expect mortality for patients having minor or elective surgery to be under 1%, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%). In fact, these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.”Aneel Bhangu, Report co-author and Senior Lecturer in Surgery at the University of Birmingham
What does this imply? If patients are operated upon without knowing their COVID status, those who are, indeed, positive, would have been put at a 20% higher risk of death.
Dr Sushant Wadhera, Advanced Laparoscopic and Bariatric surgeon in Delhi, had written a letter to the Delhi government to highlight this issue. Till the time of writing this report, he had not received a response. Speaking to FIT, he said, “It feels like the government is doing this to suppress the numbers.”
“If you cannot test a patient for COVID, you can’t conduct any surgery on them, no matter how minor. We had webinars with international surgeons on the issue, and found out there were cases of routine surgeries like hysterectomy and gall bladder removal, where patients had not been tested for COVID. X-rays conducted before the procedures showed everything was normal. Within a week of the operation, they died. They were later found to be COVID positive.”Dr Sushant Wadhera
Remember, for a routine surgery like a gall bladder removal, the risk is as low as 0.01%, which multiplies significantly for a COVID patient. “Now if I do not know your COVID status, I will not take the risk.”
Why the Surgeries Cannot be Delayed Indefinitely
Around 505,800 non-emergency surgeries, 51,100 cancer surgeries, and 27,700 obstetric surgeries could have been delayed across India during the three-month period before and after the peak of the viral outbreak, Mint reported on May 18, 2020.
The number of operations cancelled in India is estimated at 48,728 per week or about 585,000 over 12 weeks, as per a report published in the British Journal of Surgery on May 12, 2020.
Dr Sushant Wadhera said that at the beginning of the coronavirus outbreak in India, it was understandable to postpone elective surgeries as mass-testing may not have been possible then. “But after three months, that reason is simply inexcusable.”
“For how long can we keep delaying the surgeries? We don’t know when this outbreak will subside. If the patient is in pain, and it is impacting their quality of life and daily work, we can’t make them wait indefinitely. We cannot play with people’s lives. Instead of ramping up testing, the government is firing private labs and hospitals for testing asymptomatic patients.”Dr Sushant Wadhera
“Moreover, it needs to be understood that a COVID-positive patient is a risk for all lives working around him/her. The surgeon, the surgical staff and every other person in the operation theatre.”
He adds that for emergency procedures that cannot be denied right now, an entire safety protocol has to be followed by the staff. They need to wear the full PPE gear, the Operation Theatre is sealed for a day, and the attendants should ideally go into quarantine and get tested.
“When we do surgeries even normally, we take universal precautions like wearing our gloves and gowns. But when we are operating on coronavirus patients, that is not enough. Now if you say we should treat everybody as a COVID positive patient, do you realise the amount of strain it will put on an already overburdened health infrastructure? Who will bear the cost? It will again fall on the poor patient.”Dr Sushant Wadhera
He added that as the country opens up, people would want to get on with their lives. “It is their right to get treated for whatever pain they are suffering from. If anything obstructs that, it needs to be reconsidered. Some of these health problems are progressive, i.e. they worsen with time. Not treating them soon can reduce a person’s chances of survival in the longer run as well. Testing must be allowed, and smaller and medium-sized hospitals must be made available for non-COVID services. This is not the only disease we are dealing with. For COVID, the formula is simple: Test more, save more.”
(With inputs from IndiaSpend)
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