New Delhi: The All India Institute of Medical Sciences (AIIMS), New Delhi, has issued an order discontinuing risk assessment and contact-tracing of doctors and other healthcare workers who have been exposed to people with Covid-19. The order requires only those healthcare workers (HCW) who test positive to isolate.
Doctors and the Indian Medical Association (IMA) are outraged by the order, which, they say, could expose other patients, especially those that are immune-compromised, to unnecessary Covid-19 risks.
They also point out that discontinuing contact tracing is one of the tell-tale signs that the city is now facing community transmission. Earlier this month in a review meeting, Delhi Health Minister Satyendra Jain had asked the Centre to declare there was community transmission.
The IMA intends to take the matter up with the government, association president Dr J.A. Jayalal said.
The AIIMS order, dated 22 April 2021, of which ThePrint has accessed a copy, reads: “In view of the current situation of COVID-19 leading to insufficient resources for contact tracing, and shortages of staff, the risk assessment and contact tracing of exposed HCW and quarantine of asymptomatic contact should be discontinued, only the symptomatic HCW should be tested and only those testing positive is [to] be isolated and managed as per the clinical condition.”
The order also specifies a 10-day period for which any healthcare worker may take leave should they test positive. It says: “HCW who test positive may be able to join work after 10 days period from the onset of symptoms provided that they are afebrile for at least last 24 hours without the use of antibiotics, and symptoms (eg cough, shortness of breath) have improved. Those who are asymptomatic may join work 10 days from the date of the first positive test.”
Doctors to write to govt
The order has led to outrage among doctors in AIIMS and in many other private hospitals, which have now issued similar internal orders citing the AIIMS “recommendations”.
“The AIIMS notification of 22 April is quite unfortunate. Several doctors from AIIMS have got in touch with us. Doctors and healthcare workers are entitled to the same level of care and healthcare delivery that is mandated by the government. To deny them that because resources are scarce is inhuman,” Dr Jayalal told ThePrint.
“When the government specifies that the normal quarantine period is 14 days, how can they get back to work in 10? To allow asymptomatic doctors who have been exposed to a Covid-19 patient to go about their duties is a blatant mistake. This would expose other patients to a great health hazard,” he added.
In line with CDC guidelines
Asked about the IMA’s response to the order, AIIMS Medical Superintendent Dr D.K. Sharma said, “They are entitled to their opinion, but this has been cleared by the hospital infection control committee that has experts from all fields, microbiologists, clinicians, etc. They have considered everything and taken a conscious decision.”
As it were, the AIIMS order of a 10 day cut-off period for a doctor who has tested positive is in line with the US’s Centre for Diseases Control and Prevention (CDC) guidelines updated earlier this year.
The interim guidance from 13 February 2021 says: “Available data indicate that adults with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset. Most adults with more severe to critical illness or severe immunocompromise likely remain infectious no longer than 20 days after symptom onset; however, there have been several reports of people shedding replication-competent virus beyond 20 days due to severe immunocompromise.”
However, doctors say the concerns about exposed healthcare workers spreading the virus further to vulnerable patients remain even as more and more hospitals replicate the order from AIIMS.
ThePrint is in possession of at least one such order from a prominent private hospital chain that gives detailed guidelines about the conduct of a healthcare worker who has returned to work following Covid exposure. This includes maintenance of social distancing and the need to eat or drink in a secluded area rather than in the presence of colleagues. Such workers are expected to keep their masks on at all times and self-monitor for symptoms.
“This is now becoming the norm in many places because AIIMS has set the precedent. That is why we are planning to write to the government,” Dr Jayalal said.
A doctor from a private hospital, speaking on conditions of anonymity, however said, “These are tell-tale signs of community transmission. That is why AIIMS has decided to stop contact tracing and we are following suit. However, to knowingly expose patients to this additional hazard is a calculated risk, especially at a time when the city is running short of everything from beds to oxygen to medicines.”
(Edited by Manasa Mohan)