The Indian Medical Association is preparing an area-wise list of general practitioners who will monitor Covid-19 patients in home isolation. The Pune Municipal Corporation on its part will set up ward-wise war rooms where home isolation patients will be monitored.
Pune Municipal Commissioner Vikram Kumar told The Indian Express that he held a meeting with Indian Medical Association doctors, where the process of treating patients in home isolation was discussed.
In just 45 days, cases have risen from 1,250 to 33,000 active cases, Kumar said, adding that most of them are in home isolation. “We have asked IMA doctors to strictly monitor patients,†Kumar said, adding, “We will set up ward-wise war rooms, where doctors will be engaged in checking on patients and assessing their situation.â€
As on March 30, as many as 44,867 patients are in home isolation in Pune district, according to district health authorities. In areas under PMC, at least 27,957 people are in home isolation. Across hospitals, there are a total of 725 critical patients while 3,016 are on oxygen support.
“We have urged our IMA members to generate an area wise list of physicians who can treat Covid-19 patients online,†said Dr Sanjay Patil, chairman of the Hospital Board of India, Pune chapter. A session will be also conducted with doctors to update them on new developments in Covid-19 management.
However, Patil said that a detailed plan needs to be prepared in the eventuality that a patient’s condition deteriorates in home isolation. “Our members are not attached to big hospitals and so, IMA will be unable to find hospital beds. There should be a proper referral system chalked out by PMC authorities to direct home isolation patients to hospitals in case they turn critical,†Patil said.
Home isolation under strict monitoring and supervision by doctors is crucial, doctors across various hospitals have said. There is a tendency to delay diagnosis while home isolation protocols do not seem to be followed properly, Dr Jitendra Oswal, Deputy Medical Superintendent Bharati hospital told The Indian Express.
“There was one case with one of the members of a family testing positive and within the next two days, all 11 members were infected. Strict isolation has to be ensured to break this chain of transmission,†Oswal said. Monitoring of symptoms by expert doctors, including checking oxygen saturation levels after a six minute walk test, is important, he said, adding that the early warning signs are being missed – for instance, new symptom onset or saturation levels that need to be checked after a six minute walk test.
Patil also said that after testing positive via an RT-PCR test and doctor consultation, the patient does not report for a follow up and get the necessary tests to evaluate his/her condition. “These are big challenges and here it is important that the patients’ relatives play a responsible role,†Patil said.
Across hospitals, doctors have observed people coming in late and at a critical stage of the disease. “Either their oxygen saturation levels have dipped or CT scores have got worse,†said Dr Pradeep D’Costa, chief intensivist at KEM hospital and Sahyadri Super Specialty hospital. Dr Parikshit Prayag, infectious diseases specialist at Deenanath Mangeshkar hospital, said the number of patients in home isolation is steadily rising and at least 40 per cent from their outpatient department are youngsters. “Most do well but compared to the first wave, we are seeing more infectivity among youth,†he said.
Prof Joy Merwin Monteiro, assistant professor at department of earth and climate science at IISER, who is part of the Pune Knowledge Cluster which is closely analysing data related to Covid-19, told the Indian Express that the reason why increase in cases is so rapid will be known once changes in the virus are understood. “Last time a strict lockdown was imposed and people were careful. However, this time with gradual phase-wise unlocking, there has been less strict observance of physical distancing guidelines, which could have contributed to this large increase,†Monteiro said.
“There are three different points in the pandemic: early (Mar-June 2020), previous peak (Aug-Sep 2020) and second wave (Jan-March 2021). Our analysis indicates that mortality for the second wave is almost five times lower than the early pandemic and almost 2.5 times lower than the previous peak,†Monteiro told The Indian Express. The response of the public health system to ramp up testing from 3,000 tests per day in the beginning of February to more than 15,000 tests in the past week has also played an important role in keeping mortality to a minimum, he added.
Union home secretary raises issue of strict monitoring of home isolation patients
With a weekly Covid positivity rate of 23 per cent Maharashtra, Union Health Secretary Rajesh Bhushan has sent a letter to the chief secretary of the state regarding urgent measures to be taken in each of the worst affected districts, adopting a detailed action plan. The top 10 districts with active Covid cases in the country include Pune (59,475), Mumbai (46,248), Nagpur (45,322), Thane (35,264), Nashik (26,553), Aurangabad (21,282), Bengaluru Urban (16,259), Nanded (15,171), Delhi (8,032) and Ahmednagar (7,952 ). “Any complacency at this stage will have heavy costs,†Bhushan has written in the letter. “We need to check whether home isolation protocol is being monitored or whether the infected person has been stepping out,†Bhushan said.
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