Even as the COVID-19 case graph threatens to spiral up, the State’s sole focus should be in improving care and reducing mortality, rather than testing and containment.
Since Delta is transmitted through air, there is very little that any health system can do to stop community transmission other than mandating masks and social distancing in public places.
With less than 15% of the total active cases getting admitted in hospitals, it is quite evident that the State needs to pay more attention to improving the care of the 85% of cases who are in home isolation.
Since the beginning of the pandemic, doctors have flagged the fact that delayed arrival of patients to hospitals to be one of the major reasons for the increase in casualties.
Despite the State having brought out home care guidelines, the incremental effect of gaps in care and monitoring of patients at home, implementation at the field-level, miscommunication and systemic faults have been pushing up the mortality of home care patients.
In fact, the State’s own data analysis on 8,017 COVID deaths (the period of deaths is not clear), where delays in hospital admission might have played a key role, shows that in approximately 25% of these deaths, the patients stood a better chance at life if they had been reached to hospitals on time.
The data, presented at the Chief Minister’s COVID review meeting on Saturday, shows that of the 8,017 deaths, 444 patients died at home and 127 in transit. Of those patients who had reached hospitals, 691 patients died within a day, while 533 died within three days. Taken together, admission delays contributed to the death of 1,795 patients (22.39%).
The deaths due to delays in admission was the highest in Thrissur at 32.98%, followed by Palakkad (26.85%) and Kasaragod (25%). The lowest was in Thiruvananthapuram (15.54%).
“Many reasons can delay in presenting COVID patients at hospitals – it could be lack of awareness of the red flag signs indicating clinical worsening, reluctance to go to hospitals, failure in proper follow-up by the system and in most cases, critical delays in decision-making at home,” a critical medicine specialist said.
“The causes may vary across districts. A verbal autopsy of some of these deaths due to delays in admission in each district would show if there is a pattern in these deaths and if there are any common factors – systemic or at the field-level – that needs to be addressed, “ he said.
Many public health experts, however, do not concur with the government’s premise that shifting all patients with co-morbidities to hospitals would solve the issue.
“The basic premise that only those patients with co-morbidities are dying at home is also wrong. We have lost many youngsters to COVID because they stayed home believing themselves to be healthy. What is needed is a planned and focused approach to identifying and correcting the lacunae in home care,” a senior public health expert said.
