Poor implementation, monitoring weaken Covid-19 strategies

When Sadagopan, 62, tested positive for Covid-19 on June 13, he was taken to a designated Covid-19 hospital in Chennai for initial check-up and later advised home isolation with necessary precautions and support. He found his road to recovery from the dreaded coronavirus rather smooth.

However, Dr Lakshmi Narasimhan, 61, had to struggle to find a hospital bed in Pune when he developed a breathing problem on July 14 and passed away the next day, for want of an ICU bed. While the former is a rare situation, instances like that of Pune have been reported from many cities and states.

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As India battles with an exponential increase in infections, adding nearly 50,000 new cases every day, the response and strategy of state and local governments are deciding the Covid-19 trajectory in a particular area.

Home care for Covid-19 patients who are asymptomatic or have mild symptoms, contact tracing and efficient treatment at hospitals have emerged as three important approaches to control Covid-19.

Reports from Uttar Pradesh said that Lucknow was running out of hospital beds for Covid-19 patients as the city reported 250 new cases each day. In Bihar, the strain on hospitals was visible as patients had to wait for days together to get a hospital bed. The situation is no better in Bengaluru.

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The sudden surge in cases has forced Uttar Pradesh, which insisted on institutional treatment even for asymptomatic patients, to change its strategy.

Last Monday, Uttar Pradesh joined Delhi, Maharashtra, Karnataka and Tamil Nadu and a few other states to allow home isolation of patients, to ease the pressure on the healthcare infrastructure.

States opting for home quarantine is also an indictment of the poor healthcare system and the lack of preparedness of authorities to combat the virus.

UP Additional Secretary Awanish Awasthi said the permission for home isolation would also encourage people with mild symptoms to come forward to get tested.

Awasthi’s remarks were effectively an admission that not many were coming forward to get tested for Covid-19 for fear of hospitalisation in state-run facilities, signalling the average citizen’s lack of faith in the public healthcare system.

Also Read: Covid-19 outbreak in Agra: First hit, first on its feet

In Mumbai, the civic authorities allowed home quarantine for asymptomatic patients, as well as those with mild and pre-symptomatic conditions. “We are allowing patients who have separate rooms with attached toilets so that isolation can be maintained,” a BMC officer said.

Health department officials in Mumbai said those patients under home isolation are required to have caregivers monitor their health and inform designated hospitals if their condition worsens.

In Mumbai, of the 22,443 Covid-19 cases under active medical supervision, more than 40% were receiving treatment at home.

The Greater Chennai Corporation (GCC) has recruited college students and members of Self-Help Groups (SHGs) to monitor the health of patients who were under home quarantine.

Also Read: Coronavirus: In Karnataka's Nanjangud, contact tracing in time saves lives

The mobile phones of the patients are monitored to ensure they do not jump quarantine and step out of their homes.

The GCC personnel call positive patients every day to enquire about their health and check for any symptoms.

In some areas, the GCC has opened WhatsApp groups to share guidelines and tips. The GCC has also roped in volunteers to keep track of the daily needs of those under home quarantine and supply the essentials at their doorstep. "This is one of the reasons why home quarantine is successful,” a senior GCC official told DH.

The Delhi government is providing oxymeter to patients in home isolation to regularly check oxygen levels. Once oxygen level drops below the desired level, the patient is required to inform the authorities via telephone.

Also Read: Massive testing, isolation helped contain Chennai's Covid-19 outbreak

One state which continues to buck the trend is Kerala, which is presently focusing on having Covid First Line Treatment Centres (CFLTC) and is considering home isolation for Covid-19 patients only in the next stage. Already 187 CFLTCs with 20,404 beds have been set up, with the state planning to set up a total of 742 CFLTCs with 69,215 beds by the end of this month.

Problem of enforcement

Sources in the Kerala Health Department point out that home care options involve practical issues, the major one being that most houses might not have a separate room for Covid-19 patients. Another challenge is the flouting of quarantine norms.

In an incident which occurred last week, a 30-year-old woman placed under home quarantine in Pune, managed to give caregivers a slip to reach Mumbai and take a flight to Dubai to be with her family. The matter came to light when she messaged the health official monitoring her after reaching Dubai, where she had tested negative.

Also Read: The High Court intervenes to stop Covid-19 outbreak in Ahmedabad

In Karnataka, the number of people breaching quarantine has seen a steady increase since July. The recent data, from July 21, shows that 55% of all people in 1.68 lakh people in home isolation (including Covid-19 cases, interstate travellers, primary and secondary contacts and suspected Covid-19 cases), broke quarantine norms. Some 93,743 breaches were registered between July 15 and 19.

Lax efforts

The surge in fresh cases across states also exposes the shortcomings in the contact tracing, surveillance efforts, as well as the containment strategies in places that were witnessing localised outbreaks.

Bengaluru, which has been witnessing a spurt in new cases, is trying to turn its Urban Primary Health Centres (UPHCs) into bases for Covid-19 containment and treatment operations.

“We are working on upgrading staff with medical officers and staff nurses, supplying laptops, deploying one mobile collection lab at each UPHC to help sustain constant testing and also making the UPHC a hub of operations,” said D Randeep, Special Commissioner, BBMP.

Also Read: Kerala: How hygiene, social distancing worked in Wayanad against Covid-19

However, not enough personnel have been found to fill these positions, said the new BBMP Commissioner N Manjunath Prasad. “We need many lab technicians and data entry operators,” he added.

The vacancies means that only 149 UPHCs are currently operational, when 198 is the goal. While the BBMP has recruited 976 medical staff since July 10 (including 380 doctors), it requires a potential 1,386 personnel for UPHCs alone. This excludes backup staff. The mobile collection van programme is also sputtering in Bengaluru.

The ward level and booth level committees, empowered to monitor spread of the disease in their respective areas, are faced with manpower shortages.

“Many government employees are not reporting to work, claiming that they have comorbidities and other other health issues. There is fear of the disease,” L K Atheeq, the IAS officer in-charge of implementing ward and booth level strategies for Covid-19 containment, said.

Also Read: Maharashtra: Tracking, trouncing the coronavirus in Mumbai's Dharavi

Meantime, citizen ward level committee members said that nothing much has really changed on the ground. “We have not yet received PPE kits and other protective equipment that we have been promised. How can we take stock of Covidcases or do monitoring?” asked Binu Wilson, a committee member in Begur, Bengaluru.

By scaling local measures, officials hope to catch the disease spread earlier and place more people in home isolation to reduce the burden on hospitals which are bursting at the seams.

(With inputs from Arjun Raghunath, ETB Sivapriyan, Mrityunjay Bose, Sanjay Pandey, Shemin Joy, Soumya Das)