Features
COVID-19: Some crucial reflections on current scenario
[MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)] is a Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka)
It is all about the present situation of COVID-19 in our country. You have probably heard about most of it by now. You may have even read many an account of it in the newspapers. For sure, you have even seen the tell-tale evidence of the prevalent situation over television channels. There is no doubt about it at all. We are definitely in a soup; quite a nasty one at that. Make no mistake, we are in the vice-like grip of this virus that has caused the pandemic and it has now got us by the throat. The variants of concern, particularly the Delta mutant, is spreading far and wide quite fast across the country. The entire island is in turmoil wondering as to what will happen in the not-too-distant future.
The situation is very definitely of the gravest concern. Our healthcare facilities are on the verge of being completely overwhelmed by the relentless march of this coronavirus. Healthcare personnel, in the frontline, are facing a real-life burnout situation, in not being able to see any light at the end of the tunnel. They are terribly exhausted, even though they continue to fight valiantly. The numbers of detected cases are rising and we know for sure that the real total of affected people is many times more than the detected test-positive numbers. The numbers of admissions, both adults and children, are rising rapidly and those needing oxygen therapy too are going up progressively. The Intensive Care Units and the High Dependency Units of the hospitals are filled to capacity with COVID-19 patients. Deaths are an indirect proxy indicator of the gravity of the situation and quite ominously, are going up exponentially. The picture is one of sustained gloom.
To make matters worse, all forecasts point to even a possible worsening of the situation over the next few weeks. Mathematical predictions, based on modelling and even common sense itself, suggest that the numbers of cases needing hospital care will escalate significantly over the next few weeks. The daily number of deaths too will go up, perhaps over 200 or even 300 in the very near future.
Immunisation against the disease, using vaccines of one type or another, is being carried out at break-neck speed and it is being promoted fervently as the final solution to the problem. It will definitely help if we can achieve vaccination for the required proportion of our population to induce that all-important protective herd immunity levels. That will mean around 70 percent of the population being successfully vaccinated with both doses for the best effect at controlling the spread of the disease. This will necessarily take time. Even if we can vaccinate the necessary numbers of people, the effect will take at least another six to eight weeks to kick in. In the meantime, the disease will rage on relentlessly.
There is nothing worthwhile to be gained by pointing fingers at various people at this late stage. Crying over spilt milk and trying to apportion blame on someone or another is certainly not going to help at all. The entire populace of the country has to act most responsibly and we need to act now. At this crucial juncture, the compelling mantra should be prevention, prevention, and even more PREVENTION.
Just for this moment in time, and for the immediate future, it is of utmost importance for the people in the country, adequately vaccinated or not, to scrupulously comply with health guidelines.
We have to avoid crowds, large gatherings, all kinds of demonstrations, celebrations and any activity that involves more than just a few people. We have to painstakingly maintain a minimum of at least one metre of social distancing. Repeated washing of hands and using hand sanitiser liberally is essential. All unnecessary travelling should be avoided at all costs. Just staying at home, as far as possible, would indeed help to prevent contracting the disease or contributing to its spread.
Through absolute necessity, many people who test positive for COVID-19 but who are either asymptomatic or have only very mild symptoms may be advised by the medical authorities to stay at home and manage themselves under medical supervision in their homes. However, it must be stressed that although their condition is not of grave concern at the time this decision is made, things might develop and even get out of hand. These people must be told what to do and what to look out for, while they are being looked after at home.
Over the last weekend, in a newspaper article, Dr. Upul Dissanayake, Consultant Physician at the National Hospital of Sri Lanka in Colombo has graphically described what they should do. His advice, reproduced verbatim, is as follows:
“Take bed rest and paracetamol only. COVID-19 positive patients should be admitted to a hospital only if their oxygen percentage drops below 96 percent, or they suffer from breathing difficulty and other major complications. If one family member becomes positive, the rest of the family is considered to be positive no matter whether they have symptoms or not. No medications other than paracetamol should be taken for fever. Bed rest is a must. Bed rest reduces the oxygen requirement. COVID-19 positive patients who are at home should rest in bed, drink 2,500 millilitres of liquid per day and measure the oxygen percentage using a Pulse Oximeter. COVID-19 positive mothers should take bed rest without attending to household chores. The patient should measure his or her oxygen level at rest and then sit and stand up six to eight times continuously and then measure the oxygen level again using a Pulse Oximeter. If the percentage drops by two, he or she should get admitted to a hospital. For example, if the patient’s oxygen level is 98 before starting the sitting and standing exercise and if it becomes 96 after completing eight rounds of the exercise, he or she should be admitted to a hospital. No COVID-19 positive patient should try to use any other method to check the oxygen level or the ability to breathe, especially the methods mentioned in social media or on the internet. They should not climb staircases to check themselves.“
This is expert advice at its best and it should be followed to the letter.
It cannot ever be over-emphasised that the name of the game should be INTENSE VIGILANCE on the part of everybody concerned, whether it is for prevention of the disease or for management of patients who develop symptoms. Health authorities would strive diligently to do their very best for our people but public cooperation is of the essence in this hour of desperate need.