India needs a database of ‘long covid’ cases and complications

Photo: Bloomberg
Photo: Bloomberg

Summary

We must not just deploy healthcare resources to villages but also set up systems to monitor and study post-covid complications

As the country awaits more reassuring findings following its dip in covid cases, a stark contrast waits to be addressed in its rural areas. India’s first wave was largely about the elderly population and big cities. The fight, hence, became more about containment than medical assistance. Now, with partial lockdowns, the virus spread has affected the country’s working-age population and tier 2 cities.

Judging by the death numbers in rural India, there are no winners in this battle yet. The pandemic continues strongly, straining our healthcare system. India needs to arm itself against two key concerns: restricting case numbers in rural areas, and addressing post-covid symptoms among its recovered population. A disproportionate focus on tackling cases in urban areas and infrequent reporting from rural regions has thrown up a yawning gap in the prevalence of cases in cities vis-a-vis rural areas.

Unreported deaths in rural areas remain largely untracked. Images of cremations from cities have flooded the news, with almost no reports from villages. Rural deaths often are attributed to causes other than covid. This is more often because of accurate details not being shared by the kin, as also misdiagnosis. Add to this the deficit that exists in medical facilities in villages and tribal areas.

With care-giving facilities spread sparsely across vast areas, immediate medical attention is difficult to obtain in rural India. As the virus shows alarming progression, the deficiency of specialized testing kits in community health centres needs to be plugged on a war footing. Adequate screening of patients can happen only once primary level health infrastructure is strengthened. Much like the National Tuberculosis Programme, a dedicated team of workers and doctors can be placed in villages to deal solely with covid-related concerns. Rather than setting up makeshift facilities in urban locations, existing health centres in rural areas can be re-purposed as dedicated covid facilities, with adequate oxygen concentrators, hospital beds, essential medicines and health professionals.

ASHA workers going door-to-door for surveys must be provided basic equipment like pulse oximeters and non-contact thermometers to track symptoms, and refer serious cases to covid health centres via pool cars that could be stationed in villages in the absence of ambulances.

Breaking the chain of the virus requires its timely reporting. With looming fears of forced admission to hospitals, delayed reporting of symptoms only adds to the numbers afflicted by covid. That post-vaccine fever is being perceived by large numbers of people as being symptomatic of the illness itself adds to the problem. Hesitancy in getting a vaccine jab frustrates India’s aim to vaccinate the larger part of its population that resides in rural belts.

A way of encouraging more people to get vaccinated is to get sarpanchs or pradhans (village chiefs) to act as government agents. These local leaders can be supported by panchayat-level funds from the government, while existing finances can be deployed for the distribution of medicines and creation of isolation beds. In this emergency, those with influence in villages, like patwaris, teachers, anganwadi workers, policemen and home-guards should effectively be used as motivators and counsellors against siren songs of vaccine resistance.

The set of standard operating procedures on covid issued by the ministry of health and family welfare on 16 May recommends training village heads through the Diksha portal (bit.ly/33W3Npp). However, the site’s training content needs to be made more interactive, with audio visuals, and translated into local dialects, so as to increase its reach in tribal and semi-urban areas. This is a measure which, if implemented with careful handholding, can prove crucial in securing gains in this health crisis.

A clear pattern confirms that intramural cases have formed a major part of the caseload in this second wave. Without being dismissive of symptoms, some of which are common to a huge pool of patients, India must work on creating a database for post-viral impairment faced by those who have recovered fully. A further, and perhaps more useful, subgrouping in such a database could be of age groups and gender profiles. Surely, there remain complications that necessitate a wholly different medical study in the country of how this virus affects bodies over an extended period of time.

Mucormycosis is an invasive infection being talked about lately. Similarly, other complications like chronic fatigue, pneumonia, prolonged bouts of fever, neurological disorders, and pulmonary problems need to be assessed. Even if not fatal, these trends need due documentation and assessment for doctors to treat ‘long covid’ disorders.

Corona control rooms set up in districts can be a good medium to track this trend. From teams that are currently deployed to offer tele-medication to patients, a select number of people can be dedicated to follow up on recovered patients and prepare records of post-recovery complications. On a pan-India scale, students enrolled in medical colleges can also be tasked with monitoring post-viral symptoms in clusters to help with the database.

As of now, India is looking at a pandemic which demands a model that also involves behavioural change to suppress its spread. Government authorities should ideally maintain clear communication with the public, enabling people to see on what grounds decisions are being taken at the highest levels. There is an opportunity to change course before super-spreaders like weddings and crowded gatherings nullify containment efforts. Beyond doctors and health workers, this needs the participation of all citizens. Among fundamental duties, the Indian Constitution speaks of a need to develop a scientific temper. How we contribute to arresting the progression of this pandemic at our individual level is a litmus test of our education and awareness as a society. A scientific temper must be developed, and its application in combating covid is a good place to start.

Falguni Tewari is a policy analyst. Her twitter handle is @falgunipmd

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