CHENNAI: Eight months into the COVID-19 pandemic, the fatality rate in Tamil Nadu has fallen marginally from 1.7 per cent in August to 1.5 per cent now. Doctors in the State attribute the improvement in outcome for COVID patients to a better understanding of the disease, which has contributed to some key changes in treatment protocol and infrastructure in government hospitals. In fact, doctors believe that the single biggest contributor to fatalities currently might be patients seeking medical attention late in the course of the illness.
Tamil Nadu reported its first COVID case on March 7 and first death related to COVID on March 25. As on Friday, October 16, the State has reported 6,79,191 cases and 10,529 deaths. What changed between March and October?
First, doctors learned that it was not ventilators that were needed for patients who developed breathing difficulties due to COVID but rather high-flow oxygen therapy. Director of medical education Dr R Narayana Babu points out that the State’s premier medical facility, the Rajiv Gandhi Government General Hospital had only 10 beds with oxygen supply when the first COVID case was reported. “Now the hospitals under the DME have 32,000 beds with oxygen supply,” he says.
In fact, RGGGH dean Dr Therani Rajan says that the hospital now has oxygen lines installed outside toilets as well.
"We noticed people falling unconscious after coming out of the bathrooms. So we put oxygen lines outside to allow them to take the oxygen before going in and also immediately after they come out," Dr Therani Rajan explains.
Second, doctors learned that steroids -- not often used to treat viral infections -- could be helpful in treating COVID.
“Initially we thought it might not be advisable to administer steroids for a viral disease. Now we have found that steroids help in the clinical outcome of the patient,” Dr Narayana Babu says.
Similarly, doctors learned that the disease also caused blood clotting.
“Initially we thought the virus affects the lungs, causing fibrosis and then deaths. Now we know that blood clotting in vessels is also a problem," he adds. Hospitals now administer blood thinners to patients at risk of developing clots.
Third, the importance of efficient nursing care has come to the fore. "Constant monitoring of vitals and other parameters of the patients is important in COVID. We also have dedicated oxygen nurses to see if the patient is getting the correct quantity of oxygen and if the patient is comfortable with the flow of that much oxygen or if it should be stepped up. That is very important," says Dr Kalpana Ramanathan, professor, medicine department, Government Stanley Medical College Hospital.
In fact, more than a disease just of the lungs, doctors learned a multidisciplinary approach is needed. “We have analysed the deaths and found that low or high levels of electrolytes in the body are also a problem. So, now we have put a dedicated nephrology team to monitor that, apart from other specialists like diabetologists for managing diabetic patients.This multidisciplinary team has really helped," says Therani Rajan.
Above all, early treatment plays a key role in reducing deaths, the RGGGH dean adds.
"Most deaths occur in late referral cases from private hospitals or in patients coming for treatment late in the course of the disease. We now know how to prevent moderate cases from becoming severe. Early intervention and constant monitoring helped,” she says.
“If patients come for treatment early they can be cured, so patients should come forward and get medical attention without delay.”