While the health authorities in Tamil Nadu have been talking about the relative ease of treating the bulk of patients in the State, here are figures to demonstrate that for a fact.
An analysis of COVID-19 positive cases in the State until April 29 shows that over 85% of the cases remained asymptomatic. A mere 14.7% patients report symptoms, very rarely at testing and even at the point of hospitalisation, doctors say.
“This has been the trend right through,” says Narayana Babu, Director of Medical Education. Over the months, as the number of cases increased, asymptomatic cases as a percentage of the total number of cases also went up.
For instance, out of a total of 780 patients who were treated, an earlier analysis revealed that 74.1% of the cases remained asymptomatic; 16.4% reported ‘mild’ symptoms; 5.64% reported moderate symptoms; and 3.84% of the cases had severe symptoms, requiring ICU care. These figures have since been amended favouring asymptomatic cases over symptomatic ones, as a percentage of the whole, with more people being tested, another health official added.
Serious symptoms
“When we say mild and moderate symptoms, we usually mean fever and cough — meaning that the patient might require some medication, paracetamol, antibiotics perhaps,” Dr. Narayana Babu explains. The asymptomatic people can actually stay out of hospital, and we have started sending these people from hospitals to COVID Care Centres, which we have set up in colleges and schools. It is also ideal to follow the ICMR recommendation on making sure that asymptomatic people who test positive for COVID-19 remain at home, with some supervision by medical personnel. It is the 16 % of the people who test positive that do need careful attention. “They show serious symptoms like breathlessness, and more often than not, have multiple co-morbidities — diabetes, hypertension, cardiac diseases or pre-existing lung diseases. In addition, senior citizens would be on this list, even if they do not have symptoms. They need to be in hospital and under constant monitoring,” Dr. Narayana Babu says.
In effect, this means over 85% of the population can actually be easily managed in step down institutions, or at home, if they are able to practise isolation in their home itself, a senior health official says. In them, the chest x-ray is normal, they are under 55 years of age, healthy and have no symptoms or complaints whatsoever. What happens if someone in this category develops symptoms suddenly? “We have a 108 ambulance on call at these CCCs. If necessary, it can rush the patient to a government hospital nearby for admission,” Dr. Narayana Babu clarifies.
It seems from this that Tamil Nadu has perhaps a milder presentation of COVID-19, after all, reflected in its remarkable recovery rate of 57%. The World Health Organisation in its report of its joint mission with China on COVID-19 in February 2020 recorded that “most people infected with COVID-19 virus [in China] have mild disease and recover.” But “approximately 80% of laboratory confirmed patients have had mild to moderate disease, which includes non-pneumonia and pneumonia cases, 13.8% have severe disease and 6.1% are critical. Asymptomatic infection has been reported, but the majority of the relatively rare cases who are asymptomatic on the date of identification/report went on to develop disease.”
The road ahead includes ensuring that the vulnerable populations are protected from exposure to the virus, and this would also keep the fatality rate low.
