KARACHI: Healthcare facilities must take concrete steps to prevent crowding on their premises to contain the spread of coronavirus. A single most important step could be increasing the time span of clinical outpatient services and conducting them in two or three eight-hourly shifts, suggested an expert on Tuesday.

Sharing his concerns with Dawn over the coronavirus crisis, Prof Rafiq Khanani, president of the Infection Control Society of Pakistan, said heavy rush of patients and attendants, a common sight at public hospitals and clinics, posed a serious threat to patients and medical staff.

“Patients visiting hospitals with health complications are more vulnerable to COVID-19, the disease caused by novel coronavirus,” he said adding that there were ways to address this challenge.

Dr Khanani, professor of pathology and also the director of laboratories at the Liaquat College of Medicine and Dentistry, suggested that health facilities start clinical services on telephone for minor ailments as well as telemedicine using proper medical records and case files.

‘If proper counselling is done and reason of quarantine explained, no prudent person will try to defy the system’

“This strategy would help in the management of chronic cases, treatment and follow-up of patients as well as connecting patient with labs and referring them to other services,” he said.

Explaining ‘screening’ and screening test/s for diagnosis, he said (thermal) screening was done at arrival points, including airports, seaports and road entry routes, to check if the person was suffering from fever.

“This screening is misunderstood by many as a test of coronavirus infection. This misunderstanding has the disadvantage of creating ‘fear’ among those who are having high temperature because of some other reason.

“There could be a thousand reasons for a person to have fever. Also, it also creates a sense of complacency in those who do not have fever at that particular moment,” he explained.

Dr Khanani strongly objected to what he described as ‘forced quarantine’ done at certain entry points without proper counselling.

Such a practice, he feared, may suggest to all travellers to take fever-lowering tablets before reaching the point of entry to mask fever. “If proper counselling is done and reason of quarantine explained, no prudent person will try to defy the system. Besides, in such a rapidly evolving pandemic, quarantine services cannot be provided to all the travellers or exposure suspects,” he said.

Self-quarantine

Dr Khanani believed that volunteer self-quarantine and self-isolation with tracking, counselling and follow-up by health facilities with support from community, non-governmental organisations, medical associations and faith groups was the need of the hour.

He also advocated the use of rapid serological (blood) tests for screening patients in field or at healthcare facilities. The costly PCR test, according to him, should be reserved for those whose serological tests come positive.

The serological tests, he said, were much lower in cost as compared to the PCR test.

“The gold standard test for the virus is based on the PCR (Polymerase Chain Reaction) technology but it is available only at a few locations in the whole country. Hence, it cannot meet the increasing demand of community.

“Besides, it (PCR-based test) also requires strong infection control measures in place as the procedure of taking sample from inside the nasal cavity carries high infection risk.

“The rapid serological tests based on checking the antibodies against the coronavirus are available in market and can be performed in field conditions. These tests have a sensitivity and specificity in the range of 85-90 per cent,” he explained.

Published in Dawn, March 18th, 2020