Delayed referral of Covid patients, steroid overuse red-flagged in Himachal Pradesh

SHIMLA: Fear of quarantine, social stigma and tendency to take common cold lightly have led to delayed referral of Covid patients to health facilities. The state clinical team drew this conclusion on the basis of death audit.
It has also been observed that Covid patients are taking steroids indiscriminately without consulting competent medical personnel, which may result in delayed clearance of the virus from the body and adverse outcomes like suppression of immunity and precipitation of diabetes mellitus as well as uncontrolled blood sugar level.The state clinical team warned that such indiscriminate use of steroids could increase susceptibility to various infections, including mucormycosis.
It has been advised that steroids should be used only in Covid patients with low oxygen levels and under strict medical guidance. The team members said that the medical practitioner should prescribe steroids only in moderate and severe Covid infection, in accordance with protocol laid down by the Union ministry of health and family welfare.
Health department officials have requested people with symptoms of upper respiratory tract infection to get tested for Covid-19 at the earliest and avoid self medication with steroids. They said that comorbid patients should be admitted in the dedicated Covid care centre (controlled comorbidities) and dedicated Covid health centre (uncontrolled comorbidities) with intense monitoring and early recognition of a dip in oxygen saturation and/or breathing problems.
To avoid exposure of comorbid patients during their routine hospital visits, it is advised that the comorbid and aged population use tele-consultation services by e-sanjeevani OPD.
If such patients come to hospitals, they should be prescribed medicines for underlying comorbidities for at least three months. All comorbid Covid positive patients insisting on home isolation should monitor their medical parameters frequently and diligently, experts said.
Officials said directions have been issued to address delayed presentation of Covid patients to healthcare facilities. It has also been directed to establish a dedicated central desk manned 24 × 7 with dedicated personnel for timely referral.
Doctors involved in care of Covid patients have been directed to attend regular updates by the state Covid clinical team, State Institute of Health and Family Welfare, Parimahal, Himachal Pradesh and AIIMS. All doctors have been asked to follow treatment protocol issued by the MOHFW, GOI, AIIMS/ICMR and state treatment guidelines.
It has been directed that patients suspected to be suffering from Covid-19 like symptoms and whose RT-PCR test report is negative but who show features of SARI (fall in oxygen saturation, tachypnoea), should be admitted in triage area of the hospital and presumptive therapy recommended for Covid management must be started till the RT-PCR report is available.