|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 73-74
Learning from case – Sheet of a COVID-19 ward
Harish Gupta, Ajay Kumar, Satish Kumar, Amit Kumar
Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
|Date of Submission||11-Aug-2021|
|Date of Decision||06-Sep-2021|
|Date of Acceptance||06-Sep-2021|
|Date of Web Publication||29-Nov-2021|
KG's Medical University, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta H, Kumar A, Kumar S, Kumar A. Learning from case – Sheet of a COVID-19 ward. Saudi Crit Care J 2021;5:73-4
“This amazing spirit of human solidarity must become even more infectious than the #coronavirus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before.”
-World Health Organization. March 16, 2020.
Dubey et al. share their experience at their tertiary care center in preparing a COVID isolation ward from scratch in their well-written article in July – September 2021 issue of the Journal. They mention their preparations, challenges faced in the brave journey, their untiring efforts to overcome them, and also narrate concerns about fellow health care workers. Moreover, they touch a sensitive issue of doctor-patient communication when several aspects of the scourge remain to be explored and we sorely need to find a few novel drugs to treat the disease and improve the prognosis of admitted patients. Nevertheless, there are a few additional points which need to be taken into account when we went through the letter.
Under a heading of “Equipment,” the authors write that isolation intensive care units (for COVID-19 patients) should have a provision of a negative pressure system to prevent airborne transmission of the virus. Thereafter, they elaborate that, they went with their existing system. What needs to be emphasized here is that as the novel coronavirus is airborne, exhaled air of occupants of the ward needs to be separated from other persons to stop the transmission chain. And for this purpose, exhaust fans come handy which pull air from the red zone, where the patients are housed, and blow that one outward in that direction where no one is there. The World Health Organization highlights this instruction on its webpage. Hence even when full preparation for the purpose may not be there due to paucity of time and there is a pressure to provide the most essential services rather than the best (ones), strategically installing a few exhaust fans is a cost and labor-saving measure which can to be put in place without any specialized engineering support.
Then, the authors underscore that a patient information chart was prepared to record the brief details of the illness and treatment provided. Therein they mention various pieces of information which are jotted there and sometimes shared with the attendants. We went through the chart and found comorbidities as a heading there. Here, we want to mention that diabetes is a comorbidity which is associated in many ways with the development of complications, admissions, and mortality with the Covid-19 and this one should be assessed in each patient at the time of admission, and afterward.
Rubino et al. highlight that there is a bidirectional relationship between COVID-19 and diabetes. Mrigpuri et al. discover that uncontrolled diabetes mellitus is a risk factor for post COVID fibrosis. Therefore, we need to record if diabetic patients were having their blood sugar under control and which medicines were they consuming to do so; as it may have a bearing on their medical outcome when undergoing treatment. Also, corticosteroids improve mortality figures in severe COVID patients when they are on ventilator, and to some extent when they are on oxygen therapy. As these drugs are known to cause elevation in blood sugar profile, an eye should be kept specifically on such patients and regularly recorded in daily charts. What we need to realize is that preexisting high blood sugar level may indicate poor quality care, during admission may indicate deranged metabolic profile, and sometimes the derangement may persist afterward either due to the effect of drugs or due to intrinsic medical conditions. In either case scenario, good quality sugar control is known to improve prognosis, reduce complications with duration of hospital stay, and needs to be followed up after discharge in some cases as well.
As hundreds of millions of cases have been diagnosed until now and we do not yet know that how many more will be diagnosed in future, even if a small proportion of them turn into post-COVID sequelae or post-COVID syndrome or postacute complications; it will massively strain our health care system and we need to keep an eye on this development when we are visiting COVID ward. It's for this reason that the patient charts should include the assessment of preexisting cardiac, pulmonary, kidney, liver, immunosuppressive diseases if any, and vaccination status so as to guide us in their management.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Dubey PK, Gopal K, Kumar S, Akhileshwar. The second wave of COVID-19: Rapid establishment of an isolation unit at a tertiary care setup in India. Saudi Crit Care J 2021;5:55-7. [Full text]
Rubino F, Amiel SA, Zimmet P, Alberti G, Bornstein S, Eckel RH, et al
. New-onset diabetes in Covid-19. N Engl J Med 2020;383:789-90.
Mrigpuri P, Sonal S, Spalgais S, Goel N, Menon B, Kumar R. Uncontrolled diabetes mellitus: A risk factor for post COVID fibrosis. Monaldi Arch Chest Dis 2021;91:1607. [doi: 10.4081/monaldi.2021.1607].
RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al
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Sosale A, Sosale B, Kesavadev J, Chawla M, Reddy S, Saboo B, et al
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Gupta H, Kumar A, Gautam M, Nigam N. Recovery from Covid-19 may be prolonged. J Family Med Prim Care 2021;10:1797-8. [Full text]