Given the growing possibility that a case of infection with the new strain of Puerto Rico was reported in Puerto Rico coronavirus (COVID-19), the country’s hospitals have begun to prepare.
But its response capacity is limited to identifying the possible suspected cases of the disease, since, until this week, everyone did not know what would happen if a patient was positive for this respiratory virus that originated in China and of which there were more than 82,000 yesterday confirmed cases.
“Everyone says, because we take it (to the patient with COVID-19) to the Medical Center, but one wonders, will it be smarter or better to take it to another hospital that is enabled for that?”asked Dr. Lemuel Martínez, president of the Infectious Diseases Society of Puerto Rico.
According to the infectologist, given the rapid evolution of the respiratory virus, its management could change day by day, as new information emerges.
“(Having hospital rooms with) negative pressure is cool, while the number of patients is manageable. But, when there are many patients (with the same disease), you put them in cohorts (groups). The most important thing is to know how to handle the few or many cases (that may arise), ”Martínez said, commenting that, at the Doctors’ Center Hospital in Manatí, where he runs the Infection Control area, there are eight isolation rooms.
Other doctors and hospital managers interviewed by El Nuevo Día also ensure that they have the respiratory isolation rooms required to locate and treat these patients, as well as the personal protective equipment necessary to attend these cases without compromising the health and safety of the staff of the institution.
This newspaper learned that, in recent weeks, more than a dozen suspected cases of COVID-19 have been identified in different private hospitals on the island, in the north, south and the metropolitan area. All, to date, have been ruled out, as their symptoms have tested positive for other respiratory conditions, such as influenza and mycoplasma.
However, as a preventive measure, some have been placed in home quarantine for 14 days, the incubation period estimated for this virus. The common element among all has been that they have recently traveled to China or to any of the countries with confirmed cases of the virus, such as Italy.
Dr. Carmen Deseda, a state epidemiologist, reported this week that there were four people under surveillance for this disease. Yesterday, the official informed this newspaper that one of them left home surveillance during the day. Everyone, he said, had recently traveled to China and, although they had no symptoms, were put under observation.
Health issues surveillance guides
On January 22, the Department of Health issued a “Guide for the surveillance of the novel coronavirus 2019”. That document details the symptoms of the disease (fever, cough and shortness of breath). In addition, it offers guides on how to notify that agency of suspected cases for the collection of laboratory samples to send to Centers for Disease Control and Prevention (CDC).
However, it does not detail what to do if a positive case occurs, which has been the main complaint of doctors consulted on this issue.
Yesterday, in a telephone interview with El Nuevo Día, Deseda abounded. The official reported that if a hospital reports a suspicious case to the agency, Biosafety Office staff would go to the hospital to collect the sample for transport to the Health laboratory. There, it would be packed and sent to the CDC.
If positive, he added, the patient must remain in the hospital where he went to seek medical assistance for a minimum of 14 days. During that time, he said, supportive treatment should be given to the symptoms it presents.
Deseda also noted that the CDC updated its protocols for suspicious patients yesterday. People who have arrived from China in the past 14 days and who have symptoms of the virus will be tested and isolated. Those who come from countries with community transmission – such as Iran, Italy, Japan and South Korea – and require hospitalization will be activated by the isolation and sampling protocol, he emphasized.
Hospitals are prepared
Several of the suspicious cases have been treated at the Hospital Auxilio Mutuo, in Hato Rey, confirmed yesterday Jorge Matta Serrano, administrator of that institution. “We have had cases of interest and we have followed the protocol used by the CDC, with the basic travel questions (recent to countries with confirmed cases),” said Matta, who commented that those cases were reported to Health, although they were later ruled out. for not meeting criteria to validate them.
He said that the Mutual Aid Hospital has 16 rooms that can be enabled for respiratory isolation with negative pressure.
“This is more of an infection control team work,” said Omar Portalatín, manager of the Infection Control Program at the same hospital, who stressed that this situation coincides with the high season of the influenza virus.
Damas Hospital, in Ponce, also recently had a “drill” when they received a patient who was originally treated on suspicion of COVID-2019. “He was a patient with viral symptoms that came from New York. He was in isolation one day, ”said Dr. Pedro Benítez, the institution’s medical director, who reported that there are six quarters of respiratory isolation there.
The patient, he said, was positive for other respiratory conditions, so the suspicion of COVID-2019 was ruled out.
At the Mennonite Hospital in Cayey, an alleged case of the disease was also recently treated. As explained by Mr. Rubén Norat, chief operating officer of the Mennonite Health System, the patient arrived about two or three weeks ago referred by a doctor from Cidra, where the patient had come to seek medical assistance.
“Health was called, and they gave us some recommendations,” he said of the case that tested positive for mycoplasma, another respiratory illness.
Among the four Mennonite System hospitals – in Cayey, Guayama, Aibonito and Caguas – there are 53 isolation rooms, 33 of them with negative pressure, Norat reported. He indicated that, for all the suspicious cases they receive, they will be tested for influenza and mycoplasma “to rule out that it is nothing else.” “The important thing is to control the first case so that it does not spread,” he added.
All the hospitals consulted by this newspaper have activated their protocols to identify suspicious cases, which includes the training of their personnel.
Mr. Jorge Matta González, executive director of the Medical Services Administration, reported that they have reviewed their protocols, trained their staff and are alert to the use of hand sanitizers by all hospital visitors.
Dr. Ricardo Moscoso, from the University Hospital, reported that in that institution alone, there are 16 isolation rooms with negative pressure and anteroom to the room.
The protocol at the HIMA Hospitals, meanwhile, includes the early identification of the patient in the Emergency Room during their registration, as well as the identification of patients with catarrhal syndromes, the epidemiologist Zoraida of Valle Colón reported.
The Hospital del Maestro has a respiratory isolation room with negative pressure, said Dr. Ángeles Rodríguez, who runs the Infection Control area of the hospital.
Meanwhile, Hospital La Concepción, in San Germán, considers the patient who has traveled 14 days or before the onset of symptoms to a country where there are confirmed cases and has symptoms of the virus a suspicious case, said epidemiologist Catherine Díaz.
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