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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

New Delhi, Jul 15: The employees union of state-run telecom operator BSNL will stage protests across the country on Thursday on a host of issues including the cancellation of its 4G tender and non-payment of salaries.

All major unions are organising ‘lunch-hour black-flag' demonstrations throughout the country under the banner of All Unions and Association of BSNL (AUAB), said a statement by AUAB. These demonstrations will be organised, by maintaining social distancing and by taking other precautions, like wearing of masks. The BSNL employees will also wear black-badges the whole day on July 16.

The employees body would demand that BSNL should immediately be allowed to roll out its 4G services and the tender should be issued immediately. Further, they want that in the matter of procuring new equipment and upgradation, there should not be any discrimination between BSNL and other private telecom service providers.

Recently, the Centre cancelled the 4G upgradation tender for BSNL as it had decided to come up with fresh specifications for the upgrade process, in a move to keep Chinese technology companies at bay as the border tussle escalated with the northern neighbour.

The Department of Telecommunications (DoT) would issue a fresh tender for the same, and people in the know said that Chinese companies may not be allowed to participate.

"The agitational programme is being organised to express the deep anguish and resentment of the employees against cancellation of BSNL's 4G tender, cancellation of BSNL's proposal for upgradation of its 49,300 BTSs to 4G, abnormal delay in issuing ‘Add on Order' for 4G equipments, inordinate delay in the implementation of BSNL's Revival Package and against the non-settlement of the burning problems of the employees," said the statement.

The umbrella body of BSNL's employees' unions noted that rolling out of 4G services is the backbone for the revival of this telecom PSU, but the recent cancellation of the tender floated by BSNL for procuring 4G equipment at a cost of Rs 9,300 crore, has brought the company back to square one.

It said that BSNL is already having 49,300 base transceiver stations (BTS), which are 4G compatible and through minor upgradation, all these equipment can be converted into 4G BTSs with an investment of about Rs 1,500 crore.

In addition to this, BSNL could have added another 15,000 BTSs, by placing an Add on Order to the existing mobile tender, it added.

Noting that in October 2019, the PSU could have rolled out pan-India 4G services, AUAB said: "Being the sole owner of the company, the Government of India also cannot shirk its responsibility in this matter."

"Adding insult to injury, the tender floated by BSNL to procure 4G equipment, has been cancelled by the government, based on a complaint from the Telecom Equipments and Services Promotional Council (TEPC)," it said.

AUAB said that BSNL is already lagging four years behind the private operators, in terms of 4G and the cancellation of the tender is going to inordinately delay the company's 4G launch.

Saying that TEPC's contention has been to bar foreign companies from participating in BSNL's tender, AUAB statement pointed out that when private operators are procuring equipment from multinationals, "why BSNL alone should be compelled to procure 4G equipments from domestic vendors, whose 4G technology is not tested or proven so far."

It alleged a conspiracy to destabilise BSNL by disrupting its rolling out of 4G services.

AUAB further said that even after the lapse of nine months, the implementation of the much publicised BSNL's Revival Package is moving at a snail's pace.

"Except the swift retrenchment of 79,000 BSNL employees under VRS, all other assurances given in BSNL's Revival Package have been put in cold storage."

The management should ensure that the salary payment of the employees is made on the last working day of every month. Deductions made from employees' salary, on account of "society dues", should immediately be remitted, it said.

Regarding the monetisation of the company's assets under the revival package, the organisation said that the land asset should not be handed over to corporates, at "throwaway" prices.

"These lands should be sold in a transparent manner and at the prevailing market rates. They should not be sold at book value or at circle rates. The AUAB will strictly monitor these dealings," it said.

Mumbai, Jun 27: The Bombay High Court observed that COVID-19 patients from poor and indigent sections cannot be expected to produce documentary proof to avail subsidised or free treatment while getting admitted to hospitals.

The court on Friday was hearing a plea filed by seven residents of a slum rehabilitation building in Bandra, who had been charged ₹ 12.5 lakh by K J Somaiya Hospital for COVID-19 treatment between April 11 and April 28.

The bench of Justices Ramesh Dhanuka and Madhav Jamdar directed the hospital to deposit ₹10 lakh in the court.

The petitioners had borrowed money and managed to pay ₹10 lakh out of ₹12.5 lakh that the hospital had demanded, after threatening to halt their discharge if they failed to clear the bill, counsel Vivek Shukla informed the court.

According to the plea, the petitioners were also overcharged for PPE kits and unused services.

On June 13, the court had directed the state charity commissioner to probe if the hospital had reserved 20% beds for poor and indigent patients and provided free or subsidised treatment to them.

Last week, the joint charity commissioner had informed the court that although the hospital had reserved such beds, it had treated only three poor or indigent persons since the lockdown.

It was unfathomable that the hospital that claimed to have reserved 90 beds for poor and indigent patients had treated only three such persons during the pandemic, advocate Shukla said.

He further argued that COVID-19 patients, who are in distress, cannot be expected to produce income certificate and such documents as proof.

However, senior advocate Janak Dwarkadas, who represented the hospital, said the petitioners did not belong to economically weak or indigent categories and had not produced documents to prove the same.

A person who is suffering from a disease like COVID-19 cannot be expected to produce certificates from a tehsildar or social welfare officer before seeking admission in the hospital, the bench noted and asked the hospital to deposit ₹10 lakh in court within two weeks.