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LETTERS TO EDITOR
Year : 2020  |  Volume : 64  |  Issue : 14  |  Page : 150  

The dilemma of being non COVID-19 hospital in the era of COVID-19


Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Date of Submission29-Apr-2020
Date of Decision11-May-2020
Date of Acceptance14-May-2020
Date of Web Publication23-May-2020

Correspondence Address:
Dr. Swati Singh
4A/8 Jagdqamba, Patna Boring Road, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_489_20

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How to cite this article:
Singh S. The dilemma of being non COVID-19 hospital in the era of COVID-19. Indian J Anaesth 2020;64, Suppl S2:150

How to cite this URL:
Singh S. The dilemma of being non COVID-19 hospital in the era of COVID-19. Indian J Anaesth [serial online] 2020 [cited 2020 Oct 28];64, Suppl S2:150. Available from: https://www.ijaweb.org/text.asp?2020/64/14/150/284915



Sir,

Our hospital is declared as a non-coronavirus disease-2019 (COVID-19) hospital by the state government. This means we will not be involved in active management of COVID-19 positive patients. We will attend other medical and surgical emergencies. In the current situation where lockdown is being considered as the only option for reducing transmission of this virus can any patient be considered as COVID-19 negative? Even if the patient is negative for COVID-19 at one point of time, the question remains that is he really COVID-19 negative? The means to test COVID-19 can broadly divided in reverse transcriptase-polymerase chain reaction (RT-PCR) testing and rapid diagnostic test (RDT).[1] One type of rapid diagnostic test (RDT) detects the presence of viral proteins (antigens) expressed by the COVID-19 virus in a sample from the respiratory tract of a person. If the target antigen is present in sufficient concentrations in the sample, it will bind to specific antibodies fixed to a paper strip enclosed in a plastic casing and generate a visually detectable signal, typically within 30 minutes. The antigen(s) detected are expressed only when the virus is actively replicating. Therefore, such tests are best used to identify acute or early infection. There is another, more common type of rapid diagnostic test marketed for COVID-19 – a test that detects the presence of antibodies in the blood of people believed to have been infected with COVID-19.[2] Antibodies are produced over days to weeks after infection with the virus. The strength of antibody response depends on several factors, including age, nutritional status, severity of disease, and certain medications or infections like HIV that suppress the immune system.[3] Based on the current data, World Health Organization (WHO) does not recommend the use of antibody-detecting rapid diagnostic tests for patient care. The sensitivity of reverse transcriptase-polymerase chain reaction (RT-PCR) testing and overall test performance characteristics have not been reported clearly or consistently in medical literature. A negative test often does not mean the person does not have the disease and test results need to be considered in the context of patient characteristics and exposure.

Thus looking at the above data all patients taken up for any procedure irrespective of their COVID-19 status should be managed taking all necessary precautions. I agree that in order to minimize resource exhaustion, the use of Personal Protective Equipment (PPE) and other resources must be well pondered and balanced. In this COVID era, no patient can be considered as COVID negative. If a health provider gets infected, it will further have huge negative impact on the other health care professionals and hospital resources.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes. Emerg Microbes Infect 2020;9:386-9.  Back to cited text no. 1
    
2.
Li Z, Yi Y, Luo X, Xion N, Liu Y, Li S, et al. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis. J Med Virol 2020. doi: 10.1002/jmv.25727.  Back to cited text no. 2
    
3.
West CP, Montori VM, Sampathkumar P. COVID-19 testing: The threat of false-negative results. Mayo Clin Proc 2020. doi: 10.1016/j.mayocp.2020.04.004.  Back to cited text no. 3
    




 

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