When the burgeoning case burden of COVID-19 is threatening to bring the State’s robust health system to its knees, the decision whether the State should let the asymptomatic cases heal at home and not choke the health system, has become a dilemma of sorts.
Community transmission of COVID-19 in Thiruvananthapuram and the formation of large community clusters in other parts of the State over the past two weeks have seen hospitals filling to capacity and the government struggling to set up more and more COVID-19 First-Line Treatment Centres (FLTC) to manage mild/asymptomatic COVID-19 patients.
The projections for the State predict a scenario wherein within a few weeks, when the epidemic scales the peak, there could be at least 75,000 people at a time filling the State’s hospitals.
With 80-85% of COVID-19 patients in the FLTCs being asymptomatic, the State Medical Board and the experts’ committee headed by Dr. Ekbal had recommended that this category of patients may remain in home isolation, with regular monitoring by the field health staff. This would free up the hospitals and FLTCs for symptomatic patients who need institutional care.
With limited facilities and resources, the numbers are already becoming unmanageable and there is immense pressure on the system to mobilise human resources to run the FLTCs.
For the government, which has already begun to feel the heat over its COVID-19 strategy coming undone, taking a decision to keep these patients in home isolation has now become a touchy affair.
Change of strategy
“So far it is our strategy of early hospital admission and treatment of all symptomatic cases and addressing any incremental issues early to prevent secondary organ damage, which has helped us keep the mortality down. Happy hypoxia, a rare state wherein the patients remain unaware of the drop in oxygen saturation in the body only to suddenly collapse and die, has been a characteristic feature of COVID-19 world over. As happy hypoxia can be totally unpredictable, sending the asymptomatic patients home could be a decision which invites political backlash, the government fears,” a senior Health official said.
The State has treated over 18,000 COVID-19 cases so far. What is the proportion of people who remain absolutely asymptomatic throughout the course of illness? What proportion begins as asymptomatics only to develop symptoms later on? What is the nature and proportion of the patients who go on to develop hypoxia? At what point in time after developing symptoms did hypoxia occur? Analysing existing patient data to elicit these answers are crucial to help the government take a rational decision regarding the care of asymptomatic patients and the logistics issues it is creating for the health system.
“If we send all the asymptomatic cases home, with the instruction that they get in touch with the health system if they develop any symptoms, we are pinning the entire responsibility of that decision on them. This could be dangerous as people are likely to dismiss symptoms like fatigue or diarrhoea and find excuses not to go to a hospital,” a public health expert said.
Support needed
The authorities will have to draw on the State’s social capital and enable systems in each locality such as ‘ayalkoottams’ to support over each other, and arrange for Pulse Oximeters/mobile apps to monitor oxygen levels and a vehicle with oxygen in each locality for accessing emergency care, if they decide to send asymptomatic patients to home care.
