Long curfew helped TN docs to prepare better for COVID battle
CHENNAI: From March 25, when the lockdown was imposed, the State only had 15 COVID cases. Today, on July 2, after 100 days of lockdown, health officials have come a long way in fighting the pandemic even as the cases continue to pile. Though the numbers are high- with the tally crossing 90,000 - officials express confidence about having gained more insight into the disease and know how to manage it better.
While fever, breathlessness and dry cough were the only recognised symptoms earlier, doctors now associate loss of smell, taste, general weakness, fatigue and even abdominal pain as warning signs.
Officials from the Directorate of Public Health and Preventive Medicine said that various co-morbidities that would make a person vulnerable are also clearer now. As a result, cocooning and monitoring of such people is being better planned and this has also led to an evolving strategy. Though the basic protocol on quarantine, isolation and other preventive measures remain the same, treatment strategies have greatly improved. The time period of quarantine has also come down from 28 to a maximum of 10-14 days and there is no discharge test needed anymore. Also, use of steroids, injections and other drugs has been well established over a period of time.
“Heparin can be used as an anticoagulant drug to save critical patients. Steroids can be life-saving drugs; anti-viral drugs including Remdesivir, Tocilizumab, and Enoxaparin can also be used. The effect of these drugs on patients has been understood over the past three months. Case by case review also helped in coming up with better treatment standards and the use of Ayurveda and Siddha medicines to build immunity has also proved beneficial,” said public health expert and former public health director Dr K Kolandaisamy, who had been spearheading the public healthcare system until his retirement recently. “Though we stressed on strict lockdown earlier, the effectiveness could not be established. We now know that only vulnerable people need to stay indoors and controlled lockdown can be implemented,” he added. Health officials also said that the spike in cases led to strengthening of the public health sector, including infrastructure and capacity at government and private hospitals. “Despite having one of the best health sectors pan India, we had to ramp it up completely. Besides, ensuring adequate testing was also a major task. We realised micro level plans are needed. Earlier, we did not have local influencers but now many NGOs help COVID management in slums,” said Health Secretary J Radhakrishnan.
He pointed out that standard protocols were not available then and doctors and researchers had to analyse ICMR and international recommendations for solutions. “We now have plasma therapy trials. Besides we are continuing with add-on therapies and studies on effects of Indian medicines. At present, we have 11 standard protocols, especially for those with co-morbidities,” said Radhakrishnan.
As more than 50,000 people have recovered, doctors have realised that early treatment can help reduce mortality rate. “COVID-19 being a new strain, people are not yet immune to it. Besides, there is no 100% compliance to masks, social distancing and hand washing as people are generally negligent till they are affected,” Radhakrishnan added.
CHENNAI: In the last week of March, handling a coronavirus patient was like handling a mythical dragon. It was a chilling sight to see the infected persons and their relatives were picked up and closely monitored by PPE-clad health workers, which was followed by streets being closed with iron barricades. But 100 days on, the number of cases has exploded, making these are sights that do not trigger fear but only a sense of familiarity and perhaps inevitability. Dealing with coronavirus is the new normal in Tamil Nadu.
According to senior officials, dealing with the pandemic for the past three months has helped doctors and administrators to understand the virus and the effects of lockdown better.
“Tamil Nadu is spending more than Rs 100 crores per month only for testing and tracking COVID patients. This unexpected expenditure has burnt a deep hole into the State exchequer,” a highly placed official told DT Next. The logistics and local body expenditures add another Rs 80 crores per month, the official added. To improve the infrastructure of government hospitals, including ensuring oxygen cylinders and pipelines, another Rs 75 crore was sanctioned for the Public Works Department on Wednesday.
“By imposing a series of lockdowns, the State managed to control the intensity of the virus. Though Tamil Nadu has one of the best public health infrastructure, the demand brought about by the pandemic was far higher and unique when compared to swine flu or dengue outbreaks,” explained Health Secretary J Radhakrishnan.
The advancements in medicine also helped increase recovery rate, with more than 50,000 people having recovered till now. The bed strength has improved by several folds, and the infrastructure facilities like oxygen cylinders and ventilator support have also increased. “We are not looking at the numbers now; the focus is to improve critical care at the hospitals. There are loopholes, but we are improving the system. Non-medical methods and other forms of alternative medicines like Siddha and Ayurveda are also given impetus,” Radhakrishnan added. ‘It is time for us to move to a monitored home and community-based care model for those who are asymptomatic or mildly symptomatic,” said Principal Secretary B Chandramohan, who is the COVID monitoring officer for Madurai, a district that has been recording a spike in the recent days. Asymptomatic and mild patients should not occupy beds needed for the seriously ill ones, and work was on to double the number of beds with oxygen facility, he added.
The expertise gained from the three months’ experience handling the pandemic was shared for fine-tuning the processes, Chandramohan said, citing the examples of deciding when pulse oximeter should be used for effective management and how a physician can speed up the treatment while waiting for COVID results.
“Chennai is an IT hub, a potential that has to be tapped and synchronised for better medical care. Besides the healthcare improvements, IT tools will soon be part of the medical care approach. Works are on for this. This will give more data and precision to reduce mortality rate in the coming days,” added senior official Rajesh Lakhoni, who is the monitoring officer for Vellore. Until a vaccine or medicine emerges, the public should not lower protective guards, the official added.
According to politicians and political commentators, the pandemic and its aftermath would be the topic for the AIADMK and DMK in the coming Assembly polls scheduled for next year. “Corona has dwarfed every other political issue, and its effects like loss of lives, livelihood and the rate of recovery will determine the results in the upcoming assembly polls,” opined political commentator R Mani.
From tsunami, floods, dengue, swine flu and cyclones, disasters and epidemics are common for Chennai; but nothing has mauled Chennai this bad, added former Chennai mayor M Subramanian MLA. “Three months ago, lockdown was something strange, unheard of and practically infeasible. But now, lockdown is the new norm of life in Chennai, though the price public are paying for lockdown and the pandemic is too high,” he said.
As Tamil Nadu completes 100 days of lockdown today, DT Next takes an inventory of the losses the State had to suffer, what the government could have done to handle the pandemic better and how experts and frontline workers are coping with the situation