TRIPURAINFO

"COVID-19: Asymtomatic cases are burden, but overall success is visible!"

Dr Basab Ghosh

April 23, 2020, 14:01:31   

Tripura and Sikkim both have geographical position wise similarity, both have huge international border and connected with mainland by a stalk! If Sikkim is the crown of India, Tripura is definitely the hanging hip pocket! Still Sikkim could restrict entry of coronavirus by their wise wisdom.

1. They stopped entry of foreign tourist form 5th march 2020, though WHO declared pandemic on 11th March.

2. From 17th March 2020, further they stopped entry of all outsider countrymen who were travelling as tourist. So, all travellers' entry restricted much before countrywide lockdown from 25th March.

3. Their main income is tourism, but they could lock the entry of travellers because of strong wisdom of both the administration and common public.

4. Even during lockdown disciplined populations following the government orders by their hearts. Since loosening of lockdown government servants are attending office by only dedicated government vehicles.

Lockdown and social distance cannot be fruitful only by strict government administration; the understanding and discipline of every citizen is the root of success. In Tripura we could be free from COVID-19 if we were alert like Sikkim! Our both the cases entered through railway station. If our railway screening was tight enough like airports, if our passengers were disciplined to follow the instructions, lastly if they had wisdom for own motherland!

In Tripura, first case was symptomatic COVID-19 positive patient. Covid-19 symptoms are fever, dry cough, tiredness along with loss of smell, loss of taste, body ache, headache, heaviness of head, etc. Please note that fever, dry cough is very important, and then only other symptoms will be considered for clinical diagnosis. In addition, some people have gastrointestinal (GI) symptoms, such as loss of appetite, nausea, vomiting, diarrhoea, and abdominal pain or discomfort associated with COVID-19. These symptoms might start before other symptoms such as fever, body ache, and cough. The virus that causes COVID-19 has also been detected in stool, which reinforces the importance of hand washing after every visit to the toilet and regularly disinfecting bathroom fixtures for COVID-19 positive cases.

According to ministry of health govt of India, 20% COVID-19 positive cases show symptoms as mentioned above. However all of them do not require hospital treatment. Few cases that have mild symptoms are improved within 14 days strict isolation and with close monitoring over telephone and symptomatic medical treatment for mild fever, dry cough, headache, body ache is enough. They should be isolated for 14 days strictly in a room or dormitory of a centre or may be in their own house strictly away from other family members. As they have some symptoms their viral load is more so chance of spreading is more. But 15% of total COVID-19 cases become severely symptomatic with fever more than 101 degree F, dry cough becomes worse and complains some sort of breathing difficulty, and then hospital treatment has to be given. Only 5% of total COVID-19 cases become critically ill requiring ICU support.

In Tripura, our 2nd coronavirus positive case was detected during contact tracing after the first positive case confirmation. Our administration is doing very systematic work in contact tracing maintaining the protocol guided by ICMR. This COVID-19 positive case did not have any symptoms or trouble mentioned above; his condition is called asymptomatic positive. However he was immediately hospitalised.

Some people become infected but don't develop any symptoms and don't feel unwell; they are call asymptomatic. About 80% of total positive COVID-19 cases are asymptomatic. They recover from the disease without needing special treatment; only strict isolation of 14 days is needed so that they should not spread infection to anyone. They should be isolated 14 days strictly in a room or dormitory of a centre or may be in their own house strictly away from other family members. Hospital treatment is not required for them. In between swab test is done to confirm negative virus load and two consecutive negative tests are confirmatory of their coronavirus free certificate.

Chinese authorities began publishing daily figures on 1 April 2020 on the number of new coronavirus cases who do not have any symptoms of the disease (as we call them asymptomatic) and with the first day’s figures suggesting that around four in five (80%) coronavirus infections caused no illness. Asymptomatic cases or asymptomatic patients are same group of persons; they are showing positive swab test result but are apparently fit, however are capable of spreading the disease with the virus through their droplets. They remain totally asymptomatic in their 14 day isolation period or may develop some symptoms which may or may not require medical treatment. So, they do not require hospital treatment in the isolation period, rather they should be isolated 14 days strictly in a room or dormitory of a centre or may be in their own house strictly away from other family members. On 14th day as per the protocol of the country if there swab is again tested to confirm negative virus load it is always better. Asymptomatic cases are disease carrier, so should be tested till they become negative.

As total 80% are asymptomatic, 16000 are asymptomatic in India if total coronavirus positive cases are 20000 and they do not require hospitalisation. With this protocol,

  1. We could save lots of Govt money by avoiding hospital admission.

  2. We could prevent hospital spreads among health workers. Italy did the mistake and lost maximum doctors life!

  3. Even we could avoid coronavirus contamination of the hospital, otherwise where the non corona patients will go for treatment?

  4. The saved money from unnecessary covid-19 hospitalisation of asymptomatic patients can be extended to the lockdown affected families or for contact tracing.

  5. It is very difficult to detect asymptomatic cases and they can be found out only after tracing the contacts of people who have been tested positive. Tracing of contacts are mainly administrative work, involves lots of man power, coordinative works and huge money is involved in the whole process.  

Many experts believe that unnoticed, asymptomatic cases of coronavirus infection could be an important source of infection. "80 per cent of the cases are asymptomatic. Our biggest worry is on their detection. There is no other way than contact-tracing," said Dr Raman R Gangakhedkar, a senior scientist at the Indian Council of Medical Research (ICMR). The top scientist also added that testing everyone is almost impossible.

Around 1 out of every 6 people (15%) who get COVID-19 becomes seriously ill and develops difficulty in breathing seeking immediate hospitalisation. Doctors call it SARI - severe acute respiratory illness.  In Tripura first COVID-19 case was admitted in the hospital with SARI. Out of 20000 total covid-19 cases in India 3000 patients require serious hospital care. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. Out of all severe illness cases only 5% become critically ill; 1000 cases out of 20000 total cases require critical care. Death in India per million (1 million is equal to 10 lakhs) populations is least among all countries; total death is 645 out of total 20178 COVID-19 cases and rate is 0.5 per million populations.

Lots of hope is promising from all countries as death rate is decreasing. The graph below shows death tolls are either at peak or falling in many countries!

Ultimate goal of the world should be preventing of death, so death per million population index should be the primary end point. Testing per million population index should be the secondary end point to isolate infections. India successfully managed top of the list in the death per million index, because of the following reasons,

  1. Earliest lockdown by our Prime Minister under the best guidance of ICMR (Indian Council of Medical Research).

  2. India is having the world best health professionals as bold frontline warriors who always give best out of limited resources.

  3. ICMR is the best organization with limited resources.

"Make no mistake, Virus will be with us for long time" WHO mentioned in their 22nd April 2020 press release. In a war, we need to rectify our mistakes and keep on correcting our future actions! COVID-19 pandemic is like third world war against a tiny human respiratory coronavirus. Here the take home messages from this article are given below.

  1. It is very difficult to detect asymptomatic cases and they can be found out only after tracing the contacts of people who have been tested positive. Tracing of contacts are mainly administrative work, involves lots of man power, coordinative works and huge money is involved in the whole process. If public do not support total success is impossible.

  2. Asymptomatic COVID-19 positive cases should be isolated 14 days strictly in a room or dormitory of a centre or may be in their own house strictly away from other family members. They do not require hospitalisation.

  3. Developed countries are not spending for hospital treatment of 80% asymptomatic COVID-19 positive cases. Asymptomatic COVID-19 positive are treated at home isolation. Might be in India our illiterate population will not allow home isolation of COVID-19 positive for treatment in their own locality. So we are wasting huge money on hospital treatment of asymptomatic positive cases.

  4. Death per million population index should be the primary end point and testing per million population index should be the secondary end point to isolate infections. In India total tests done is 4,62,621 and rate of testing is 335 per million populations. However death in India per million populations is least among all countries; total death is 645 out of total 20178 COVID-19 cases and death rate is 0.5 per million populations. Developed countries are spending their money for testing. When in USA total tests done is 41,90,002 and rate of testing 9367 per million populations; total death is 45,343 and rate is 137 per million population.

  5. If we see examples from developed countries, country is abided by the protocol of treatment and law. Many countries are punishing for breaking home quarantine protocols. In Australia they are charging 17000 dollars as punishment for breaking self quarantine!

  6. With utmost surprise of other developed countries, our own population are even misbehaving with health workers involved in Corona treatment in many extreme ways!

  7. Our media and political analysts criticising without understanding the basic problem of India; illiterate population is our basic problem! 

Our administrative authority understands all points, but implementation is not possible because our in general population do not realize own responsibility like developed country citizens or even our own countrymen of Sikkim! Our people are playing hide and seek for coronavirus testing during contact tracing! Police is required for implementation of social distance in the market, and breaking lockdown has become a game of the city!

 

In spite of all that India is successfully managing COVID-19 battle! Before historic countrywide lockdown doubling time of total COVID-19 cases were 3.4 days and now after 28 days of lockdown doubling time of total COVID-19 cases are 7.5 days; it is a tremendous success story where whole world is looking at this huge populated country. In India total death is 645 out of total 20,178 COVID-19 cases and death rate is 0.5 per million populations which is least among all countries.

 

I believe after corona pandemic, our education system should be revised to introduce basic health science on priority from early childhood and our accelerated health budget should emphasise more on preventive medicine!

   

[Dr Basab Ghosh, Diabetologist, Dr Basab's Diabetes Care, Opposite Ramnagar 3, Krishnanagar, Agartala, Tripura. email: drbasabghosh@gmail.com ]

(Tripurainfo)

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