By Amitabha Sarkar
The spirit of the first phase of the lockdown unlock phase swept me and I went along with the nationwide chorus of “live with the virus”. In hindsight, that was stupid of me.
It was an uneventful day. After lunch, I felt mildly feverish. I took it to be a seasonal flu. By evening, I had a bout of sneezing and felt somewhat alarmed about my proximity to my parents who are more than 60. The first thing that struck me was to sanitise the TV remote and a few more things in my parents’ room. I had to isolate myself, that was the need of the hour. On day two, I tried to fix my fever with paracetamol. Finally, I called up my family physician. He wasted no time in advising a COVID-19 test.
With a nagging fever, body ache and terribly anxious mind, I struggled to find a government testing facility. But with no assistance from any official corner, I contacted a private laboratory but was told to wait for a day and pay Rs 2,800 — the West Bengal government has capped the price at Rs 2,250 — for an RT-PCR test.
Finally, I took the help of friends at a government-run COVID-19 hospital. They helped me to get a Truenat test (preliminary diagnostic test for COVID-19). It confirmed the presence of SARS-CoV-2 virus. On the morning of the fourth day, I went for an RT-PCR test at the same hospital. After three days, I got a call from the state’s COVID-19 nodal authority confirming that I was COVID positive. My stable medical condition and no comorbidity were a relief of sorts. I was allowed to opt for home isolation but only after providing soft copies of a doctor’s certificate along with a self-declaration.
The phone rang almost daily for 10 consecutive days – these were routine enquiries about my health status from the state COVID-19 control room. The Kolkata Municipal Corporation’s ward-level outreach team rang my doorbell thrice during the 14-day quarantine period. They dutifully handed over HCQs for my parents (as prophylaxis to exposed contacts) and conducted a sanitisation drive, both inside and outside the premises. But could they not have assured my parents and neighbours or tried to ease the environment of fear, suspicion, and panic?
My early self-isolation did help to reduce the risk to my parents. Perhaps our small family (of three members) and not-so-cramped apartment with two bathrooms also worked in my favour. The only not-so-distant contact was while taking food with an outstretched hand from my mother. The imperative to protect my aged parents made me follow the isolation as meticulously as possible.
I was clinically assessed as a pre-symptomatic mild case. I did not have prolonged bouts of coughing, sneezing or breathing difficulty; the fever receded within the first three days. I did have body ache and an inflamed tonsil, loss of taste and smell followed and persisted till day 11. I was not prescribed any drug, so I chose home remedies – steam inhalation, gargling with saline water, consuming lots of liquid and staying hydrated. Ayurveda offered immunity boosters like amla and ashwagandha. I was on a low-fat, protein-rich diet.
But on day 11, I felt immense weakness along with respiratory distress especially while talking. I got unnerved and even thought of getting myself hospitalised. I tried to combat these panic attacks by practising deep breathing and meticulously monitoring the pulse-oximeter reading. Fortunately, all this did not last for more than three days.
During this period, my experience as a public health practitioner made me ask some questions about the way in which the anti-COVID intervention is designed. Testing of individuals with symptoms holds the key to this intervention. I had to wait seven days to fall under the ambit of this intervention. Unless one is a direct contact of a laboratory-confirmed case, it is unthinkable that an individual shall report to an institution, for testing, on the very first day of getting COVID symptoms. It takes two-three days to confirm the test result in most metros. This means most of the suspected/positive cases are out of the ambit of COVID management interventions for the first five-seven days, when the person is most likely to pass on the infection.
The working of the helpline numbers in most Indian cities should be redesigned. They merely repeat the contact number of testing facilities or provide the local municipal medical officer’s number. But all this is of no help in arranging an ambulance to ferry the patient to the testing centre. Admittedly, a predominantly centralised system cannot be restructured overnight. But the delegation of responsibility to the micro-level sounds like a safer and sensible option.
From Kasaragod to Bhilwara to Dharavi, successful models in the fight against COVID have demonstrated the salience of community-level intervention, instead of limiting the management of the disease within the boundary of a medical institution. With the limitations of the existing health system, an institution-centred approach to COVID-management seems unfeasible. However, involving the community shouldn’t be too difficult a task. As a first step, there should be a syndromic assessment at the community-level. Young people in the neighbourhood should be involved in isolating suspected cases at the earliest. They should be linked to public health facilities. The early containment of suspected cases holds the key to limiting transmission.
According to the WHO, 80 per cent of COVID-19 cases display mild symptoms. But it is also a fact that 69 per cent of all households in India live in one or two-room tenements. Many of them may not have personal/separate toilets. So, community-level case management through home isolation may not always be a simple task. The capacity building of the outreach worker on the ground is imperative to guide the entire household about home quarantine management.
COVID-19 cannot be confronted by healthcare interventions alone. The mediation of social care is equally necessary.
The writer, a public health practitioner is a researcher at the Centre of Social Medicine and Community Health, JNU, and is also associated with the French Institute of Pondicherry
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