Even as the debate on whether community transmission of COVID-19 is happening in the State rages on, the steady increase in the proportion of serious cases and deaths where the source of infection remains mysterious is an indication that the pandemic is progressing to a new level in the State, public health experts say.
The State has so far excelled in picking up and treating COVID cases early and curing them before any complications set in. But as the epidemic unfolds, improving the care of persons with severe acute respiratory illness (SARI) and attempting to reduce the mortality in this category may be one of the newer challenges that the State might face.
Case in Kannur
The case of a 28-year-old youth at Kannur who had turned up with fever and acute respiratory distress in hospital and could not be saved (doctors say it was an exaggerated immune response or cytokine storm which led to the rapid deterioration of the patient) is a case in point.
“A chunk of our positive cases are in the quarantine pool and, hence, we have been able to test and treat them as soon as they develop symptoms. The window of opportunity to save COVID patients is within the first week of symptom onset. Once they present with acute respiratory distress syndrome (ARDS), the disease progression is rapid. In the case of all those positive cases with no epidemiological link who presented late to hospital, we had no reason to suspect COVID. By the time they were diagnosed, they were far too along to be saved,” says a senior clinician involved in COVID care.
Case progression
“Our first 500-odd cases were all mild and we had few deaths. But with case numbers as well as local disease transmission also going up, the proportion of those presenting late with serious illness and the mortality amongst them is on the rise. The prognosis has been bad for them so far but with newer treatment options such as convalescent plasma therapy working for some, we are also learning,” he said.
Senior health officials said close to 25 seriously ill COVID patients were at present undergoing treatment in intensive care units across the State. The State Medical Board is currently doing a COVID-19 death audit to analyse each of the cases. There have been 22 deaths so far and in at least eight deaths, the source of infection is yet to be ascertained.
Equip hospitals
Epidemiologists point out that as the epidemic progresses and more cases are detected from the community, all hospitals should be equipped and prepared to recognise a potential COVID patient and provide the appropriate line of care.
Clear protocols
While there are clear protocols on who should be tested for COVID-19, a careful analysis and dissemination of the clinical progression of serious cases that originated through local transmission will improve the clinical skills of doctors in the periphery and secondary hospitals to pick out potential COVID cases.
