Covid-19: Five ways ahead as Tamil Nadu crosses 20,000 positive cases

FIRE FIGHTING: Health staff spray disinfectant on a street in Chennai
As Tamil Nadu crossed 20,000 positive cases on Friday, here are five measures that can help the state overcome the coronavirus crisis.

Testing, isolation, protection

There are no vaccines or drugs of choice for Covid-19 yet. “There are many things we still don’t know about SARS-CoV-2, the virus that causes Covid-19 illness,” said WHO chief scientist Dr Soumya Swaminathan. “There is no escaping from widespread testing and isolation of positive cases. The only way of beating the virus by knowing where it is,” she said.

National Institute of Epidemiology deputy director Dr Prabhdeep Kaur had told TOI that the state government must test at least 10,000 people in Chennai and 8,000 more across the state every day. Also, all incoming people should be tested. When tested positive, symptomatic cases and those above 60 or with comorbidities must be hospitalised. Young, asymptomatic cases can be isolated at home or isolation units. “Use home quarantines sparingly. If allowed, volunteers or health staff should visit patients at least twice a day,” said public health expert Sundararaman T, former executive director of National Health Systems Resource Centre. But Tamil Nadu’s contact tracing has been weak. “There are no visible geographical containments in some areas,” he said.

Dealing with caseloads

Vellore-based senior virologist Dr T Jacob John says relaxations may increase caseload. For instance, the cluster of returnees testing positive is growing. “The disease is already within the community and is likely to spread more. You may not be able to eradicate it now, but it is important to bring in behavioural change among the healthy and protect the vulnerable,” he said.

Social safety nets for vulnerable groups must be expanded and attention must be given to help people with diabetes and hypertension keep the conditions under control, said senior diabetologist Dr V Mohan.

Infectious diseases expert Dr Subramanian Swaminathan said a large number of people who died in Tamil Nadu are in the middle-age group. “More than two out of five people who died were aged between the 40 and 60. We have kept mortality below 1%, but we have high premature deaths,” he said.

Sharing experiences

Extraordinary circumstance needs extraordinary measures. “Amidst a pandemic, we don’t see discussions among doctors on success and failures. Everyone needs to know about the drug of protocol that helped one hospital increase recovery rate or the one that pushed many into complications. We must do more than notifying numbers. We must upload and discuss case sheets,” said senior nephrologist Dr Rajan Ravichandran. “Despite having a large number of doctors compared to many other states, not everyone’s expertise is utilised. Doctors who aren’t treating patients can run clinical trials, peer through effects of repurposed drugs used by physicians and post relevant medical literature from the internet,” he said.

Clarity, transparency

Arming patients with vital information is necessary. The state should display treating hospitals with real-time information on the number of isolation and ICU beds so patients who want private hospitals can go to, says a senior public health official. “We have been receiving complaints that private hospitals treat only asymptomatic patients. Symptomatic patients are made to run from one hospital to another. In addition, the portal should give a range – minimum and maximum cost of treatment -- so they can take informed decision,” he said.

Scientists warn against fudging cases or death records. A senior ICMR scientist said that like many states, TN has been declaring zero deaths for many infectious and communicable diseases. “Accurate and complete recording of its causes will strengthen public health and disease profiling,” National Centre for Disease Informatics and Research director Prashant Mathur had told TOI.

Public responsibility

Communication and public participation are vital. “We know there are some things that can prevent, delay and reduce the spread of the virus. Ask everyone to wear a mask when they’re going out. Ensure they adhere to physical distancing norms. Disinfection of frequently used surfaces, respiratory etiquette and hand washing will help, especially in work places and public spaces,” Dr Soumya Swaminathan said. Behavioural change is important and it may be possible for the government to ensure this is followed for a long time. “NGOs can be roped in to bring in public awareness. We should also have community leaders and role models explaining the facts,” she said.

The Chennai police have the uphill task of enforcement. Commissioner A K Vishwanathan said the force has to be protected from the virus. Not just sanitisers, masks and tablets, the department is in the process of boosting up the morale of the force. “A lot depends on public cooperation,” he said.