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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 40-43

Efficacy of influenza-like illness screening outpatient department for COVID-19 at a high-volume center: Unlocking routine outpatient department


1 Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Department of Orthodontics and Dentofacial Orthopedics, All India Institute of Medical Sciences, New Delhi, India
4 Department of Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission01-Nov-2021
Date of Decision01-Jan-2022
Date of Acceptance05-Feb-2022
Date of Web Publication16-May-2022

Correspondence Address:
Dr. Arvind Kumar
Department of Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jphpc.jphpc_35_21

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  Abstract 


Background: The impact of COVID-19 pandemic over nonessential health services has been massive. We initiated influenza-like illness (ILI) screening for resumption of outpatient services at a tertiary care center and this study attempted to gauge its efficacy in effectively pruning out COVID-19. Methods: We included all the patients who had visited for an outpatient department (OPD) appointment during the study period. Patient's details and ILI symptoms were noted. Patients were then followed up telephonically after 2 weeks. The telephonic follow-up was to ensure RT-PCR status and complaints of any newly developed ILI post-OPD visit (within the last 14 days). Results: Out of the 957 patients who were enrolled, 929 patients were successfully followed up telephonically after 14 days. Only 13 who were screened out as “possible ILI,” were either RT-PCR negative or did not follow-up with a confirmatory test. The telephonic follow-up to ensure RT-PCR status and complaints of any newly developed ILI post-OPD visit (within the last 14 days) was noted in the rest of the patients. Only one participant out of 957 screened, tested positive for COVID-19. Conclusion: The period in which the study was held, the national positivity rate was low (around 3%). Therefore, in a resource-limited country such as India, it is astute to restart the OPD services in the preexisting setup using basic precautions and a verbal questionnaire during the slope of the pandemic.

Keywords: COVID-19, influenza-like illness screening, pandemic, screening outpatient department


How to cite this article:
Mattoo B, Sarda R, Kumar A, Fatima K, Kaur R, Wig N. Efficacy of influenza-like illness screening outpatient department for COVID-19 at a high-volume center: Unlocking routine outpatient department. J Public Health Prim Care 2022;3:40-3

How to cite this URL:
Mattoo B, Sarda R, Kumar A, Fatima K, Kaur R, Wig N. Efficacy of influenza-like illness screening outpatient department for COVID-19 at a high-volume center: Unlocking routine outpatient department. J Public Health Prim Care [serial online] 2022 [cited 2022 Jul 4];3:40-3. Available from: http://www.jphpc.com/text.asp?2022/3/2/40/345276




  Introduction Top


On January 30, 2020, India reported its first case of COVID-19 in Kerala.[1] Soon, COVID-19 paralyzed the health-care system; the first lockdown was imposed on the evening of March 24, 2020, in India. This not only stunned the economic infrastructure but was critical to the health-care system as well. As COVID-19 emerged, health-care facilities began preparing for a surge of patients. To make space available for COVID-19 patients, preserve supplies of personal protective equipment, and comply with community mitigation guidelines, the routine procedures, including outpatient services were discontinued. However, the maintenance of essential services to support the needs of the community is essential for any health system.

Resuming the outpatient department (OPD) was a challenge under the looming shadow of the disease.[2] We resumed the outpatient services on June 25, 2020, with the introduction of an influenza-like illness (ILI) screening OPD which was based on the a verbal questionnaire and thermal screening. The daily footfall of OPD patients at our hospital was around 12,000 according to the Annual Report 2019–2020.[3] The national positivity rate around the time this study was conducted was around 3%.[4] Anticipating a high number of patients, the maximum number of patients were capped initially to around 60/OPD/day. We attempted to utilize ILI screening for resumption of outpatient services at a tertiary care center and simultaneously, this study attempted to gauge its efficacy in effectively pruning out COVID-19 at a high-volume center.


  Methods Top


This was a cross-sectional study conducted at the All India Institute of Medical Sciences (AIIMS), New Delhi, India. We included all the patients who had come for an appointment for OPD visit between June 30, 2020, and July 21, 2020 [Table 1]. Patients who could not be contacted via telephone after two attempts on 2 separate days were excluded from the study. The interview was conducted using a semistructured questionnaire that included complaints of fever, sore throat, headache, or any ILI-like symptom and any history of recent travel. It also included a history of similar complaints in anyone in the family.
Table 1: Total number of patients who were screened between June 30, 2020 and July 21, 2020 at the influenza-like illness screening outpatient department established at the New Rajkumari Outpatient Department at AIIMS, New Delhi

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As per the guidelines, the participants who screened positive for ILI were tested for COVID-19 and were sent for home isolation, till the results for COVID-19 were confirmed. Further, those who tested positive for COVID-19 were managed as per the protocol.

Ethical consent was obtained from the Institutional Ethics Committee (IECPG-464/23.09.2020). Nine hundred and fifty-seven patients were telephonically followed up after 14 days of their visit to the New Rajkumari OPD, AIIMS, New Delhi.


  Results Top


We screened around 1250 patients between June 31, 2020, and July 21, 2020, the details of which with the national positivity rate are provided in [Table 1].

Of 1250, only 957 were included in the study due to incomplete information about the rest. The age wise [Table 2] and department wise [Figure 1] are also provided. Of these, only 13 were screened out as possible ILI, based on their responses to the screening pro forma provided their symptoms were noted [Table 3]. [Figure 2] depicts the flow of patients through the screening OPD.
Figure 1: The share of outpatient department patients (total n = 957) according to the departments visited at the New Rajkumari Out Patient Department at All India Institute Of Medical Sciences New Delhi

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Figure 2: The movement of patients through the screening outpatient department

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Table 2: Demographic of the patients screened at the influenza-like illness screening outpatient department

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Table 3: The symptomatology and details of the patients screened as influenza-like illness positive

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The telephonic follow-up to ensure Reverse Transcription Polymerase Chain Reaction (RT-PCR) status and complaints of any newly developed ILI post-OPD visit (within the last 14 days) were noted [Table 4]. The follow-up was completed for 929 patients.
Table 4: Table describing the details of the telephonic follow-up at day 14

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  Discussion Top


This study aimed to unravel the effectiveness of having a screening OPD for ILI screening during a pandemic situation before the patient reached the concerned department.[2] The stress levels during the pandemic were high among the health-care workers and a ILI screening OPD also plays a role in allaying such fears.[5] We attempted to mitigate these fears and also safeguard the health of the incoming patients by establishing a thermal screening and simple interview-based ILI screening OPD.[6],[7]

Out of the 1250 patients screened, 13 patients were screened out, details of their ILI symptoms were noted and the necessary prescription regarding possible COVID-19 disease was provided. Of these, only three had done the RT-PCR test as prescribed at day 14 of follow-up, none of which were positive. Fever and cough were the most common of the symptoms experienced by the patients who were screened as probable ILI. The social stigma associated was the major deterrent in them not following up with testing.[8] This points us toward the importance of public awareness in such situations.

This pandemic has shown an unpredictable pattern as far as the peaks and troughs are concerned, since the predicted models were inaccurate and the forecasts had failed, especially so, during the initial stages.[9] The pandemic has had a debilitating effect on health status of patients with chronic illnesses who found it difficult to access health-care services among the pandemic.[10] Both the mortality and morbidity of chronic nonCOVID disease increased during the initial lockdown.[11] Thus, it is only prudent to continue the OPD services and add screening layers depending on the current position of the pandemic.

The problem of the lack of health-care services during the pandemic has had its impact over many chronic diseases, be it ophthalmological, orthopedic, and dental services most of which have suggested a screening system for patients and better protective gear for health-care providers.[11],[12],[13]

This exercise which we conducted at the premier Institute of India was to ensure the safety of the medical health-care workers and the patients, although the results were not encouraging in terms of the positivity rate, but it was a great learning experience for us. At the time that this exercise was conducted, we were not at the peak and at the trough, the positivity rate was low.[2]

The fact that only one participant out of 957 screened, tested positive for COVID-19 further strengthened the evidence that it was prudent to resume the outpatient services. Our logistics helped in controlling the apprehensions of both the health-care worker and consumer during this pandemic.


  Conclusion Top


Hence, we can conclude that in a resource-limited country such as India, it is astute to restart the OPD services in the preexisting setup using basic precautions and a verbal questionnaire during the slope of the pandemic. Although this is an outstretched conclusion of the present study, we are only learning as the nature of the pandemic changes, and we upgrade our defenses in doing so.

Acknowledgments

We would like to thank all the residents and support staff posted in the screening OPD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res 2020;151:490-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sarda R, Mattoo B, Kumar A, Vikas H, Madaan N, Wig N. Resuming outpatient services during COVID times: Our approach and experience at India's apex institute. Int J Health Plann Manage 2021;36:2011-9.  Back to cited text no. 2
    
3.
Available from: https://www.aiims.edu/aiims/annual-report/AIIMS_AR%202019-English_Web_Binder.pdf. [Last accessed on 15 October 2021]  Back to cited text no. 3
    
4.
MoHFW | Home. Available from: https://www.mohfw.gov.in/. [Last accessed on 2021 Sep 20].  Back to cited text no. 4
    
5.
Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: A factor analysis. Front Psychol 2021;12:611314.  Back to cited text no. 5
    
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Nicoletti A, Talarico V, Sabetta L, Minchella P, Colosimo M, Fortugno C, et al. Screening of COVID-19 in children admitted to the hospital for acute problems: Preliminary data. Acta Biomed 2020;91:75-9.  Back to cited text no. 6
    
7.
Goyal ND, Kumar CR, Pahwa A, Gautam VK, Mishra N, Kumar TP. “OPD TRIAGE” – A novel concept for better patient management in heavily loaded orthopaedic OPDs. J Clin Orthop Trauma 2020;11 (Suppl 4):S472-8.  Back to cited text no. 7
    
8.
Abdelhafiz AS, Alorabi M. Social stigma: The hidden threat of COVID-19. Front Public Health 2020;8:429.  Back to cited text no. 8
    
9.
Ioannidis JPA, Cripps S, Tanner MA. Forecasting for COVID-19 has failed. Int J Forecast. 2022;38:423-38. doi: 10.1016/j.ijforecast.2020.08.004. Epub 2020 Aug 25.  Back to cited text no. 9
    
10.
Jain R, Dupas P. The effects of India's COVID-19 lockdown on critical non-COVID health care and outcomes: Evidence from dialysis patients. Soc Sci Med. 2022;296:114762.  Back to cited text no. 10
    
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Gupta N, Chauhan AS, Prinja S, Pandey AK. Impact of COVID-19 on outcomes for patients with cervical cancer in India. JCO Glob Oncol 2021;7:716-25.  Back to cited text no. 11
    
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Reddy JC, Vaddavalli PK, Sharma N, Sachdev MS, Rajashekar YL, Sinha R, et al. A new normal with cataract surgery during COVID-19 pandemic. Indian J Ophthalmol 2020;68:1269-76.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Saqib MA, Siddiqui S, Qasim M, Jamil MA, Rafique I, Awan UA, et al. Effect of COVID-19 lockdown on patients with chronic diseases. Diabetes Metab Syndr 2020;14:1621-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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