News from Kamal

We asked Kamal, one of our newest qualified doctors, to let us know how he is coping with Covid-19 as he works as a medical intern in Patan Hospital in Kathmandu. Here is his report, in his own words:

“Till now I’m safe here, I pray to god you are also safe there. As the cases of corona virus rise day by day here also, the mortality rate is increasing as well. Up to today (September) there were altogether 44235 cases are positive among which 25526 cases were recovered and 271 cases died because of corona. The symptomatic cases are increasing. Now, our country in 2nd phase of lockdown. Even though the government made the strong intervention to combat with corona , it still fails to control the virus. The cases are because people are not following government rules strictly enough. Now it is claimed that the virus is transmitted in community level in remote parts of the country. This is bad part in our context because there are no required health facilities to fight against corona virus. In KAHS hospital there are limited ICU beds and less personal protective equipment. If larger groups of people are infected there will be no such adequate facility and “people have to just prey to god”.

Talking about my work place, now I’m working in obs /gynae department. Then after that I will do duty in Emergency department for a month and Otho for one month and ENT for two weeks. The total duration of my internship will be one year, 10 weeks per major department and 1-2 weeks in minor.

The Nepal government had made our hospital as a Corona dedicated hospital. There were total corona positive patients admitted till today 1459, and total corona positive status patient were 100 among which 10 were in ICU. Meanwhile the condition became scary in our hospital because the rate of spreading of infection between staff is raising day by day. While I work in the hospital I used to wear face shield and 2 surgical masks. Our hospital provides one mask per day for one staff. So I have to buy one mask for a day. As our Hospital is doing well for patients treatment but all staff have high chances of transmission of virus. Nowadays I feel somewhat anxious due to lack of adequate personal protective equipment here. As I’m an intern doctor, I have to work most of the time and work very sincerely to learn something but meanwhile I’m scared too.  To prevent transmission of the virus to my family I took another rented room. Despite of many precautions someday might be I will have corona virus positive status in future , I already kept in my mind. 

Besides this , I got a chance to visit Corona ward,isolation,and icu. First of all I, along with my senior, went to entry room and wore a PPE in serial manner from top to bottom with taking so many precautions. Then after we entered the ward. There were lots of cases of corona patients. Some were doing exercise, drinking hot water and meditation too. But they had sad faces. Then after we went to ICU, unfortunately one patient died in front of me because of respiratory failure. At that time I felt so sad and scared as well and I prayed to God ‘everything will be okay not today but eventually’’

In our hospital now management of corona virus is done under following ways:
– According to the conference of medicine, new case definition and treatment approaches for COVID.
– Case definition:Asymptomatic- patient with no symptoms
– Mild- Symptoms but  If no dyspnea or abnormal chest imaging 
– Mild and asymptomatic to be managed on OPD basis
– Moderate/Severe – Those who require supplemental oxygen (low flow) and those with high flow oxygen
– Criticial- Mechanically ventilated (NV, IV)

Treatment approaches once admitted:
– Enoxaparin to be given to all group of patient(40mg SC OD)
– Dexamethasone to all group patients 
– Helmet or hood CPAP. Only to those patient on moderate/severe who requires high flow oxygen
– Patients requiring >10L of O2 to maintain SPO2>90%
– Moderate/Severe: Remdesevir can be given and has been proved to be beneficial to only those who are in early stages i.e. who requires supplemental oxygen in low flow. (In Discussion moderate/Severe : use Remdesivir and even if patient requires high flow oxygen and if Remdesivir is available can also use on patients who has just started critical state even though the evidence shows no benefit for the critical one’s.Dose of Remdesivir 200mg IV on day 1 then 100 mg for 4 days (total 5 days or on date of discharge whichever comes first)Plasma has shown no benefits on research basis. So it is to be given for critical patients. Most of the research shows no benefit or very low which is not statistically adequate but yet can be given as NHRC has given the permission to use it as well.Dose: 1-2 units given within 5 days. Titer >160. After ABO compatibility and serology screening.

Hopefully this natural disaster will be over soon.”
Kamal Hamel, October 2019