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Wednesday 3 June 2020

COVID death in Bihar: Lax medical administration to blame?

The way the corpse was disposed and funeral performed breached several guidelines issued by the Union Ministry of Health for cases COVID

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As of Sunday morning, there were not officially any patients with novel coronavirus (COVID-19) infection in Bihar. Even as the opposition was raising questions on the investigation process here, the people were assuring themselves with the fact that there was as yet no news of a COVID outbreak in their state. However, by the afternoon surfaced the news that the sixth death in the country due to COVID had happened in Patna.

The person who died, Saif Ali, had returned from Qatar on 13 March. On the 20th, he had been admitted to AIIMS, Patna, as a suspect. He died there and the body was handed over to the family.

Death in Bihar case of COVID or kidney failure?

Prabhat Kumar, managing director of Patna AIIMS, said, “The patient had symptoms of COVID; so he was undergoing treatment in isolation. He died last morning (Saturday). Our investigation found that he had kidney problems too. But the COVID report arrived this morning, where he was found to have tested positive.”

The Union Ministry of Health and Family Welfare said that the death in Patna was not yet confirmed as a casualty of COVID-19. “The details of the report are being studied,” the ministry said.

The body of Saif, a suspected patient of COVID, was handed over to his family on Saturday afternoon according to the records of AIIMS, Patna. The death certificate issued by the hospital identifies kidney failure as the cause of death. That is not the bone of contention, though.

Guidelines for death by COVID breached

The AIIMS administration is facing criticism for not following the guidelines issued by the Union Ministry of Health and Family Welfare for dealing with dead bodies. According to the guidelines, after removing the bodies from the isolation ward, the administration must exercise caution while overseeing the entire process up to the funeral, which the said medical institution did not do.

For example, there is no procedure that should be performed without putting masks, gloves, and special glasses on. The body has to be kept in a special kind of bag till the last ceremony. To show the family the corpse, the morgue cannot open the chain of the body bag beyond the facial area of the cadaver. The hospital staff were allegedly found lax in discharging these duties,

Anand Kumar, a local journalist who hails from the area where Ali lived, said, “The dead body came home at around 11 o’clock on Saturday night. But nobody knew if he had the COVID infection. The family opened the body bag and kept the corpse in the house. The Islamic rituals for dead continued till late in the night.”

Anand further added, “The family was preparing to bury the body in the morning. But before that, they received the news that Ali had tested COVID-positive. Since then, the whole city has been in a state of panic. While people want to know what should be done, now that they had been exposed to the body of a COVID victim, no one could reach the AIIMS administration till 3 PM on Sunday.”

The managing director of AIIMS, Patna, said the administration did not know then whether the patient had been COVID-infected or not; so the body was given to the family members normally. “Where is our mistake in it? If the report had arrived earlier, we would have followed all the guidelines,” Dr Kumar said.

Ali might have infected many

A week before the country entered a phase of lockdown today, After returning from Qatar on 13 March, Ali had been examined in a government hospital in his home district. His samples were taken there. Doctors referred him then to the Patna Medical College and Hospital (PMCH).

According to Ali’s records, he was examined again at PMCH on 17 March. After taking his samples, the doctors asked him to go into isolation.

However, the PMCH facility was found to be inadequate. Ali was, therefore, not admitted. Family members admitted him finally to AIIMS.

Anand says that Ali, after his return from Qatar, had first gone to Mumbai, then to Delhi and then to Patna and finally to Munger. He went to the hospital after two days, before which had stayed in the city for two days. “I met many people outside too. So now the whole city is living in the shadow of fear,” the journalist said.

Sanjay Kumar, Principal Secretary, Bihar Health Department, said, “The hospital management has made a mistake. But they are saying that they had not received the test report by then. They should have followed the protocol. Should have waited till the result arrived. We are investigating the matter. We have sought an explanation from the hospital.”

Sanjay Kumar continued, “Ever since we received the report, we issued guidelines to all the people concerned. The burial of the dead body will be done under the supervision of the district magistrate. All the people associated with the deceased will be investigated.”

Bihar medical administration laidback

This case of the first death from COVID in Bihar has raised questions on the investigation process of COVID in the state. If the test report had come earlier, special attention could have been given to the patient and his life could also have been saved, critics say.

The opposition is saying this is not the only case where the investigation report arrived late. Every investigation report is arriving late by two, three or four days.

PMCH now hosts six suspected patients, whose investigation reports have not come even after three days.

On the questions of delay, the department first said that the samples had been sent to Kolkata and that the report would come from there. But now the department says that the investigation of COVID is done in Bihar itself: at the Rajendra Memorial Research Institute of Medical Sciences (RMRI). Only in a few special cases, samples are sent to Pune or Kolkata.

According to the data released by the health department, 504 suspects of COVID have been admitted to hospitals across Bihar so far. Out of these, 143 people have been sent to the lab for sample tests.

So far, two people have tested positive with COVID infection whereas 96 people have been found not to have been infected.

The department informed further that 119 people who came from outside had completed 14 days of monitored isolation.

Why the delay

Why are the rest of the test results pending? Dr Pradeep Das, director of RMRI, says in response, “The samples that are coming to us are being investigated. We have examined all the samples that have come so far. We are getting more and more samples. Each sample takes five to six hours o test.”

Sanjay Kumar, Principal Secretary, Health Department, says, “It takes time to get samples from different places. Samples come also from far-flung districts. It is taking time to collect them. We are trying to streamline the process.”

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