As the State’s COVID-19 graph begins to rise and hospitalisations begin to show a proportional increase, many clinicians are arguing for a commonsensical approach towards COVID-19. The breathless daily case count and projection of doomsday scenarios are only serving to trigger panic amongst people, when in fact most are mild symptomatic cases, they say.
It is possible that a chunk of these could be seasonal flu or H1N1 but there is not much information from the field or from the sentinel surveillance data of the Health department to ascertain if Omicron is in wide circulation in the community at present.
Many doctors, however, believe that the virus is already in circulation in the community. There are plenty of instances of family clusters with respiratory infections — cold, fever, scratchy throat — which they think are in all probability due to Omicron but that these might not be getting tested.
“The State’s focus continues to be only on international travellers when it comes to Omicron while scant attention is paid to inter-State travellers. We are getting plenty of patients with mild respiratory symptoms. None are willing to be tested because they do not want to go into quarantine, “ a doctor in a private hospital says.
”Once the community transmission is on, the virus eventually gets to every one. We should be encouraging people to keep calm and stay home till their mild symptoms resolve and focus only on those people whose vulnerabilities — underlying co-morbidities, immuno suppression or old age — pose an additional risk even if the disease is mild,” says T. K. Suma, Professor of Medicine, Alappuzha Medical College.
“While all available information suggests that Omicron infection is mild, we are yet to know how severe it could be in our population, especially amongst those with comorbidities. But hospital admission should be based purely on clinical indications, and not just because a patient is Omicron-positive. A chunk of the Omicron cases currently isolated in hospitals can very well be in home isolation. Omicron is expected to be the dominant strain and it is time to scale up triaging by teleconsultation and admit only patients needing hospital care,” says Rajalakshmi Arjun, Senior consultant , Infectious Diseases, KIMSHEALTH.
With just one Centre doing the genomic sequencing to identify Omicron cases, the turnaround time for COVID-positive international travellers admitted in hospitals to be declared as Omicron positive/negative is going up. If found Omicron-positive, they are kept in hospital till they test negative.
“No other State is doing this as far as we know. Isolating Omicron-positive cases in hospitals is in no way going to prevent Omicron transmission in the community,” Dr. Rajalekshmi says.
Use resources optimally
With COVID-19 continuing to claim an average of 20-25 lives daily, it is important that resources are used optimally and that the focus is always on ensuring quality care to those who really need it.
But there is so much anxiety being created over COVID that many people are being scared into demanding hospitalisation whether their illness warrants it or not. Even at the peak of the Delta wave, 90% of the hospital beds were occupied by people who never should have been there, a clinician at General Hospital says.
“Virus evolution is a continuous process and while genomic sequencing has a role in understanding the transmission dynamics, on the ground, the focus should shift to the better clinical management of COVID-19 patients so that more lives can be saved,” he adds.
Public health experts also feel that it is high time the Health department stopped handling COVID-19 as a perennial public health emergency that has to be fought with all its resources and much to the detriment of all non-COVID-19 health issues. They also suggest that COVID-19 surveillance be made a part of the regular disease surveillance under the Integrated Disease Surveillance Project, as too much human resources and time is now spent on just COVID data management.
One of the many viruses
In an Op-ed piece that appeared in the January 6 issue of Journal of the American Medical Association (“A National Strategy for the “New Normal” of Life With COVID) medical experts suggest that going forward, “The “new normal” requires recognizing that SARS-CoV-2 is but one of several circulating respiratory viruses that include influenza, respiratory syncytial virus (RSV), and more and that COVID-19 must now be considered among the risks posed by all respiratory viral illnesses combined.
