Covid-19 pandemic is ultimately connected to our careless handling of the environment writes the author and a medical practitioner in her part memoir and part narration of the state of the healthcare industry.
When Covid-19 struck in March 2020, the Indian economy was already reeling from the tragic effects of demonetization. In addition, Kodagu had not recovered from being battered by floods and landslides for two consecutive years. Crops had been damaged, houses wrecked and tourism—a mainstay of Kodagu economy—was yet to recover fully. The lockdown in late March 2020 was imposed when we had just one positive case of Covid-19 in the district. So it was the lockdown that became our problem for several months.
With no public transport, patients who suffered from chronic and acute ailments were unable to seek medical help. (On an average, our outlying villages are 5 to 15 kilometres away from any town which might have a chemist’s shop, a public health centre, a nurse, or doctor.) Shop-owners, forced to shut down, took the brunt of the economic slide. A few shops remained open for about three hours a day but many essential provisions and medicines were in short supply…
The lifting of the lockdown in May 2020, which resulted in frenetic attempts to return to normal activity, caused a surge in Covid-19 cases. The following months saw their numbers increase to nearly 6000 cases in Kodagu…
I shut the clinic, opened it, shut it again and finally decided to stay open. I lost about two months thus, but continued to see patients at home. Epidemiologists had warned that for each clinically confirmed case, there would be at least twenty more who were infected but asymptomatic. I tried to work within the confines of this crucial detail, did my own bit of clinical detective work in tracing persons who were most likely to be affected. I learnt about building immunity against the virus naturally, and about preventive medical treatment through seminars, online conferences and newly emerging clinical data.
The best help I could get came from a friend in Pune (non-medical, from the armed forces) who sent me a steady supply of medicines and alerted me daily about new developments that I might miss. The other source of help was my brother (also from the armed forces). He provided me with a stack of N-95 masks and gloves and offered to buy me PPE clothing. The last, I declined because I was not working in a hospital environment where the risk of infection is much higher than it is for me. I do know that he supplied protective gear to a large number of medical staff who needed them.
The role of these two army guys was far, far more important and genuine than the showy praise from the Armed Forces with helicopters showering flowers over hospitals, and serenading medical staff with music, thus expending Rs 68 crore. The banging of thalis and lighting lamps to ring in good health was just as empty a gesture.
I spoke to the district health officer at the beginning of the lockdown to find out if he had some guidelines for independently working practitioners like me. ‘Madam…age…I advise you to shut the clinic and stay safe at home.’ But I was one of the three doctors working in our town and one doctor became Covid positive and had to stay off duty for a long time. We two doctors catered to patients from many of the outlying villages and the town. The gentle warning from the DHO aside, no one interfered with my work; nor did I get any guidelines.
There must be hundreds of doctors around the country who relied on their own resources to handle the pandemic in their areas. Such small, self-regulated efforts were an essential part of the rural struggle to cope with the crisis.
There has been enough evidence from several countries on the effective use of simple, safe oral medicines that can be given to patients quarantined at home. The front-runner among such drugs has been Ivermectin, a drug discovered in 1976 by Campbell and Omura and used widely in tropical countries in the treatment of certain parasites and worms. In 2015 they were awarded the Nobel Prize for the discovery of Ivermectin. Its early use has been found to be highly effective in curing 76 per cent of patients with Covid-19. It is antiviral and anti-inflammatory.
Only those who present with more serious symptoms like recurring fever, cough, breathing difficulty or decreased oxygen saturation needed blood tests, CT scan and hospital referral. Ivermectin is useful as prophylactic therapy for family members and those who have been in close proximity to infected cases, and for all frontline workers in society, like the police, traffic inspectors, autorickshaw and taxi drivers, shopkeepers, vendors—all those who have to go out on work. I first tried hydroxychloroquine for myself, as a preventive, along with Vitamin C, Zinc and Vitamin D3 and then switched to Ivermectin.
Based on these facts, I devised my treatment strategy. Those who presented at my clinic with symptoms and signs of respiratory infection were given routine treatment for three to five days. If they did not recover within three to five days, blood tests were done to rule out bacterial infections, typhoid, dengue and malaria.
If the tests pointed towards a viral infection, the patient was given the choice to either get tested for Covid-19 or to undergo a week’s treatment which I would closely supervise, by having the patient or the family member report to me on alternate days. All such patients were counselled at length about the illness, the need for distancing from family members and isolation, even within their homes.
Many of the patients I treated were hypertensive, diabetic or had other causes of chronic ill health. Since most of them had been in my care for years, it was easier for me to convince them about their role in containing the disease. Only those who presented with more severe symptoms like florid lung infections, breathing distress or extreme fatigue were referred to the district hospital.
(Excerpted with permission from Speaking Tiger from the book A Luxury Called Health: A Doctor’s Journey through the Art, the Science and the Trickery of Medicine by Kavery Nambisan)
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