The second wave of COVID-19 in the State, fuelled by the Delta virus variant, saw a steep rise in the number of COVID deaths.
With speculation rife about the pace and intensity of a possible third wave in the State, the Health Department has decided to turn its attention towards those at the highest risk of mortality, amongst the vulnerable groups in the population.
“The huge number of deaths amongst COVID-positive pregnant women was something we seemed to have no control over during the second wave. Between March-June over 40 mothers-to-be died in Kerala. COVID also claimed the lives of many with uncontrolled diabetes, chronic kidney disease, malignancy or haematological disorders. We need targetted interventions to reduce the COVID-related mortality amongst these categories ahead of the third wave,” says R. Aravind, Head of Infectious Diseases, Government Medical College, Thiruvananthapuram
COVID-positive patients presenting late at hospitals with the onset of hypoxia was a major issue that complicated patient care during the second wave. The sheer volume of patients meant that the State was forced to keep most of them in home care or at first-line treatment centres.
Lacuna in home care
And it was the deficiencies in home-based care – less than adequate follow-up care, lack of awareness amongst patients on the red flags they had to watch out for – which resulted in many patients reaching hospitals late and dying of complications later.
The Health Department is now learnt to be drawing up new guidelines for an ‘empowered COVID home care’ initiative, which could close the gaps in home-based care of COVID patients.
Treatment protocols are also being revised so that the high-risk categories like pregnant women or those with uncontrolled diabetes, are treated in hospitals and not assigned to home care, once they test positive for COVID.
Very early stage
The idea is to ensure that these patients are hospitalised as early as possible and may be offered monoclonal antibody therapy.
“The therapeutic window of opportunity for treating a patient with monoclonal antibodies is at the very early stage of the disease. These high risk patients should be tested as soon as they exhibit mild symptoms and hospitalised so that they can be started on this treatment. These are identified as focus intervention areas which may help prevent COVID deaths,” Dr. Aravind says.
In Kerala, the proportion of those who died of COVID without any co-morbidities was just 4%. Uncontrolled diabetes emerged as a major predictor of COVID mortality. With non-COVID care taking a back seat during the pandemic and all major hospitals turned into exclusive COVID hospitals, the treatment continuity of many people with diabetes and such chronic conditions had been affected badly.
Public health experts have suggested that the State devote more attention to the management of chronic, progressive non-communicable diseases like diabetes and hypertension so that the vulnerability of this population to severe COVID can be reduced.
Protocol revision is thus expected to focus on the vigilance to be maintained while treating pregnant women who are COVID-positive as well as identification of those at additional risk amongst the vulnerable categories.
