Both started as a trickle. Both caught us unawares. Both took lives on scales unimaginable.
Tamil Nadu with its healthcare infrastructure and human resources led from the forefront in testing and treating COVID-19 cases. Though numbers were high, the health infrastructure was able to manage and sustain its efforts on testing and treating Covid 19 patients with Covid related mortality around 1.4 %
As a health professional at the forefront for more than a year dealing with various aspects of management of the patients, the lessons I have learnt are shared:
On treatment protocols:
Much hype surrounds various new drugs and remedies only to die out as soon as the idea is born.
Any drug should satisfy certain basic criteria like consistency, reproducibility and cost effectiveness in curing an illness.
The WHO clinical trials registry list out more than 200 drugs and compounds that have been tried from donkey milk, home remedies to Remdesivir, biological formulations and even radiation. At the end of the day steroids and anticoagulation alone have stood the test of time and early treatment with these save lives. Covid 19 is increasingly being recognised as a diffuse inflammatory condition, highlighting the role of anti-inflammatory agents like steroids. Early diagnosis and timely addition of steroids saves lives.
On Vaccines:
Vaccines do play a role in control of spread of infections but one must be wary about the false sense of security created. Vaccines may not be the panacea yet. Breakthrough infections are happening and the need for Covid appropriate behaviour such as masks and physical distancing among the vaccinated too should be stressed. Also, side effects should be reported, documented and analysed so that public confidence is restored and more opt for vaccination.
On Hospitalisations and optimum use of resources:
With greater burden on the health care system, prudence dictates that the triage system should be in place and hospitals admit patients with saturation of less than 92 or with comorbidities alone so that the healthcare system is not overwhelmed and the resources are utilised properly. Overcrowding of hospitals will not only deny beds for the needy but also lead to cross and secondary infections and increase the viral load.
We need to focus on non-Covid illnesses too, as non-communicable diseases may add to the mortality.
On Testing:
RTPCR continues to be the gold standard for diagnosis. But it should be interpreted with caution. Both false positive and negatives can occur. Viral mutations may make the test irrelevant and lower the sensitivity. Inflammatory markers, for all the hype surrounding it, do not have much therapeutic value which is the main purpose of doing a test. At the end of the day, it is sound clinical judgement combined with basic imaging and monitoring of oxygen levels that is saving lives.
On public private partnership:
The need of the hour is that the private sector needs to partner with the Government in various aspects like Oxygen generation, increasing vaccine and drug production and greater involvement of private medical colleges and hospitals to successfully end the pandemic. The Public Private Partnership model is the need of the hour and CSR funding needs to be utilised for improving the amenities in hospitals and saving lives since any society cannot function in the presence of sickness.
On the role of the individual:
It is important the individual is aware of the disease and the way it spreads and owns up to his responsibility of not infecting others by following covid appropriate behaviour like cough hygiene, hand washing, early testing and isolating himself to prevent spread of disease, health seeking behaviour etc.
We are morally responsible for wearing masks in public places not only to protect ourselves but also preventing transmission of the virus. Social distancing norms and avoidance of overcrowding is also important to cut the transmission. Exposure to sunlight, good ventilation and healthy eating habits such as consuming plenty of vegetables, fruits, nuts may help boost the immune system and aid in fighting the infection. Avoiding prolonged use of cell phones in public spaces also needs to be emphasised since it can generate aerosols and transmit the virus. Restrict or minimise personal interaction with others or as a group even in office or place of work.
At the end of the day, it is in everyone’s interest that the pandemic ends soon and life and livelihood moves. The government can add infrastructure and ramp up manufacturing of medical supplies, but these measures will only help to cure patients. Only when each and every one of us follows the precautionary norms will the number of cases come down. The onus is on us, as individuals to make the world COVID free again!!
About the Author:
Dr. Vinod Kumar MD,DNB, MBA, FRCP, Professor of Pulmonary medicine at Stanley Medical College and Senior Consultant pulmonologist at Chennai. Has treated more than 10,000 COVID cases so far and has been member of COVID expert panel at Stanley. He has more than 70 publications to his credit.
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