When taking the history of a patient suspected to have COVID-19, doctors ask about their recent travel history and whether they have had contact with a confirmed coronavirus case. They also assess the person for any underlying conditions such as diabetes or heart disease that might put them at greater risk.
Now they’ve added a new comorbid: whether the person goes to the mosque to pray. With Ramazan approaching and the government deciding to keep mosques and imam bargahs open, medical professionals fear a drastic increase in cases.
“We got more sick patients this week and the same is predicted for the next week,” Dr Saima Salman, consultant physician at the Emergency Room in Indus Hospital, told SAMAA Digital Friday.
While screening patients, she said, the hospital now also asks them whether they attend congregational prayers.
At the time when SAMAA Digital spoke to Dr Salman, the government’s decision regarding mosques hadn’t been announced. But hospitals had already started seeing a rise in the number of critically ill patients.
“Four to five days ago the number of critical and dead on arrival cases started increasing,” said a doctor in the respiratory unit at the ER in Jinnah Hospital. “Earlier we didn’t have serious patients coming in. Now we see at least seven to eight critical patients per day,” the doctor said. “I think relaxing the lockdown is a misguided decision.”
Earlier during the day, an English daily The News reported that “more than 300 such patients have been brought to different public and private hospitals in the past 15 days.”
JPMC’s ER doctor told SAMAA Digital on Wednesday that he had seen one such case during his shift that day. A 60-year-old woman was brought to the ER dead on arrival. The doctors suspected diabetic ketoacidosis, a life-threatening complication of diabetes where acids build up in the blood, but the patient’s chest X-Ray showed pneumonia.
Two critically ill patients were also shifted to isolation wards afterwards as a precaution. However, the deceased woman was not tested for COVID-19, neither was a history taken. The standard procedure for such cases was to perform an ECG and declare death, the doctor explained.
“We’re doing chest x-rays now,” the doctor said. “If there’s a picture of ARDS or pneumonia then we notify authorities.”
He said he earlier thought the situation in Pakistan seemed controlled. There wasn’t a massive influx of patients and dying in hospitals like in the US, where the highest reported one-day death toll surpassed 2,000 on April 7.
“I know people are saying it’s because we’re testing less but hospitals would still be overcrowded with people dying which wasn’t the case,” he warned. “From here onwards I think the situation can rapidly deteriorate and we won’t be able to handle it.”
The same sentiments were echoed by Dr Salman who said a catastrophe could only be prevented if the lockdown continued. “Please cooperate with police and doctors, what we’re telling you is for your best.”
She said Indus was taking swabs for COVID-19 investigation of patients who were dead on arrival if they were considered a suspected case.
The current definition of suspected cases is given on the hospital’s website. Tier 1 cases are always tested and these include patients with cough, fever and shortness of breath who have these points in their history:
• International travel in the last 14 days
• Household contact with an asymptomatic international traveler
• Close or household contact with a confirmed or probable COVID-19 patient
• Engaged in public dealing e.g. bank teller, general physician
• Attended a large religious or social gathering recently
• Healthcare worker involved in the care of a confirmed COVID-19 patient
• Healthcare worker involved in the care of a patient with pneumonia of unspecified origin
• Healthcare worker working at a point of entry like outpatient department, emergency, reception/registration counters
• Caregiver of a person with pneumonia of unspecified origin
Tier 2 cases are only tested if the doctor thinks it’s necessary. These patients usually have a history of:
• Intercity travel in the last 14 days
• Close or household contact with an asymptomatic domestic traveler
• Daily or very frequent use of public transport associated with crowding
There are two respiratory teams working in the ER, Dr Salman said. One deals exclusively with COVID-19. “All our shifts are occupied in dealing with this and I urge people not to take it as a joke.”
She said patients were not serious about the threat of the virus as she narrated the case of one woman who had tested positive and was advised self-isolation, but used public transport and visited the hospital.
Some young men were also treating the pandemic as a challenge to prove their bravery. The ER doctor at JPMC said these boys would come in to take selfies with the corona posters and tell people on social media that they were getting tested.
Others would come to the hospital to get their tests done randomly.
“In the ER you never know who is positive. Some patients lie about their symptoms and travel history,” said a surgery resident at the Aga Khan University Hospital, whose team member had tested positive for COVID-19.
The doctor and the entire team had to be quarantined. She was talking on her 14th day of isolation and told SAMAA Digital she hoped they would be called back to work.
At the start of the epidemic in Pakistan surgery residents weren’t given personal protective equipment because medicine teams were dealing with COVID-19 patients, who had been isolated far away from other patients, the doctor explained.
Thus, the AKU team had not been able to figure out where exactly the infected resident acquired the virus from. The most likely cause was contact exposure to an asymptomatic patient in the ER.
A source in the WHO confirmed to SAMAA Digital on April 9 that 84 healthcare workers were infected by the virus in Sindh. As many as 138 HCWs across the country had been affected.
“Doctors in Pakistan are used to working in poor conditions with lack of resources,” said Dr Abeer Farooqui of Patel Hospital. “We have always been exposed to diseases like TB, hepatitis B/C and HIV and have never backed off, but this time our families and the patients we assess are at risk.”
Dr Farooqui also warned that the country’s healthcare system, which gets overwhelmed every summer by preventable diseases such as malaria, dengue and typhoid, would not be able to handle a sudden influx of COVID-19 patients.