Kerala

Spike in cases may swamp public health system

State moves into the next phase of COVID-19 containment

With the return of expatriates and non-resident Keralites (NoRKs) from other parts of the country, Kerala has moved into the next phase of COVID-19 containment, when an exponential increase in the number of cases could overwhelm the public health system.

In the earlier phases of containment, an aggressive quarantining and contact-tracing exercise had ensured that almost all of the COVID-19 cases were picked up early and case fatality kept at a low.

Handicap

Ironically, this triumph in the earlier phases could actually turn out to be a handicap in the current containment phase when hospitalisations spike and the proportion of serious cases may go up, clinicians fear.

“Our experience in the previous phases of the pandemic has largely been restricted to the management of mild cases. But moving into next phase, this “inexperience” in the management of serious cases could be a major disadvantage resulting in increased case fatality,” a senior clinician says.

Public health experts point out that dengue mortality used to be quite high in the initial years of the epidemic, stabilised only in recent years as doctors became more experienced in dengue management.

In fact, Kerala has only had a handful — may be six or seven — severe cases of COVID-19 which required ICU care and three of whom had died.

“How many clinicians in the State are aware of the critical care protocols involved in managing a serious COVID-19 patient? The lockdown period before expatriates started coming should have been better utilised in preparing the medical fraternity in managing emergencies,” he adds.

Private sector’s role

It is becoming more evident that the situation in Kerala is not something that the State health system can handle on its own and that private health sector would soon have to step in to provide care.

“Most clinicians in the private sector have had little exposure to the clinical features or course of disease progression of COVID-19. We have had nearly 600 cases but the government is yet to share any of the details with the State’s medical fraternity,” he says.

Indian Medical Association (IMA), which has a huge representation of private health sector, has already raised this issue with the government.

Kerala model

It is imperative that the rest of the doctors in the private sector are trained in the strategies of the “successful Kerala model” as the disease transmission goes up, it has said in a letter submitted to the Chief Minister.

IMA has also requested that the medical fraternity is given access to the clinical registry of patients in Kerala and the treatment course for research purposes.

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Printable version | Jun 3, 2020 7:29:09 PM | https://www.thehindu.com/news/national/kerala/spike-in-cases-may-swamp-public-health-system/article31609018.ece

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