Dr. Jeshnu Prakash Tople:
In December 2019, corona virus, later named SARS-CoV-2 emerged in Wuhan province of China and fiercely spread across the globe affecting all the age groups of all the genders. It is now well-established fact that this virus which causes COVID-19 spreads by micro-droplets and fomites leading to rapid and uncontrolled community spread.
The mortality rate supposedly varies between 2-4% across the globe. But what is scarier with respect to the spread of virus is large number of the affected populations are the asymptomatic carriers. And testing for SARS-CoV-2 is usually done only for patients with symptoms of COVID-19 and the close contacts of COVID-19 patients. One may not know about own incidental exposure to positive patient rendering this new asymptomatic carrier the unknown threat for spread of the virus. Moreover there is no uniformity between the states and even between the districts of same state for the testing guidelines for COVID-19 patients. Also, though illegal during the period of lockdown, many people were travelling from one district to another, from one state to the other without permission from the statutory authority, without even following norms of social distancing and quarantine.
Considering all the obstacles and loopholes in managing this COVID-19 pandemic, there is constant and increasing risk to healthcare workers of getting exposed to this virus and pain physicians are no exception. On top of that, it has been observed that not all the patients are tested prior to the interventional procedures or surgeries; reasons may be varied such as lack of facilities, financial constraint, etc.
We, the pain physicians have to accept this situation as new normal and there is a critical need to modify our day-to-day pain medicine practice. There are guidelines and recommendations put forth by various academic bodies across various specialties of medicine to manage the patients during this pandemic. We have published the guidelines for pain physicians and readers are encouraged to read the same- https://www.jorapain.com/doi/JORAPAIN/pdf/10.5005/jp-journals-10046-0161.
These guidelines are for the management during pandemic. However considering the current status of SARS-CoV-2 spread, it is unsurprising that we have to accept the situation as the new normal and it is need of an hour to modify our medical practice accordingly. We have the following recommendations apart from those stated in the article mentioned above.
- The wide use of telemedicine consultation should be adopted. The ban on the use of telemedicine has been nullified. Telemedicine can be offered in the form of text, audio-calls or videoconferencing. This can be effectively used especially for follow-up patients. Guidelines for telemedicine have been put forth by Govt. of India. For details, readers can refer it. https://www.mohfw.gov.in/pdf/Telemedicine.pdf
- Screening of all the patients, preferably at the entrance of a hospital or clinic should be done. This can be done by a paramedic.
- Isolation or a separate consultation room should be preferred for suspected and positive patients.
- Consultation for positive patients should be weighed on risk-benefit ratio.
- All the patients must use face masks.
- Personal protective equipment should be used for all the patients during consultation. At least use of N95 or similar masks, face shield, gloves, and disposable paper or plastic aprons must be the minimum.
- Disinfection of the hospital or clinic should be done on regular basis.
- All the consultations should be strictly by appointment to avoid overcrowding and to follow social distancing norms.
- Consultation of isolation ward patients must be done with the use of all personal protective equipment.
- Interventional procedures should preferably be done after testing for COVID-19 irrespective of the presence or absence of the symptoms. We are of the opinion that like HIV, HBsAg, and HCV testing, COVID-19 testing should be made mandatory for all the patients planned for any interventional procedure.
- Washing and disinfection of personal clothes of all the healthcare workers should be done daily.
To conclude, there is no choice than accepting this situation as the new normal and it is for the betterment of health care workers and society that we should adapt medical practice as per this new normal situation.