Kolkata: A thermal screeening device checks passengers arriving in India from China including Hong Kong in view of outbreak of Novel coronavirus (CoV) in China, at an airport in Kolkata, Tuesday, Jan. 21, 2020.
While international protocol demands separate cubicles for housing suspected cases of novel coronavirus (nCoV), absence of such units has forced the state to use existing H1N1 wards in district hospitals and medical colleges as isolation wards so far. The state government is now trying to rope in private hospitals with specialised quarantine wards as reserve beds for suspected cases.
In Mumbai, talks are on with several private hospitals, including Bombay Hospital, Lilavati Hospital and Research Centre, Kokilaben Dhirubhai Ambani Hospital, to reserve a few beds, sources said.
“We have reserved two beds in our intensive care unit. These are separate cubicles and protocol for the infectious disease will be followed,” said Dr Gautam Bhansali, consultant physician at Bombay Hospital, a private facility. He added that the unit will, however, continue to admit patients suffering from other infectious diseases, as each bed is separated by glass cubicle and has separate air-conditioners to avoid mixing of infected air.
Meanwhile, talks are on with Lilavati Hospital and Research Centre in the matter. “We have the infrastructure ready. A meeting for this will be held today,” said chief operating officer Dr V Ravishankar. Hospital superintendent Dr Sitaram Gawde said Lilavati has four isolation beds.
The Kokilaben Dhirubhai Ambani Hospital too is working on logistics for reserving beds, although a hospital spokesperson said they have not officially arrived at a decision. “We may need to reserve an entire ward. Since there are already other patients admitted in a ward, the logistics need to be worked out,” the official said.
Medical superintendent Dr Vijay D’Silva said Asian Heart Institute has 12 isolation beds and are ready to reserve them for suspected cases. At Hinduja hospital, director Dr Avinash Supe said, they are awaiting BMC’s direction to reserve two isolation beds. Jaslok hospital also has three wards for isolation. The state government said they have agreed to reserve bed when required.
As per international standards, a quarantine ward — used to observe patients with suspected infectious disease and limit their contact with other patients — must have controlled airflow so that infectious particles do not travel outside. A normal air conditioner has 4-6 cycle changes of air, while one in quarantine ward will have 12-40 cycle changes. The ward must also be installed with high-efficiency particulate air (HEPA) filters for air purification, ultraviolet light, pressure isolation technique so that infection does not travel from one room to another, and ideally negative pressure in the room. It must also have an anti-chamber room where protective gear can be worn.
Infectious disease expert Dr Tanu Singhal told The Indian Express that a quarantine ward for the new strain of coronavirus must have proper ventilation if it falls short of the international standards on air conditioning and negative pressure. “The infection spreads through droplets. Care should be taken to have a separate entry and exit points for the (quarantine) ward and the rest of the hospital,” she said.
Government hospitals chosen for creating isolation wards in the state, so far, have been found lacking in air conditioning, HEPA filters and negative pressure norms. These hospitals are therefore using existing wards for quarantine facilities, sources said.
So far, five persons with the suspected infection have been admitted to Kasturba hospital in Mumbai, while five others are admitted at Naidu hospital in Pune — both official isolation centres — and another in Nanded. Three patients were released Thursday from the Mumbai hospital.
According to sources, Kasturba hospital’s isolation ward number 30, located on the second floor in a separate building, has no air-conditioning or negative pressure. However, staffers here have been trained to use protective gear. While the entry of people from outside must be prohibited, food delivery men are permitted to enter the ward at least three times every day. “I bring breakfast, lunch and dinner every day for a few patients. The hospital never asked me to wear a mask,” a waiter from Shiv Prasad hotel near Kasturba hospital, said.
When approached, infectious disease expert Dr Pravin Amle said, “Such wards should have a high degree of isolation at it is a highly contagious virus. Ideally, prevention should be taken for entry without complete protection.”
Meanwhile, in Nanded, a 49-year-old food scientist with suspected symptoms of the virus has been admitted to an existing H1N1 ward at Dr Shankarrao Chavan Government hospital. The 10-bedded ward reportedly has no separate cubicles or air-conditioning, and in fact, has windows that may lead to the infection to spread. “We are doing whatever best we can manage,” Dr Chandrakant Mhaske, the hospital dean, said.
In Nandurbar, an existing two-bedded room to be reserved for suspected coronavirus cases was earlier used for H1N1 patients. “We are yet to receive special guidelines from the state to handle patients admitted for suspected coronavirus cases. We are currently following the training given during H1N1 outbreak for health workers,” a senior Nandurbar official said.
In Beed, too, the civil hospital has no separate cubicles for infectious patients. District health officer Dr Radhakishan Pawar said safe distance is maintained between two beds to prevent cross-infection in the ward. Experts said at least 3.7 meters distance must be maintained between two beds in an isolation facility.
Officials point out that Rs 10-30 lakh is required to set up a single isolation bed, while their maintenance cost is also whopping. “The government does not have such finances to create isolation wards for diseases that occur rarely,” Dr Sadhana Tayade, director of Directorate of Health Services, said. The last infectious disease, H1N1 outbreak, was reported between 2012-13. A Severe Acute Respiratory Syndrome spread was reported in 2003 in Maharashtra.