With input from Dr Monica Vasudev

1172: IMA-CMAAO Webinar on “Current situation of COVID-19 in the South”

21^st November, 2020, 4-5pm

Participants: Dr KK Aggarwal, President CMAAO, Dr Jayakrishnan Alapet, Dr Brijendra Prakash, Dr S Sharma

Faculty: Dr JA Jayalal, National President-Elect, IMA

The webinar was dedicated to the memory of Dr Gangadhar Rao, Past National President, IMA and was named “Dr Gangadhar Rao Memorial Lecture”.

Key points from the discussion

• Earlier, Tamil Nadu was contributing the major share of the total number of COVID cases in the country.
• Today, nearly 90 lakh people in the country are affected; the daily average has again started rising. The recovery rate is; however, very high, around 93.8%.
• In South Indian states (Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu, Kerala, Telangana), the active cases are coming down, except Kerala where the active cases are still high.
• In Karnataka, Andhra Pradesh, Tamil Nadu, the daily rise is coming down; 500-2000 per day; in Kerala, the average rise is 6000, though it is coming down.
• Although it may be premature to say, but now there is a positive trend – decreasing case load in every state.
• Well planned activities in a systematic manner have helped to control the disease.
• In Tamil Nadu, the amount of testing has been consistently high. It started with few thousands, increased to 50-60,000 and now it is 80-90,000 average. The state has crossed 1 crore testing. The positivity rate is much lower than the national average. The recovery rate is very high. Only 13,000 people are in the hospital. Routine hospital work, including elective surgeries, has started. Only schools and colleges have not opened yet.
• In Kerala, there is an increase in active cases since June with almost 1 lakh cases hospitalized. But cases have now started coming down. Testing has increased; daily 56 lakh testing.
• In Karnataka, earlier the cases were high, but now they have started to come down. The recovery rate is also increasing. Around 94-95% cases have recovered.
• In Andhra Pradesh, the positive cases are 8,57,000; only 15,000 active cases. The daily cases have come down.
• Testing was less initially in Telangana, but it is now picking up well. The trend is positive.
• Andhra Pradesh and Tamil Nadu are among the states with the largest healthcare workforces and public health expenditure per capita and are known for their effective primary healthcare delivery models. There were no shortages of beds; good COVID care centers.
• A good surveillance and contact tracing system early on in the pandemic has helped. These include syndromic surveillance and increased testing for all persons who seek care for severe acute respiratory illness or ILI. Area of 5 km surrounding a positive case was cordoned off as “containment zones”, daily door to door surveillance and daily follow-up of contacts.
• One of the reasons for the increased number of cases in Kerala was the festival of Onam. Hence, the government took adequate measures to educate the public about social distancing, masking and hand washing for Diwali. No increase in cases has been reported, although data not final yet.
• Total tests conducted across the country have crossed 13-14 crores.
• An apprehension is whether a second wave will come in Tamil Nadu. But, there is a belief that there will be no second wave. Good infrastructure, preparedness and awareness have had a major impact on the chain of infection.
• The slogan of “immune boosting” is being followed in South India, which may be through Ayush systems of medicine, rest, diet. So, even if a person gets the infection, it will not be severe.
• The current understanding of COVID-19 comes from studies from China and high income countries of Europe and North America. But, in low and middle income countries, the affected persons may be at higher risk of severe outcomes and face barriers to accessing quality health services.
• Traced contacts were younger and more often females than their linked index cases. Positive individuals identified through contact were younger and less likely to be male. The focus is now on pediatric age group and the asymptomatic.
• Cases in Tamil Nadu and AP showed a younger age distribution vs. cases reported in the US up to August 21, 2020.
• The incidence decreased steadily at ages older than 30-39 years in Tamil Nadu and AP, the incidence increased at ages >65 years in the US.
• The mortality is lower, especially where the mortality is less than 0.4, which is much lower than the national average of 1.6. Mortality rate in Tamil Nadu is 1.4. The low mortality rates are indicative of the preparedness of hospitals and the availability of infrastructure in healthcare institutions in South India. Tamil Nadu has one doctor per 700 population; Kerala has one doctor per 600 population. The national average is one doctor for 1000 population.
• Tamil Nadu followed the PALM regime: Prone position, Avoid activity, Low molecular heparin, Methyl prednisolone.
• Remdesivir is still being used; no decision regarding this has been taken yet.
• Differential pressure monitoring system is being adopted in most hospitals.
• Pandemics are not new to the medical profession. There have been quite a few pandemics, where the medical profession, by their sheer perseverance and collective wisdom, have been able to protect the community.
• Regarding South India, we are on the positive side and will be able to combat the disease.
• An end to the pandemic can be anticipated when it becomes endemic, when effective drugs will be found and effective vaccine will be available. Till then, we have to take care and save our patients and ourselves.
• How to conduct OPD? Avoid air conditioned rooms and try to keep the windows open, restrict old cases and review cases, don’t touch the patient documents; use the soft copy and do online consultations.
• Outside triage area: Display signage to direct patient to different areas based on their symptoms (COVID symptoms and non-COVID symptoms).
• All hospitals should have a single point of entry, no long working hours to avoid fatigue, ask patient to wash hands before entering the hospital, and provide face mask and sanitizer to all patients before entering the hospital.
• South India is facing corona cases in an optimistic mode; ensuring safety of the patients and that of the medical profession.  

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA