Kathmandu, April 5

Sukraraj Tropical and Infectious Disease Hospital, which has been designated by the government for treating coronavirus patients, lacks anaesthetists and critical care physicians.

According to the hospital, there is only one anaesthetist and it doesn’t have any critical care medicine physicians.

This is all the more alarming as Nepal reported its first case of local coronavirus transmission yesterday.

Critical care is an integral component of the global response to COV- ID-19 infection. Patients need intensive care and should be kept on ventilator when their oxygen saturation drops and they suffer from severe and acute respiratory illness.

According to the World Health Organisation, critical illness patients suffer from acute respiratory distress syndrome or sepsis with acute organ dysfunction. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14 per cent develop severe disease that requires hospitalisation and oxygen support and five per cent require admission to an intensive care unit.

“In severe cases, COVID-19 can be complicated by ARDS, sepsis and septic shock, multiple organ failure, acute kidney injury or cardiac injury.

We need critical care physicians as they are the ones who treat patients in ICU,” said Subhash Prasad Acharya, head of the department of critical care medicine at Tribhuvan University Teaching Hospital.

“We need to keep patients on ventilators if their health deteriorates. We have treated patients with only mild and moderate symptoms till now. But if the number of patients surges, we’ll need critical care physicians and anaesthetists to support us,” said Anup Bastola, consultant tropical medicine at Sukraraj Tropical and Infectious Disease Hospital.

“The patients’ lungs can deteriorate when there is severity of infection. That’s when we need critical care physicians,” said Acharya.

“Regular supply of oxygen will not be sufficient in patients with severe COVID-19 illness. To maintain oxygen saturation when it starts dropping, we need critical care medicine physicians and anaesthetists,” said Bastola.

“Coronavirus patients placed on a ventilator will probably need to stay on it for weeks. We need skilled manpower to treat such patients,” said Bastola.

According to STIDH, the hospital needs six to 10 such medical practitioners to work round the clock for providing ventilator service to COV- ID-19 patients in critical stage. The hospital is installing 20 machines for providing intensive care to patients on ventilator support.

“Oxygen plant is being installed to provide the service. We are working on it. It will be completed within a week,” said Sagar Kumar Rajbhandari, director at Sukraraj hospital.

“Not only doctors, we also need well-trained nurses in ICU. The government had announced vacancies for anaesthetist, critical care physicians and nurses, but the posts have been lying vacant,” said Rajbhandari.

“We need at least four nurses to work daily in ICUs with ventilators.

The nurse to patient ratio should be 1:1,” said Acharya.

Nine cases of COVID-19 have been reported in the country so far. Eight of them are undergoing treatment in hospitals in Kathmandu, Baglung and Dhangadi, while one had recovered in January.

A version of this article appears in e-paper on April 06, 2020 of The Himalayan Times.