Managing the Covid

Covid is an insidious enemy.in March 2021 it knocked us again when we thought that we concurred our invisible enemy. Within a month, load of active cases had gone to 6 lacs ten thousand from one lakh sixty five thousand. This figure can establish the enormity of our enemy. Why did it spread so fast? From top policy makers to the normal public all became complacent. We shunned our covid appropriate behavior. Covid spread was so exponential that by 23^rd of May our confirmed cases tally reached to 267 million. India reached another grim landmark and became second most affected country by active cases, total cases  and  third by death. Though India`s CFR(Case fatality rate) 1.12 % is among the lowest but still it will be pertinent to highlight that it took just 27 days to add last 1 lakh death. India is now accounts for 19.08% of all active cases globally and 8.33% of all deaths globally. It shows how much stress was there on our health infrastructure. In some cities we reached the stage where hospital had to take extreme step of discharging asymptomatic at the earliest so that more serious patient can occupy the beds. Same strategy was adopted for ICU as well. Drugs like remdesivir and other steroids suddenly became out of stock. The sudden spike of the cases is the cumulative result of lack of Covid appropriate behavior, different mutants of virus, casual approach from govt and lack of vaccination.

How can we handle disease`s progression and its clinical management? Health infrastructure is pathetic across the country. From one lab before pandemic to 2500 plus lab today and still during the peak of the pandemic labs couldn’t fulfill the demand. Production capacity of liquid medical oxygen has been enhanced to 700 MT per day at pre pandemic period to 9000 MT per day today but still hospitals were short of oxygen. Same story is with hospital beds, medical staff, and equipment and so on so forth. We all know that disease is very infectious and we can’t match its speed with our infrastructure. Let us face this reality and we should work around it. Since long to tackle the Covid government of India emphasize on Test, trace, treat, Public compliance and vaccinate. After all this emphasize still we are facing the second wave and experts are predicting for 3^rd wave as well. Is the strategy wrong? Answer is no. Problem is with the implementation. Holistic approach for health infra and robust system needs to be placed to tackle the pandemic. Instead of chasing the virus we need to be few steps ahead from it.

 Let us examine the each of the strategy and find out how we can succeed.

Test

 Right now we are testing in less numbers. Although we have ramped up lab infrastructure across the country .Till today we have tested 33cr people but still this number is less due to the size of the population. We need to deploy the technology for mass testing. Whole methodology for testing needs to be changed. We need to deploy mobile bans, testing booths in schools, community centers and RWA offices. People need not to travel beyond a point for test. Team of community health workers, Asha workers, RWA team needs to be formed who will survey each home and keep tracking their respective area and as per the established protocol they will encourage people for getting them tested and dedicated team can collect the sample at home. Testing centers collecting the sample should   generate unique number which will comprises individual detail date and time. This unique number will be referred during whole tracing or treatment protocol. Please note if we won’t test adequately   then even moderate infection can lead to severe complications. So expansion of testing base and infrastructure is the key. We should  do this in a mission mode.

Trace

Traceability is another factor which implementation needs to be reviewed. We need to make evidence based data base for contract tracing. When it comes to the traceability due to the  load of the case we choose to ignore this aspect of pandemic. Please understand people whom we are not tracing today, tomorrow they might come to us as mild/moderate cases and even we might find him in a hospital or in ICU. So its better that we should create robust infrastructure for contact tracing. This exercise should start when person tests positive and whoever has come in the contact of a person needs to be traced and handled as pre defined established protocol. All the exercise needs to be captured in handheld device/mobile app which is syncing the data at real time with local command/control center. Effective tracing will always keep positivity rate low. So after testing, tracing is the second most important pillar in defeating the Covid.

Treat

As far as Covid treatment is concern, First step should be the effective communication with the patient. During the peak of pandemic I used to receive hundreds of calls for hospital bed, oxygen ,medicine. After discussing in detail with the patient`s relative it was found that actually this was a case of home isolation but as a precautionary major they have started searching the oxygen and beds. This is a panic situation. If every patient will start searching for bed and oxygen you make any kind of health infra it is bound to fail. So effective communication with patient should be the important part of treatment protocol. We need to communicate them that average recovery rate of Covid is more than 87%.There are states, where recovery rate of the patient  is even 95%.We need to communicate them that if situation arises oxygen or hospital beds are amply available and they will be provided. In the back end command center should keep tracking the patients and supporting them suitably as per the established protocol and all needs to be transparently displayed in the app or information should be available through IVR.

In Covid treatment first phase can be home isolation .Doctors should be available 24X7 for tele- consultation. In case of home isolation, home isolation kit should be provided by local treating team. That isolation kit should comprise Pulse oximeter, thermometer, necessary medicine as per the local treating doctor. Medication detail in the set format preferably through  mobile  should be stored in  district command center  so that treating doctor or other senior doctors should keep monitoring the patient in real time situation. Since in Covid control isolation or distancing is the key so If required doctors should check the patient and maximum necessary tests needs to be completed at  door step.  In the case of Covid treatment we will have to change whole thinking. Normal practice is patient go to the doctor or to the hospital but in this case we will have to bring all the medical facilities to the patient door step or nearest Covid care center

 If team of doctors monitoring the data of patient in a specific cluster (cluster can be a group of panchayat or wards depending upon the convenience of a particular geography) find that a particular patient in home isolation/community isolation needs hospitalization then they should immediately pass on the detail to the next team who are taking care the hospitalization. From here that team should take over the management of the patient. If positivity rate is increasing in a particular geography then to reduce the positivity rate micro contentment zone needs to be formed..

Public Compliance

It is high time that general public should go beyond the  compliance and I would say It is time for participation not just a compliance. They need to actively involve themselves in managing the pandemic. It is not a choice but compulsion now. We have found that during the peak of second wave near absence of governance and political leadership. If I would say that they are incompetent or they don’t want to work then it would be injustice to the 20-30 % of political class who are working day in day out and trying to make the difference. But I would certainly say that problem is so huge that without public cooperation we can’t fight this Covid. Public compliance or participation is expected in Covid appropriate behavior like social distancing, wearing a face mask. Apart from that people should involve themselves in managing contentment zone, non medical work of isolation centers, vaccination centers. Idea may look absurd but we need to understand that medical staffs, police are over worked. They are working in very stress so in this hour of crisis we need to become an example and share their work load in whatever little way we can.

Vaccinate

As per the expert, vaccination is the key. We need to expedite the vaccination. Right now our avg vaccination is 25 lacs per day if we continue the vaccinate in this speed then to cover 50% of our population  we may require at least 2 years. This scenario is certainly not desirable. Pharma companies have assured that they will increase the supply by June-July. To expedite the vaccination we need to negotiate with world leaders for technology transfer and need to allow foreign vaccines to start the production here. Govt is assuring that it will vaccinate all the population by December 21.It will be certainly a great feat. As far as vaccination strategy is concerned we need to use the school network, residential colonies and try to keep hospitals out from this drive as they are already over worked. Till the time our vax doesn’t match the demand we should certainly prioritize the vaccination. Doctors, para medical staffs front line workers should be prioritized. They are working in most challenging environment. In this second wave we have lost many bright doctors. We need to avoid this situation and should try to protect them first.

In short, to manage the Covid we need the support of technology, General public, vaccine and proactive government. Everyone will have to work as a team to conquer the enemy.

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