Lots of doctors died last week due to COVID. Why??

Latest official data says that more than 87,000 healthcare workers have been infected with 573 dead; 74% cases from six states Maharashtra, Karnataka, Tamil Nadu, Delhi, West Bengal and Gujrat. But other states which catches the speed late, now heading towards the same trend.

IMA says that while an increasing number of doctors are getting infected and losing their lives every day, substantial number of them have been found to be general practitioners.

As significant proportion of the population consult general practitioner due to fever and its related symptoms, they remain the first point of contact as well as care.

But worldwide trend shows that physicians from almost all specialties have died from COVID-19. The majority of physicians that died from COVID-19 were of older age.

CME INDIA discussed it. Few comments are worth pondering:

Dr Ambrish Mithal, DM Endo, Delhi: In my observation, serious disease seems to be hitting non-frontline workers more than actual covid teams. Could it be that the frontline uses all protective gear while others don’t? Please correct me if I am wrong.

Dr Meena Chhabra, Diabetologist, Delhi:  Absolutely. You are correct sir!

Dr Pd Gokhale, Jamshedpur: I think that is plausible explanation. Because, those working in war zone, take PPE seriously whereas others take it rather lightly paying heavy price

Dr Prabhat Agarwal, Agra: Sir in our centre, only those residents became positive, who are working in non covid areas.

Dr Vinod Mittal, Diabetologist, Delhi: Right, Non Covid19 HCW have a false sense of security and don’t take it seriously.

Dr Meena Chhabra, Delhi:  Particularly in duty rooms and consultant’s common rooms no masks, no distancing, talking and drinking tea coffee.

Dr Raju Sharma, Jamshedpur: So paediatricians who are not really seeing COVID patients and OBGs should take extra and usual precautions.

Dr Vijay Arora Phy Max hosp., Delhi:  Absolutely sir, it has been three months now taking daily rounds of COVID pts (25-27) with full gears …with the grace of God & taking all precautions have saved till now … but the scare of getting sick is still there. Now have admitted 5 of our icu consultants in last two weeks, four of them went home after a stay of 10-11 days (CORAD-5) all of them, 5th one was little more sicker.. CORAD-6 doing

Dr Gajanan Repal, DNB general medicine, Dharwad, Karnataka: Sir here also, we medicine PG and professors working in covid area take best possible proper PPE and we are getting No covid PG friends positive… I think we are safer than non covid area….. it’s my opinion….

Dr Swati Srivastava, Jaipur: Absolutely true Sir. Also, there are greater chances of getting infected in the marketplace than in the hospital, I think, because we are always secured in N95 in the hospitals whereas elsewhere we tend to be more casual.

Dr N. K. Singh: Lesson of the day.

We would like the share a post from Dr Gangadhar Gundapu, Pediatrician:

Why paediatricians are more affected by Covid19? Tips for paediatricians in Corona pandemic.

As we are now witnessing that there is a constant rise of number of paediatricians affected with Covid 19 infection. With much pain and grief, we have to admit that many of them who were infected with Covid succumb to the illness.

This made us think about doing study on following questions.

  1. Why is it so common in paediatricians?
  2. How does it spread among Paediatricians?
  3. What could be done to prevent it?

Below, we have pointed out probable cause of spread of COVID infection in paediatricians. This will help them all in focusing over areas of precautions, what they need to take.

(1) Feeling of false security:

  • This is because of a false belief that children are very less prone to get infected with Covid-19.
  • It was said that to have very low incidence of this infection.
  • This false belief was based upon one fact that symptoms in Covid in children are entirely same as any other cough, cold and diarrhea.
  • So, it is very difficult to suspect.
  • So, paediatricians often take these symptoms lightly and get infection.

(2) Why children are worrisome?

  • It is seen that infected children are either asymptomatic, mildly symptomatic or having atypical symptoms. So paediatricians become less careful in protection or may have complacent attitude.
  • It is also seen that children have high viral load (10-100 times) in their naso pharynx as compared to adults.

(3) Buy one get one scheme:

  • Children are the patients who are closely accompanied by their care taker.
  • So many times, accompanying person, his/her father or mother or both could be spreaders. So, when they are in your chamber for consultation, you have buy one, get one scheme applicable and you become more prone to catch infection.

(4) Difficulty in examination of children faced by paediatricians:

  • For examining a paedia patients, a paediatricians has to examine them very closely.
  • Moreover, children are continuously busy with coughing and crying. So more droplet production.
  • Third one, children are seen very less comfortable with masks. So most of time keep their face uncovered. Sum total of these three factors cause a great rise in possibility of a paediatricians getting infected.

(5) Paediatricians can indirectly get infected from the child:

When children are in consulting chamber, paediatricians give their PEN, STETHOSCOPE, TOY KEPT ON TABLE to patient to play while they are examining them. So, indirect contact with coronavirus in the affected area can takes place.

(6) Some other factors:

  • Each child needs weighing. So, fomite.
  • History of positive case in family not revealed.
  • Now in next coming session, we will throw light over precautions and measures for prevention to be taken by paediatricians to make themselves safe
  • It is always told that prevention is better than cure.
  • So, following this old proven fact, we are aimed at suggesting some steps that may help to prevent spread of infection to paediatricians.

So based upon close observations, we have identified two areas from where paediatricians can easily get infected.

  • Paediatricians own OPD set up
  • During LSCS call at an Obs & Gyenc Hospital

So, discussing about OPD area, we have come with a suggestion to separate paedia patients into following main 3 groups and accordingly management should also be carried out.

They are respectively:

  1. Vaccination OPD
  2. Well baby OPD
  3. Sick baby OPD

So now discussing each OPD separately.

  1. Vaccination: These pts come to the hospital for sole purpose of vaccination. These babies are having almost zero percent possibility of spreading infection to paediatricians. So, this type of patients should be separated from other two groups.
  2. Well baby: This is the class of patients who are Afebrile, Routine follow up pts or pts without any respiratory symptoms.
  3. Sick baby: This class includes all other patients apart from the above mentioned class and with symptoms like Fever, Cough, cold (respiratory symptoms) or any serious illness.

Moreover, OPD timings for these three class of patients should also be separated. Preferably:

  • Vaccination in morning sessions
  • Well baby after finish of vaccination with an interval of half an hour.
  • Sick baby should be called in afternoon session.
  • So, after finishing OPD, in late evening or late night, you can clean OPD area and leave it overnight. So, preparing healthy for next day vaccination babies.

Mask etiquette:

For children above 2 years’ age:

  • This group, children should be encouraged to put on mask. In market many colourful paediatric mask are available with pictures of their favourite cartoon character on them which the child will love to wear. This will help in developing mask etiquette in the children for future also.
  • Apart from this, there is a common problem with almost all babies that they don’t keep their nose and mouth covered.
  • You can make children above 3-4 years to put mask properly.

For children below 2 years’ age:

  • Unmonitored use of Masks is not recommended in this age group due to risk of choking, but at the same time use of mask under supervision of parents or the paediatrician can be recommended even in this age group for a brief period say during close examination.
  • So, you can make them put on a mask, or a face shield which comes with hat.
  • This will not only make them happy but also relieve stress of accompanying person.

Precautions during LSCS at Obs & Gynec Hospital:

In OT during LSCS:

  • If mother is COVID POSITIVE, then we should wear full PPE KIT.
  • if COVID STATUS is unknown even then also, we have to be careful and ideally need to wear PPE
  • Paediatricians have tendency to go very near to mother to recieve baby from gynaecologist and chances of spillage of amniotic fluid is there better to recieve baby in other room
  • Avoid going near to mother
  • Need to be very careful in OT as most of us are under impression that neonates don’t spread and we are protected but we can get infection from mother or relatives
  • Ideally, obstetrician should be encouraged to get the Covid test of the pregnant patient done within 24 hours of planned LSCS.
  • For emergency LSCS at least rapid antigen test should be done prior to surgery.

Paediatricians should avoid to go to OT:

  • Near the pregnant lady.
  • And avoid directly receiving the baby because amniotic fluid can have high amount of virus if the patient is having Covid.
  • Ideally, only receive the baby in separate room from hospital staff.
  • All above measures will minimise the risk of infection to the Paediatricians but don’t forget the importance of Universal Precautions.
  • Use of Appropriate Mask and optimal PPE.
  • Hand hygiene.
  • Physical distancing.
  • Visitors restriction.
  • Cough etiquette.
  • Importance of sanitization & disinfection.

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