The critical gaps in Kerala’s care initiatives for COVID-19 patients in home isolation need to be identified and rectified urgently as deaths due to incremental delays in reaching these patients to hospitals at the appropriate time have been going up, adding to the State’s COVID-19 mortality.
According to the Health Department’s data presented before the Chief Minister on August 28, the proportion of COVID-19 deaths due to admission delays was 22.39%. (Deaths happening at home, during transit and within one to three days of admission in hospitals are collectively taken as deaths due to admission delays).
However, beyond flagging the issue, at the field-level, little seems to have been done to resolve the issues in home care as two weeks later, this figure has gone up.
The data presented at the Chief Minister’s review meeting on September 10 shows that of the 9,195 deaths which happened between June 18 and September 3, 30.44% or 2,995 deaths could be attributed to delays in hospital admission and care.
The fact that nearly 3,000 persons who died of COVID-19 stood a chance at a better outcome had they received care at the appropriate time, calls for the Health Department doing a detailed analysis on the nature of the delays and why these could not be avoided.
Hospital care
The government’s conclusion is that all COVID-19 patients with co-morbidities should be treated at hospitals and not left for home care. But, given the high prevalence of diabetes (over 20%) and hypertension (32%) in the population, admitting everyone with these conditions in hospitals would lead to a strain on the health system, indirectly impacting COVID-19 mortality.
The COVID-19 pandemic has reached a stage wherein the virus will maintain a steady, low level of transmission in the community, with occasional waves.
In this situation, rather than focusing on testing and the number of COVID-19 cases, the State’s single agenda should be a reduction in deaths. Focusing on preventing deaths amongst those in home care should be the first step towards that goal.
“Having good guidelines will not help if at the field-level, health workers are not trained properly on monitoring symptom progress regularly and most importantly, issuing clear communications to patients. A doctor or trained nurse should talk to the patient on day 5, 6 and 9. Rather than leaving the decision-making to the families, a medical officer should direct the patient on when he/she should get admitted and which hospital to go to. It is crucial that the patient is transported to the hospital in an ambulance with oxygen support, or else the patient could go worse while in transit,” a Health Services doctor said.
Follow-up
“Regular follow-up of COVID patients in home care through tele-consult over a period of 10 days, patient education on self monitoring and encouraging those with persistent symptoms over five days to come to the hospital has helped us pick up many cases where the outcome could have been unpredictable. We have had over 3,500 cases in our home care package, of whom 5-10% were admitted following early warning signs and they have all done very well,” said Rajalekshmi Arjun, senior consultant, Infectious Diseases, KIMS hospital.
“The day of onset of symptoms is important and a consult on day 5 or 7 will give us a clear idea of the clinical course. Following up and giving clear directions to patients is the key,” Dr. Rajalekshmi said.
The State, which has a good tele-medicine network and e-health support, should have no problem in setting up a remote care model to monitor home care COVID patients
