JAILED: If any resident of the building or waddo in which you stay tests positive your entire building or colony may be declared a containment zone. For a minimum of 14 days you will not be permitted to go out of the containment area. Nor will your neighbours, relatives and friends be permitted to visit you!
By Rajan Narayan
I had a first person experience of what it is to live in a containment zone. Staying as I am just 10 meters from the containment zone I could see the trials and tribulations of those who could neither go out nor have anyone visiting them. Even essential supplies were delivered to them and they could not go out to buy them. It was like living in a prison camp where you are limited to small area for a minimum of 14 days…….
IF your neighbour or even if a member of your own family gets infected by the coronavirus, there is nothing to be so worried about! It has been our unfortunate experience that when somebody close to us gets Covid-19, we try to stay as far away from them as possible. When a patient is kept on quarantine it does not mean that he has contacted the infection.
The incubation period for the manifestation of coronavirus infection symptoms is 14 days. During these 14 days the patient is advised to be under quarantine, which means that you stay at home and do not go wandering around market or at your friends’ places. This is just to ensure that if you have the infection you do not spread it to others.
You must make a distinction between quarantine and isolation. In the case of isolation the symptoms have already manifested themselves. So the patient has to be kept alone as there is the threat that he or she will infect others who come close to them. In the case of those who are quarantined you can safely talk to him as long as you maintain a decent amount of social or physical distance or even one meter. You must ensure that not a single droplet from his mouth or his nose falls upon you. These droplets are the main agents of transmission of coronavirus.
Thousands of Goan seafarers stranded abroad have returned to the country and Goa and have been directed to self-quarantine themselves. Similarly, thousands of Indians working in the Gulf and other parts of the world have been repatriated back to their country of origin. Those who were coming back from some of the worst Covid-19 affected areas like the United States and United Kingdom include tourists. Including Goans who have travelled on cruise liners as tourists and not as employees.
SYMPTOMATIC OR NOT
IF YOU have only mild symptoms or in fact no symptoms at all, you are placed in the category of asymptomatic. Which means that you may have the infection even though you are not suffering the obvious symptom’s of temperature above hundred degrees, cold and cough, chest pain, etc. But anyone who has been out of Goa in the neighbouring states like Karnataka and Maharashtra and Mumbai which have very high rates of Covid-19 infection, nothing short of complete testing is required. The thermal gun pointed at you everywhere whether it is mall or bank, or even some shops is only very minor precaution.
The guns are actually thermal thermometers. They are intended to gauge the core temperature of your body. But high fever above 100 degrees alone or below 100 degrees are not proof that you may not be infected. The thermal gun only eliminates one symptom of Covid-19. The fool-proof method of confirming whether you are positive or negative is to extract tissue fluid from the throat or the inside of the nose. This is what is meant when people refer to as swabs. The swab taken from the nose or mouth has to be taken at a very low temperature to the virology lab. At the lab it is dipped in a solution which has coronavirus drops which changes colour if the person is positive. The nasal or oral swab’s are the ultimate test of whether you have the infection or not.
THE number of cases have been multiplying by the hundreds, particularly in the last two weeks. On an average the fresh cases have been almost 200. The only consideration is that the recovery dates are also are very high. For instance on Sunday there were 175 fresh cases as against 230 recoveries. So that net active cases come down as a result of the recoveries.
It is only when patients are critically ill that they are totally isolated. It is only recently that the Health Department approved a proposal of every patient being attended to. What happens when a patient is in isolation, the standard operating procedure in an isolation case is detailed here.
Dr Edwin Gomes, who has been the superstar working continuously for 98 days initially when Covid-19 made its entry into Goa, has been given a break. It would appear however that Dr Gomes and his team are physically and mentally exhausted. The wife of Dr Edwin Gomes has moved the High Court stating her case that her husband is 58 years old with a pre-existing condition of hypertension, so he is a high risk person according to WHO. But he has been fortunate enough to recover after being infected himself and he should not be asked to return to the Covid-19 hospital to treat patients.
Dr Gomes wife has pointed out that not a single head of department of GMC consisting of 27 departments have been appointed on duty at the Covid-19 hospital. It is obvious that the standard protocol of posting a consultant even in the Medicine Department headed by Dr Edwin Gomes, shifts are not being followed. The standard protocol is to rotate responsibility even in the Medicine Department between its six separate units.
This is in sharp contrast to the insistence of Health Minister Vishwajeet Rane who wants Dr Edwin Gomes to be permanently appointed as In-charge of Covid-19 hospital as long as the infection is not eliminated from Goa. This is a totally unfair condition as no one knows how long Covid-19 will be around us. Poor Dr Edwin Gomes had only asked for a month’s leave and even this has been denied. So much so that there is a severe shortage now not only of equipment but even medical staff to treat Covid-19 patients.
While the number of cases registered set a new record every day there are no beds available even for patients who have been identified as positive. Chief Minister Pramod Sawant has been forced to agree that patients with only mild conditions or do not display any symptoms at all may be treated at home. The protocol detailed for isolation patients applies to them only.
An additional problem is that with a rush up of suspected cases even testing facilities are falling short. In the beginning test results used to posted to the patient on the smart phone in two days or a maximum three days. In a case very close to my residence in Dempobhat though it’s been a week plus, plus and results have still not come. It all began with the daughter-in-law of the house contracting the infection at her in-laws place. She had come to her mother’s house to spend some time with her large joint family at Dempobhat, however her cough and cold turned serious with fever and an ambulance had to be called to rush her to hospital.
Unlike in the case of other diseases you cannot just ring up a hospital or hire a private ambulance. Like everything else about Covid-19 there is a uniform standard operating procedure even for taking an infected patient to the hospital. There is state toll free number and a national toll free number. In a critical condition you call the toll free number which puts you on to a doctor. After conversing with the patient and family the doctor directs a special ambulance to the resident to pick up the patient. The ambulance takes the patient to the Covid-19 hospital.
In the Dempobhat case, the patient’s family along with neighbourhood people staying in close proximity, will also have to be kept in qaurantine till the patient is cured and other members of the family test positive. As long as they are in quarantine and asymptomatic they do not pose any risk to those living within a radius of 10 meters. I am specifically mentioning this as following the Dempobhat proving to be a positive case a barricaded containment zone was imposed right from the beginning of the lane, leading to the micro containment area or residence of the patient. This created unnecessary panic and threatened to interrupt the livelihood of those working for the Goan Observer and other industrial units in the area. It also amounted to stigmatisation of the family to whom nobody would talk initially, because the rest of the residents at first thought the mere act of talking to her family would also infect them! This is not so.
When national capital Delhi was faced with a similar crises it ramped its testing capacity while simultaneously increasing the number of beds for Covid-19 patients. This went to the extent of converting the Firoza Kotla cricket stadium grounds into a giant Covid-19 facility. The problem is that you cannot mix Covid-19 patients with patients suffering from other health problems. Covid-19 cases may not be treated even in public hospitals which treat an entire range of diseases from heart attacks to neurosurgeries to fractures and knee transplants. Covid-19 is so infectious that these patients with varying diseases would easily be infected.
Conversely if there are diabetic or blood pressure patients in the hospital it can aggravate the patients of Covid-19. All this connections are described as co-morbidity conditions. This is the logic behind advising citizens above 65 years and children below five years not to sit in a garden or go for walks as they are more vulnerable to picking up infections. However, this not mean as Governor of Goa Satya Pal Malik rightly pointed out that all deaths in Covid-19 hospitals are due to co-morbidities. The death of a patient due to other serious conditions cannot be attributed to Covid-19 to inflate the numbers of Covid-19 fatalities!
The government of Goa should immediately increase testing capacity to at least a thousand a day. With fresh cases increasing on an average by 200 a day you need to test the patients quickly so that they can be treated before they turn serious. As with other medical conditions the earlier the diagnosis condition is treated the better the chances of survival.
Health Minister Vishwajeet Rane’s proposal for reserving 20% of beds in private hospitals for Covid-19 patients is Impractical. If Covid-19 load rises beyond the capacity of government hospitals and availability of beds the entire corporate hospital should be taken over exclusively for treating Covid-19 patients. The only risk is that since private corporate hospitals charge exorbitant rates there should be a ceiling imposed on charges. There have been cases where patients going to private hospitals have been charged
16 to20 lakh for a week’s treatment. The most expensive item in the billing is the PPE which has to be word by the entire team attending to a Covid-19 patient and these have to properly disposed of every six hours. If three sets of PPE are used every 24 hours on each patient who has to be treated for seven days the PPE bill alone will add up to above `10 lakh!
There is a conflict between various corporate hospitals on whether they should accept Covid-19 patients or not. Nursing homes cannot accept Covid-19 patients as they do not have more than two or three ventilators for their patients.