Need of a Protocol to treat Patients with Respiratory Symptoms

07. 04. 2020 | 11.14pm
Need of a Protocol to treat Patients with Respiratory Symptoms

Respiratory symptoms, as for the hitherto known medical knowledge, remain the main manifestation of the novel corona virus 2019, the causative agent of the Covid 19 pandemic that is devastating the world today.

The most common symptoms of corona (according to the World Health Organization) are cough, fever and tiredness. Severe cases may develop difficulty in breathing.

On the other hand, respiratory infections remain one of the commonest, if not the most common, ailment for which patients seek treatment. This is the case in the outpatient departments (OPD) of the public and private hospitals or in the government dispensaries or in GP clinics.

Statistics of Respiratory Infections in Sri Lanka

According to the Annual Health Bulletin, 2017, total government sector OPD consultations per year are 55,400,000. Assuming that 30% of these were respiratory infections (for the non availability of that statistic), on average, the total number of patients with respiratory symptoms seen in all government healthcare facilities per day will be 45,000.

Going by the government to private ratio of 45:55 with regard to the patients treated in outpatient settings, this means another 55,000 patients with similar symptoms are treated in the private sector, amounting to 100,000 patients with respiratory symptoms being treated (both in government and private) island wide on daily basis. Applying the initial guesstimate that respiratory to non-respiratory ratio of the outpatients is 30:70; it will mean that there will be around 235,000 patients seeking treatment from all outpatient facilities around the country a day. These macro statistics will speak for themselves the need to segregate the patients with non respiratory symptoms from the ones who have.

In addition to protecting the corona non-probable from the corona probable, a protocol with regard to the management of patients with respiratory symptoms will protect the doctors and other healthcare workers from corona as well. In this regard, while it is primarily important for the healthcare staff to adhere to the universal safety precautions at all times, they having an anticipatory position with regard to the patients will also help them in executing their obligations towards patients. 

Within this backdrop, this author on 05.04.2020 wrote to Dr. Anil Jasinghe, Director General of Health Services, Ministry of Health with a copy to Dr. Sudath Samaraweera, Chief Epidemiologist, urging the need of issuing directives on dealing with the patients with respiratory symptoms in healthcare intuitions.

  • The Letter,

  • Dr. Anil Jasinghe,
  • Director General of Health Services, Ministry of Health
  • Dear Dr. Jasinghe,

  • Issuance of Directives to Healthcare Institutions and Doctors on Measures to be Adopted in Treating Patients with Respiratory Infections

  • 1.The Covid 19 epidemic spreading across the country has caused a lot of hardships to both patients and doctors (both in the public and private sectors) alike. As doctors have a prime obligation towards their patients in treating them, it is needless to say that the present epidemic had led doctors into a state of bafflement, with regard to their services towards the patients.

  • 2.Considering the rationale for the stringent preventive measures adopted by the country today, it could be safe to assume that any patient with respiratory symptoms is a potential/ probable Covid 19 patient, unless proven otherwise (by testing negative).

  • 3.In that case, any patient with respiratory symptoms in any healthcare facility could be considered a potential/ probable risk to the doctors as well as to the other patients in the vicinity.

  • 4.In such case, I would be grateful if the Ministry of Health could issue directives, applicable both to the public and private sector healthcare facilities and doctors (and other healthcare staff) working in these facilities, as to the measures to be adopted with regard to dealing with patients with respiratory symptoms.

  • 5.At the very basic level, this would mean segregation as to the patients with respiratory symptoms and others.

  • 6.This segregation would be applicable to both out as well as in patients.

  • 7.At the same time, I may suggest that whatever the measures adopted, they should cause least inconvenience to the patients.

  • This letter was written after discussing the issue with a number of senior doctors in the public and private sector.

  • Hope this matter would reach your due consideration.

  • Thank you,
  • Dr. Prasanna Cooray
  • MBBS, MSc
  • Health writer/ Activist

  • Written By: 

Dr. Prasanna Cooray


(Public Health Writers' Collective.The writer is a former Regional Epidermiologist)
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