DHARAN: With the surge of CoVID-19 cases worldwide and the detection of the first case in Nepal, BP Koirala Institute of Health Sciences (BPKIHS), a tertiary care referral hospital in Eastern Nepal, decided to begin preparations for fight against CoVID-19. The institute formed a rapid response team for CoVID-19 under the leadership of the Hospital Director.

The team worked hard day and night to form a guideline for the screening, sample collection, admission, and management of suspected patients. It comprises experts from Microbiology, Family Medicine, Internal Medicine, Pulmonology, Anesthesiology, Pediatrics, Gynecology, Public Health, Psychiatry, and Dental Sciences. The RRT also evacuated a building for arranging 20 beds for isolation ward with 2 ICU beds.

The team started a help desk for screening of suspected patients and fever clinics for the management of non-CoVID patients. It's task also included training of the faculties, residents, and nursing staffs regarding proper usage of personal protective equipment and infection control measures.

Furthermore, the team devised a proper guideline for the optimal usage of PPE based on exposure and risk involved and also suggested the hospital administration for the purchase of N95 masks, PPE, and emergency drugs for the management of patients.

Recently, with the nomination of a new Vice chancellor, who also took over as the chairman of rapid response team, a new CoVID-19 hospital has been build within a week, which was inagurated by Chief Minister Mr. Shredan Rai on 26 th April 2020. The dedicated CoVID-19 hospital consists of 100 beds including 20 ICU beds.

At the inaguration ceremony, the Chief Minister said that although province 1, especially Udaypur District, has been the hotspot of CoVID-19 cases in Nepal, it is fully equipped to tackle this global pandemic and BPKIHS is a major part of it. The high-level team led by the Chief Minister, inspected the molecular laboratory and expressed gratitude for its service to the whole province and the country as well in this pandemic situation.

The Ministry of Health and Population has categorized BPKIHS as level III CoVID-19 hospital, which means it has to handle all the severe cases requiring multi-disciplinary critical care. Therefore, the asymptomatic and mild patients that tested positive for SARS-CoV-2, have been referred to CoVID Hospital in Biratnagar which is the level I hospital.

The institute has already admitted 30 suspected patients in its isolation ward, screened 756 persons among which 719 were suggested for self-quarantine and 37 has been sent to dedicated quarantine facilities.

BP Koirala Institute of Health Sciences is the first centre besides National Public Health Laboratory (NPHL) to start testing for SARS-CoV-2 using real-time reverse transciptcase polymerase chain reaction (RT-PCR).

The Department of Microbiology started testing 12 samples at the beginning, which was gradually upgraded to perform 100 samples per day.

Dr Narayan Raj Bhattarai, additional professor and PhD in molecular microbiology said, "We can easily test around 200 samples per day by using our PCR machines in two shifts, provided the kits and logistics are supplied regularly on time."

Likewise, Dr Basudha Khanal, Professor and Head of Microbiology said, "We have been getting a lot of samples lately, and we are determined to work hard to provide the results on time."

"It has been an excellent learning opportunity for us and we are very proud to be in this team," said Dr Prabhar Raj Pandey, Dr Dharnish Jha and Dr Saugat Pradhan, MD residents in the Department, who collected the samples from suspected patients for initial one month and have been directly involed in RT-PCR laboratory since the beginning.

The molecular laboratory, BPKIHS has been nominated as cross-verficiation centre for diagnosis of SARS- CoV-2 by Ministry of Health and Population, Government of Nepal. "We have already verified the reports of 8 suspected samples which were sent to us from Koshi Zonal Hospital, Biratnagar," said Dr Narayan Raj Bhattarai.

Keshav Rai, Senior Demonstrator and integral member of molecular laboratory said,"We have tested around 600 samples and reported 13 samples as positive till now. We have reported a maximum of 104 samples in a day till now and hoping to complete 100 samples today."

[Dr Lok B Shrestha is working as an Assistant Professor in the Department of Microbiology and Infectious Diseases. He is an integral part of CoVID-19 RT-PCR laboratory and member of Rapid Response Team for CoVID-19 at BPKIHS]