Individuals with severe acute respiratory infection are increasingly being monitored as some of them have been positive for COVID-19.
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Since February 10, when a man with a history of travel to Wuhan in China walked into St. John’s Hospital in Bengaluru, a screening clinic has been in place to help contain the spread of coronavirus cases. Officials in the hospital have been logging the details of every possible coronavirus patient and almost two months later, have found that there is an increase in the number of individuals admitted with Severe Acute Respiratory Infection (SARI). “We are observing 6-12 SARI patients everyday who are in need of intensive care. This number has increased since the outbreak of coronavirus cases,” says Dr. Sanjiv Lewin, Chief of Medical Services, St John's Medical College. The hospital attached to St. John’s Medical College has observed 225 SARI cases since March 22, three days before the lockdown period in India was imposed. Similarly, in Mysuru’s century old KR Hospital, 201 patients with SARI have been admitted since the lockdown over the coronavirus outbreak began at the end of March. “Everyday we admit 10 to 15 new (SARI) cases compared to 3 to 5 cases that were seen in a day prior to the lockdown,” says Dr Nanjundaswamy from KR Hospital in Mysuru, which is attached to the Mysore Medical College, a government-run college. Among the surge of SARI cases in these two hospitals, only six patients turned out to be positive for COVID-19 - 4 patients in Bengaluru’s St. John’s Hospital and 2 patients in Mysuru’s KR Hospital. Reason for increase in SARI cases Officials in the two hospitals say that the surge in cases are also linked to the refusal of private hospitals to take in SARI patients. “People are worried when they develop respiratory symptoms and think that it might be coronavirus. When they approach private hospitals, they are referred to us because private hospitals are refusing to admit SARI and related cases due to the coronavirus scare,” says Dr Nanjundaswamy. Officials in St. John’s Medical College echoed the reasons stated by doctors in Mysuru and linked the increase in SARI cases to the refusal of private hospitals to take in SARI cases. “The patients are reaching us with inadequate warning given by the hospitals which are referring them. The rise in SARI cases is not necessarily an indication that infections have increased but it is more indicative of the referrals from other hospitals,” says Dr. Sanjiv of St. John’s Medical College. “The government-run hospitals have been turned into hospitals to fight COVID-19 cases so this has left people from low-income groups vulnerable and they are running from pillar to post desperately looking for hospitals to admit patients in,” Dr Sanjiv says. TNM spoke to doctors in Udupi and Ballari districts of Karnataka who also reported a similar issue of private hospitals turning away SARI patients. Medical resources under strain Another issue facing hospital administrators is that the rise in SARI cases has strained their available resources. “All SARI patients are kept isolated and cannot be kept in a ward with other patients. In the ward with SARI patients, there is a patient in every three beds,” says Dr. Nanjundaswamy of KR Hospital. At St. John’s Medical College, COVID-19 suspects are treated in a separate block which has 60 beds available, including 15 ICU beds. Of these 15, 14 beds are currently occupied, an evidence of the burden of cases the hospital is grappling with. This has also affected the hospitals’ capabilities to deal with non-COVID-19 patients including emergency cases like burns and accidents. “Our resources are concentrated on tackling SARI cases. There were 2-3 patients who required ventilator support last week. We currently have five ventilators and we are using them,” Dr. Nanjundaswamy says. SARI and its importance in the ongoing pandemic Post the SARS epidemic of 2002, the World Health Organisation (WHO) had constituted a set of basic screening measures in the event that another similar pandemic occurred. SARI, or severe acute respiratory infection, was included on this list. Since then health experts around the world have stressed the importance of monitoring individuals who develop SARI, in light of the current outbreak of COVID-19. Some of the most common symptoms of SARI are cough which does not subside with medication, cold and fever which indicates that there is a possible onset of pneumonia. “There are a particular set of symptoms associated with SARI which can all be caused by a number of infections. The novel coronavirus can cause someone to develop cough, cold and fever, and severely impact the respiratory system,” explains Dr Asima Banu, nodal officer of the emergency department at Victoria Hospital in Bengaluru. She explains that individuals who develop SARI may not necessarily be positive for COVID-19, however, those who have contracted the virus will exhibit the symptoms of SARI. “This is why it is important to keep an eye out for SARI, because it can be caused by the coronavirus,” she adds.
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