‘Telemedicine can be the rescuer’

In times of contagion when hospitals are potential spreaders, telemedicine can come to the rescue. So says an expert.

A robust telemedicine service ensures proper treatment of all patients, irrespective of whether they carry the coronavirus or not, said Prof Ridwanur Rahman, former head of the medicine department of Shaheed Suhrawardy Medical College and Hospital.

He said this in the context of the failure of policymakers when patients were denied treatment at hospitals.

It is well-known worldwide that healthcare facilities and healthcare providers are super-spreaders of infection in the community. "What we want is that the person who is still uninfected does not carry home the contamination from the hospital."

But there were no guidelines. The health ministry and the Directorate General of Health Services should have made a decision on how and where to treat regular patients and Covid-19 patients and communicated their messages to healthcare providers.

When there is an epidemic, the existing healthcare system should be modified to contain the spread of the disease. For instance, separate care should be ensured for those who are likely to have the infection and those who are non-Covid-19 patients, said Ridwanur, who is now the head of Universal Medical College Research Centre.

But the country's system has been operating as it did in pre-coronavirus times. That is why patients ran from one hospital to another, not knowing where they could go to come by treatment. And those who were on duty at the hospitals were also unaware of where to send those patients.

Many hotlines have been opened but they are unable to attend to all the calls coming from across the country, the doctor said, adding that planning and coordinated action have been missing.

Telemedicine services should be in place to instruct non-Covid-19 patients on which hospital to go to and advise someone to seek care at a separate hospital if she or he is suspected to be carrying the virus. And this service should be available everywhere, covering not only people in the capital but the entire population.

"We cannot allow patients infected with coronavirus to come to the outpatient facilities and pass on the infection to others," Prof Ridwanur stated.
But that does not mean suspected patients should die without treatment.

"All phone calls should be attended to round the clock. The advantage of the mechanism is that one can be advised to stay in home quarantine if one has that facility and when one's health condition is not severe."

In this way, many patients could recover at their homes, leading to a reduction in transmission. "People will go to hospitals in case of emergency," Ridwanur further said.

The government or the IEDCR alone cannot make this possible. A coordinated action plan could be drawn up, inclusive of those who are already providing telemedicine services. A mapping of the places from where most calls are coming will also be helpful in containing the transmission of the disease.

This is also a scientific way to conduct surveillance and apprehend the gravity of the problem in a country when patients are unable to come to the hospital, he noted.

However, containing the transmission is not the job of the government alone. "We have to be aware and impose social barriers for those suspected of having the infection. We have to understand that it is not like imprisoning those who got infected or might be infected."

Quarantine or isolation is temporary and intended to break the chain of transmission.

Prof Ridwanur also said it was wrong to limit testing facilities in the first place. All, including private facilities, should have got permission to run the tests because that could have fast-tracked the isolation of those infected.

There was no scientific rationale behind the decision to not allow healthcare facilities, except for the IEDCR, to conduct the tests, he opined.
"The expansion of testing is happening now, which could have been done earlier in the greater interest of containing the virus," the doctor added.

"Our main target now should be to cut down the transmission. Social isolation should be strictly implemented. There is no looking back. We all are Covid-19 fighters; we will not allow virus transmission to us and from us to another person."

This is how the number of deaths can be reduced.

About the possible spread of infection in slums and from slum dwellers, Ridwanur said food should be distributed to their homes regularly.

"We have a digital capacity to reach people up to the union level. That should be activated to deliver food to the needy. Bangladesh has the capacity to feed them."