Doctors baffled over handling of Covid-19 patients

Sumi [not real name], an anaesthetist at Kurmitola General Hospital, will probably have to work soon with coronavirus patients at the hospital's Intensive Care Unit (ICU). 

The ICU has not yet been assigned to treat such patients. But with the situation turning grim with each passing day, patients at the hospital's coronavirus corner would require ICU support, Sumi said. 

"But I have not received any training whatsoever…there have been talks going on about preparing the ICU for critical coronavirus patients by not admitting any more patients for surgery," Sumi said. 

However, there are no steps yet to prepare those who will be providing services to critical patients, she added. 

Doctors have recently been given briefs at hospitals or through videoconferencing on how to use PPE (personal protective equipment) and how to collect samples from suspected patients for testing but they are yet to receive any standardised protocol or directives to support Covid-19 patients. However, nurses and other health workers, who provide critical assistance to doctors and provide regular patient care, are entirely out of the loop.

Meanwhile, the IEDCR confirmed four new cases of coronavirus yesterday, raising the total number of infected people in the country to 48.  Two of the newly infected are doctors from Delta Medical College and Hospital. 

"Previously, we used to collect samples of only expatriates, but now as the virus is spreading alarmingly, we are collecting samples from old pneumonia patients, sick elderly citizens, and other suspected people with coronavirus symptoms, including the healthcare workers," said IEDCR Director Prof Dr Meerjady Sabrina Flora. 

This lack of training for critical medical personnel is not isolated. Doctors at the Kurmitola General Hospital's internal medicine department find themselves at a loss when it comes to managing patients on isolation beds.   

They were taught about the use of personal protective equipment only this week by IEDCR.

Learning how to use PPE is very important for healthcare providers as their safety depends on it while they treat Covid-19 patients. In an interview with a foreign media, Italian doctor Giacomo Grasselli who is coordinating the network of ICUs in the European nation said many healthcare workers in Italy had been infected in the beginning of the outbreak for failing to use the protective attire properly. 

Even though it is already late for such training, experts urge to start training with a better late than never attitude. Experts emphasise the need for immediately adopting a national policy on how to support the infected patients at the primary, secondary and tertiary levels. 

There is no such policy now, said AKM Akhtaruzzaman, chairman of the intensive care medicine department at Bangabandhu Sheikh Mujib Medical College and University (BSMMU).

He said he will follow the World Health Organisation's guidelines for providing ICU support to coronavirus patients at the BSMMU. 

Yet, training is necessary on how to operate different equipment and manage patients in a better way. 

Doctors and experts consider ICU support as tertiary-level care. 

"It is not similar to normal ICU training…we are making preparations as we will have to handle an increasing number of elderly patients requiring intensive care," Akhtaruzzaman said. 

Learning from video tutorials

While his efforts are limited to his department at the BSMMU, doctors at other public hospitals in Dhaka and the district-and tertiary-level hospitals are trying to learn from the guidelines issued by other countries and from video tutorials on the internet.

Having received two suspected patients on Monday evening,  the Sher-e-Bangla Medical College in Barisal wrote a letter to the Directorate General of Health Services (DGHS) requesting for online training for its doctors. 

No institutional training has been organised yet to prepare healthcare providers to deal with the crisis, said the hospital's director Dr Bakir Hossain on Tuesday.  "We [head of departments] had a seminar last month to share knowledge and then briefed others."  

After receiving the letter, the DGHS organised an online training for pathologists and two doctors. "They were taught how to collect samples from suspected patients and send those for tests," Bakir said yesterday. 

Dr Shailendra Nath Biswas at Khulna Medical College Hospital said doctors have not been given specific instructions on the management of Covid-19 patients. 

"We are discussing among us…we have received some online documents," he said adding that doctors in the Khulna Medical College have not been prepared for providing critical support. In that case, they will refer patients to Dhaka.  

A list of 10 doctors and four technologists have been sent from Jamalpur Civil Surgeon's office to the DG Health for training. They, in turn, will then train healthcare providers at the local level. 

As of yesterday, residential medical officers were trained on the use of PPE but the knowledge has not been shared yet, said Jamalpur Civil Surgeon Gautam Roy. 

Earlier, a daylong training programme was held at the office through videoconferencing from Dhaka before the detection of the first Covid-19 case and attended by all upazila health and family planning officers, he added.   

Among others, two doctors from Jashore Sadar and Manikganj Sadar each joined training in Dhaka organised by the IEDCR more than two weeks ago. They are yet to train upazila-level healthcare providers. 

"Separate training is not really necessary," said Manikganj Civil Surgeon Anwarul Amin Akhand, because doctors were being briefed from Dhaka. 

The district has six isolation beds at the upazila level and 15 more at Sadar upazila. 

Jashore Civil Surgeon Shaikh Abu Shahin, however, said his office will start organizing training at the local level if given orders from the higher authorities.  

The Business Standard repeatedly tried to reach Aminul Hasan, director (hospital) of the DGHS on the phone for his comments but he was not available.