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COVID-19 is a ‘work in progress’

9 May 2021 By HUBERT VAZ

Dr Rohil Raghavan, regional CEO, VPS Oman, of which Burjeel Hospital is a unit, has drawn attention to the fact that understanding and gathering information on COVID-19 is yet a continuous process the world over, with new surprises showing up every now and then in different countries.

“No one has understood COVID-19 fully, neither the medical fraternity, nor the scientists – it is still ‘work in progress’. What was said last year is not what is happening here now,” Dr Raghavan said, pointing out that the clinical diagnosis process last year was quite different from what  is seen today .The presenting symptoms of COVID-19 patients has evolved over the past year.

In the Sultanate of Oman , “If we see 15-20 COVID-19 patients in a day, only one might be in a serious state and need hospitalisation, the rest can manage with medication at home,” he pointed out.

He also clarified the misinformation that is circulating about the anti-viral drug Remdesivir, which is being wrongly mentioned by many as a ‘wonder drug’. This medicine had earlier started as  a 14-day regimen but now is usually given for five-days , he said, also stressing that it was not necessary for all COVID-19 patients as it may present with side-effects. 

Dr Raghavan disclosed that Burjeel Hospital deployed a team to visit Royal Hospital in the initial stages of the pandemic, last year,  to observe the cases and study the approach adopted by the Royal Hospital physicians for treating COVID-19 cases before setting up their own unit for treating COVID-19 patients.

In doing so, Burjeel Hospital has become one of the first hospitals in the private sector to join hands with the efforts of the government hospitals in taking up ICU cases. The hospital team has been working for this cause for over a year now and had treated thousands of COVID-19 patients till date.

“We have a lot of experiences to share, many of which are very happy stories of patients who have stayed with us for over a month and  walked out as normal patients totally rid of the disease,” Dr Raghavan said, adding that the nature of the disease has, however been changing, thereby necessitating changes in treatment approaches.

Despite concerns that taking COVID-19 patients would keep other patients away, our managing director, Dr Shamsheer Vayalil, was insistent to prepare Burjeel Hospital to wholeheartedly support the government’s fight against this virus. Hence, separate contained floors, lifts and dedicated ICUs were setup in the hospital, and in addition, a section of the nearby Muscat Holiday Hotel was taken up as a quarantine centre to increase the capacity and assist in the hospital’s operations in this regard. The team comprised an 18 member team including doctors, nurses and other staff.

Pointing out that patients currently seem to need more medication and longer hospital stays than whose admitted last year, Dr Raghavan noted that the nature of the virus has changed and as the days pass by, one has to keep monitoring the changes in the disease pattern. This is also the reason why people seem to be sourcing information of all types and speculating over it as there was no definite answer to quell many of the myths surrounding this virus, he said.

 

Incidence among younger patients

Dr Raghavan also took note of the fact that the incidence of COVID-19 has been picking up among the younger generation now, as compared to last year when mostly older patients were affected.

“Last year, senior people were more susceptible to the disease but now I suppose they have started taking more precautions. May be, that is one of the reasons why the number of cases amongst seniors are dropping while the younger generation seems to be getting infected as they are the ones going about everywhere,” he said, however, adding that a new trend was the incidence of COVID-19 among children, mostly with symptoms like gastrointestinal disorders, skin rashes as well as conjuctivitis, which is in line with the current  global trend.

The incidence among children is probably also increasing because they have become fed up of sitting at home and have started going out to play or accompanying their parents to clinics or for shopping. Dr Raghavan, however, cautioned all parents that their children’s movement outside the house should be monitored and supervised with all necessary precautions.

 

Beware of asymtomatic patients

Dr Raghavan also cautioned that a lot of asymptomatic patients are out there who do not have any symptoms of COVID-19 but could pass it on to others without realising it. Many of these come in for random testing when they come in contact with infected people and discover that they are infected, too. These are the dangerous cases which one needs to guard against and the best way to do so is by wearing masks, keeping social distance and frequently sanitisng hands, he said.

He also took note of the fact poor social distance is being maintained during  rush-hour shopping as everyone is in a hurry to finish soon and get home. One needs to have greater vigilance at shopping outlets to avoid close proximity of shoppers towards closing time, he suggested.

 

Area-wise micromanagement

Dr Raghavan was also of the opinion that micromanaging of the incidence of the disease can be done by identifying hotspots in the country, imposing a lockdown in those hotspots, and simultaneously carry out a vaccination drive in that area . 

If this is done in various parts of Oman, it will help form ‘safe zones’. Movements between ‘safe zones’ can be free and from the unvaccinated zones can be monitored. Eventually as more and more vaccinated zones are created in the country, the disease will eventually be curbed.

With regard to the vaccination drive in Oman, Dr Raghavan said procurement of vaccines is a worldwide major hurdle for speeding up the drive in all countries, including Oman. “There are actually just 3-4 centres that are supplying vaccines to the entire world, so one can imagine the difficulty the authorities are having for procurement of vaccines,” he said, suggesting that it would be helpful if, from the next procurement of vaccines, a batch is given to the private sector so that it could be provided as a ‘pay and take’ option to those seeking it.

Indicating that Oman might currently be into a second wave, Dr Raghavan said, “What has happened in India is scary, as the situation just exploded. We have also seen what has happened in UK and elsewhere. So, if we get into the second wave, we have to be prepared to handle a surge of cases. Hence, vaccination is the only solution before that happens,” he asserted.

By rule of thumb, if the health sector is unable to handle the rising number of cases, then lockdown is the only solution, he said, pointing out that the government has been constantly increasing the number of beds in all hospitals that are handling COVID-19 cases. However, if it comes to a point when all beds are full and the number of patients are still rising, then a lockdown would be inevitable.

“If people cannot follow the guidelines and maintain social distance, then it is better for them to stay at home. For how long can the health professionals handle this pressure. Everyday, they leave their homes and enter a ‘war-zone’ at their work place. We feel sorry about the plight of the ‘COVID warriors’,” he said, adding, “From the bottom of my heart, I salute them for their service.” 

Beware of asymptomatic patients

Dr Raghavan also cautioned that a lot of asymptomatic patients are out there who do not have any symptoms of COVID-19 but could pass it on to others without realising it. Many of these come in for random testing when they come in contact with infected people and discover that they are infected, too. These are the dangerous cases which one needs to guard against and the best way to do so is by wearing masks, keeping social distance and frequently sanitising hands, he said. 

He also took note of the fact poor social distance is being maintained during rush-hour shopping as everyone is in a hurry to finish soon and get home. One needs to have greater vigilance at shopping outlets to avoid close proximity of shoppers towards closing time, he suggested.

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