KARACHI: There is an immediate need to enhance and strengthen admission and intensive care capacity for Covid-19 patients at hospitals as there has been a surge in cases with severe illness recently, which indicates that the epidemic is likely to enter its peak phase within next two to three weeks.

This was stated by experts at the Sindh Institute of Urology and Transplantation (SIUT) during a conversation with Dawn on Thursday.

The institute has been running a coronavirus clinic since March 18. So far, 287 people have tested positive out of the 4,596 screened at the clinic.

Currently, according to experts, positive cases constitute about 20 to 25 per cent of the total cases (150 to 200) being reported daily. Seven patients have died of Covid-19 till now.

“There has been an increase in the number of positive cases. More patients are now [also] reporting with severe illness. This pattern suggests that the next two to three weeks are crucial when the epidemic peaks,” said Dr Sunil Dodani, head of the infectious diseases department at SIUT.

SIUT reports increase in positive cases, disease severity

Over the last few days, 15 patients had been admitted to the hospital with at least three patients requiring observation in the intensive care unit, he added.

Citing increasing referrals of coronavirus cases to SIUT, he said the designated Covid-19 treatment facilities were running out of space and there was an immediate need to prepare more hospitals to admit and treat Covid-19 cases.

Asked about the number of dialysis patients reporting with Covid-19 infection, he said while only three patients registered with SIUT for dialysis had so far reported with the infection, three such cases were referred to the institute from other healthcare facilities.

“The healthcare facilities on which these patients had been relying on for dialysis simply refused to continue the life-saving procedure after they contracted coronavirus.

“Also, we received a referred thalassaemia patient who was denied blood transfusion at a centre on the excuse that the procedure would contaminate their machines with the virus,” he said.

Fear factor

Explaining how the institute manages coronavirus patients also requiring other life-saving procedures such as blood transfusion and dialysis, he said Covid-19 was not a blood-borne infection and only transmitted to humans through respiratory droplets.

“Healthcare providers are too scared to handle a coronavirus case. At SIUT, we ensure that the staff managing such patients wears the protective gear and later the surfaces the patient may have touched are disinfected,” he said, underscoring the need for creating more awareness and equipping healthcare workers with training and protective gear.

Pointing to some other challenges, Dr Jawahar Lal, senior internal medicine specialist at the coronavirus clinic, said that perhaps the most unfortunate part of the public health crisis was denial of treatment to non-Covid-19 patients at hospitals, suspecting that these patients may have developed coronavirus.

“They are asked to get a coronavirus test done first, which are currently being offered only at government-designated centres. So, non-Covid-19 patients suffer a lot as these facilities only carry out the test if the patient is experiencing clinical symptoms.

“Second, an urgent coronavirus test report at least takes a day whereas a routine report is not possible before 36 hours,” he pointed out.

According to Dr Lal, it’s not just private hospitals denying treatment to (suspected) non-Covid-19 patients but also some government hospitals where the staff just need to wear protective gear (a face mask and gloves) to take their medical history and prescribed medicines.

Dr Lal emphasised the need for public awareness and individual responsibility and said the government was doing its bit and it’s time people demonstrate civilised and responsible behaviour.

Sharing some suggestions, he said: “It should be mandatory to wear a face mask for people going out of their homes. Enforce social distancing through the police and Rangers particularly at shops. Patients who have been advised ‘home isolation’ must adhere to the medical guidelines.”

Responding to a question about disease fatality, he said the fatality rate of Covid-19 in Pakistan was less as compared to other countries but right now there was no scientific explanation for this pattern.

“Virologists studying virus strains and behaviour can comment on that.”

‘Half-hearted lockdown’

According to Dr Naqi Zafar, in charge of SIUT laboratory, around 200 patients are daily reporting for screening at the coronavirus clinic these days.

“Positive cases now constitute about 20 to 25 per cent of the total cases being reported daily. Earlier, the majority of patients had mild disease but now more patients are reporting with shortness of breath, high-grade fever and body aches.”

The institute’s data shows that 43pc cases involved people between the age of 30 and 50 years whereas slightly over 31pc involved patients above 50.

People with underlying medical complications such as diabetes, lung disease, heart problems, cancer and high blood pressure have a higher risk for disease severity and fatality.

Asked about the rise in cases of local transmission, Prof Fazal Akhtar, focal person of the coronavirus clinic, said it was directly linked to the “half-hearted enforcement of the lockdown”.

“Perhaps a strict enforcement of the lockdown would have increased our economic hardships. But, we have to be very cautious as cases with severe illness are on the rise. The lockdown has already been eased before the arrival of Ramazan, which would increase public interaction and likelihood of disease transmission.”

Published in Dawn, April 24th, 2020