Dr Aarathy MN (left) and the Kurumathoor Primary Health Center in Kannur, Kerala.
Those who have a positive and optimistic frame of mind and communicate frequently with family and friends, even if only through the phone or virtually, recover faster from Covid, says Dr Aarathy MN, assistant surgeon with the health services department, government of Kerala, who has been on Covid duty since March 2020.
Focusing on home-isolation cases in Kannur district of northern Kerala, Dr Aarathy has several observations from both waves that have hit India since the worldwide pandemic began early last year. “This time around, the 15 to 40 age group has seen the maximum deaths,” she says, noting that early vaccination among the 45+ age group may have protected them to some extent from the second wave.
But vaccinations can only do so much, as new variants of the SARS-CoV-2 coronavirus have wreaked havoc across the country’s urban congregations and have now reached the hinterlands. In fact, a new study at the Scripps Foundation in California has found that the mutations of the virus enable it to escape some of the immune response created by vaccination.
“This time, the virus is spreading much faster and if even one person in a joint family is affected, all 10 to 12 members of the family are highly likely to get it. Many cases go undetected as they may be asymptomatic. Official numbers do not reflect the truth,” says Dr Aarathy, who did her MBBS from Calicut Medical College (also called Government Medical College, Kozhikode) and MD in pathology from Pariyaram Medical College (also called Government Medical College, Kannur).
Having worked in both rural and urban areas of Kerala as part of the government’s heath department, she believes that, earlier, there were more cases in larger towns like Kozhikode but, with increasing cases in all of Kerala following the state elections last month, one can’t say how long it will be before rural areas are also equally affected.
Unlike other parts of India, Kerala has so far managed to keep its death rate relatively low, mainly due to aggressive isolation, testing and follow-ups. Those testing Covid-positive are put under quarantine for 17 days and their families for 14 days, and the government ensures that foodstuff, groceries and medicines are delivered to their homes through a team of Rapid Response volunteers.
ASHA workers, or local healthcare volunteers, report cases from their wards to doctors like Dr Aarathy, who give instructions on testing and prescriptions for immediate treatment after assessing symptoms. “In this wave, the mortality rate is higher, even in Kerala,” says Dr Aarathy.
“The challenge in the rural areas is that people don’t realise the contagiousness and severity of the virus, and don’t follow isolation and sanitisation protocol properly. They hardly wear masks, and often step out of home in breach of their compulsory quarantine,” says Dr Aarathy, whose job requires her to follow up with each patient through daily phone calls.
She says that this time, dropping oxygen levels are a major concern, but, she adds, “In the first wave, we had not been equipped with pulse oximeters (small portable devices to check the patient’s blood oxygen levels) and so I cannot say whether this variant is worse. But more Covid-positive patients are reaching critical stages and are taking longer to recover this time around. There are many more complaints of fatigue and tiredness.” Those whose oxygen levels fall below 94% need hospitalisation.
In pre-Covid days, Dr Aarathy, a mother of two little children and wife of an orthopaedic surgeon, used to see patients in the outpatient department of her primary healthcare centre in Kurumathur, which has bare minimum resources. “But now, we advise children under 10 and people above 50 to avoid coming to the hospital unless it is an emergency,” she says.
Doctors like her spend almost 10 to 12 hours a day on teleconsultations with hundreds of Covid and non-Covid patients in their assigned areas, who send them readings from their pulse oximeters through WhatsApp messages. All coordination is done through the ASHA workers, who are equipped with PPE kits and oximeters.
As an expert in home-isolation protocol for those from lower socio-economic backgrounds, Dr Aarathy shares some basic tips:
- If you are in isolation due to Covid, make sure your room is well-ventilated. Keep windows open as much as possible.
- The ideal scenario is to have an attached bathroom with the patient’s room so that no one else in the family is exposed. If this is not possible, then family members are advised to clean the bathroom or toilet with bleaching powder after each use.
- Ensure that there is a healthy caregiver for the patient as the virus is highly unpredictable. The caregiver should be taught to take full precautions – such as sanitisation techniques, social-distancing, wearing gloves while handling used utensils or clothes, and so on – and should wear a mask at all times in the home.
- The patient should be given a healthy diet including essential vitamins, and should stay well-hydrated. Taking hot water and steam several times a day are both essential to tackle the infection.
- Most importantly, both mind and body should be cared for. It is not just people with comorbidities such as diabetes or cancer who take longer to recover, says Dr Aarathy, but also those with mental-health issues or a pessimistic outlook in general.
“I had a 34-year-old healthy male patient who was always in a low frame of mind. Every time I called him, he had a host of complaints to make. It took five tests over one month for him to finally test Covid-negative,” she says, stressing that this is just one among several cases she has seen.
“Have a positive attitude, stay connected with family and friends every day through the phone or Whatsapp, think optimistic thoughts, and try to stay cheerful. Those who do so recover much faster,” she advises.First published in eShe magazine