By Dr Rouchelle Tellis

Jul 13: As we are wading through the COVID-19 pandemic with anxiety and apprehension there is one thing common among all of us and that is uncertainty. With each passing day India as a country is witnessing a new record high of positive cases and fatalities caused by this viral infection. From the time this pandemic has gained momentum, I have been a part of the team that works closely with COVID care: including infection control practices, testing facility and management of COVID cases. From this experience, I have noted that a lot of anxiety stems from lack of authentic information about this disease. Even the medical fraternity does not have a complete understanding of the virus, new knowledge is emerging of a daily basis, based on which the testing and treatment modalities are evolving. A lot of us get
carried away by the social media messages and information that has made us believe that whoever gets this infection is doomed to die.

In the last one week Dakshina Kannada (DK) district has added close to 900 new cases and 25 deaths. This surge in the number of cases can soon overburden the city’s healthcare capacity, and already there have been many reports of patients not finding hospital beds or treatment facility on time. This has led to panic and confusion about how to go about if one tests positive for COVID. However, let me assure you that the DK district administration along with the private hospitals has put in tremendous efforts over the last 3-4 months to streamline COVID care in Mangaluru.

Dear friends, with this background, I felt there is a need for reliable real time information to reach all those who need it. In the next few sentences I will try to keep you informed about how you can go about the testing and treatment of COVID-19 in Mangaluru as per the current government guidelines.

When should you suspect that you should visit a doctor?

• In majority of the cases, patients develop mild/moderate symptoms or no symptoms at all.
• Some of the very common symptoms are: fever, dry cough, body ache, sore throat, diarrhea, headache, sudden loss of smell and taste.
• More severe cases may have breathing difficulty, chest pain or loss of speech or movement.
• If you have any of these symptoms, do consult your doctor and upon their advice you can get a COVID test done.
• Several hospitals have started tele-consultation services, which can be utilized instead of visiting the hospital. All patients reporting with Influenza like illness (ILI) will be tested if indicated.

Where can the test be done

• Testing for COVID is strictly on doctor’s prescription only.
• At present, Mangaluru has 5 ICMR approved testing laboratories for COVID RT-PCR test.
• One government Wenlock Hospital laboratory where the test is done free of cost.
• Other 4 are private testing laboratories at Yenepoya Medical College, Father Muller Medical College, KS Hegde Medical College and Kasturba Medical College. Testing at private laboratories can cost between Rs 3500 to Rs 4000.

How the sample is collected and when will the report be available

• You will have to visit a sample collection kiosk where two swabs are collected, one form deep inside the nose (Nasopharyngeal swab) and other one from the throat.
• These are then sent to the laboratory in a viral transport liquid.
• Test report will be available in 24 to 48 hours.
• Stay at home and isolate yourself until the result comes.
• If your report comes negative continue to remain in home isolation for the next one week until all your symptoms subside and then can resume work.

What if you test positive?

• If the report is positive the testing lab will inform the District Surveillance Officer (DSO), who in turn will inform the local ward officials and health care workers.
• A government health team will visit the patient’s residence for a medical screening and to find out contact history.
• They will check the patient’s body temperature, oxygen levels and enquire about co-morbidities (like heart ailment, hypertension, diabetes, TB, HIV, cancer, etc.)
• This team will also inspect the facilities at the patient’s house.
• Depending on the severity of the symptoms, general health status and the provision at the house, the health team will decide if the patient is eligible for home isolation or needs to be shifted to a COVID care centre (CCC). 

Home Isolation for Asymptomatic Patients

• Home isolation is permitted for patients who are clinically asymptomatic or having mild: temperature <38?, oxygen saturation level of > 95% and age below 60 years.
• Home isolation is not allowed for those who have co-morbidities such as kidney disease on dialysis, heart disease, stroke, TB, cancer, HIV or immuno-compromised individuals.
• Pregnant women up to four weeks before the expected date of delivery can opt for home isolation.
• The person must have necessary facilities for self-isolation at home with a separate and well-ventilated room with attached washroom.
• If the home is not found to be suitable, or if the patient’s symptoms worsen, they should be immediately moved to a COVID designated hospital.

Hospital admissions for COVID patients

• All those who do not meet the above criteria for home isolation will have to be admitted either in a COVID care facility or COVID designated hospital.
• Those with severe symptoms may require to be admitted to an intensive care facility.

Hospitals providing COVID care

• Dakshina Kannada has both government and private COVID care facilities and hospitals.
• Wenlock is the government COVID designated hospital and the treatment here is free of cost.
• If the beds in Wenlock hospital are full, the patients will be referred to private hospitals with a referral letter from the District Health Officer.
• For patients referred from Wenlock to private hospitals treatment cost is covered by the State Government under the Ayushman Bharat- Arogya Karnataka (AB-ArK) scheme.
• Cost is higher if a patient approaches private hospitals directly, though the state government has capped costs.
• Package rate ceilings for Covid-19 patients directly admitted by private hospitals, making cash payment without Insurance are as follows:

• General Ward Rs 10,000
• High dependency Unit Rs 12,000
• Isolation ICU without ventilator Rs 15,000
• Isolation ICU with ventilator Rs 25,000
• An additional 10% may be charged for Twin Sharing Wards & 25% more for Single Rooms

Discharge Policy for COVID cases

• After treatment, a patient can only be discharged if they meet these criteria.
• Asymptomatic individuals who continue to remain asymptomatic will be discharged 10 days after the positive COVID test (For example if the patient is admitted on 1st July and continues to remain asymptomatic he/ she can be discharged on 11th July).
• All mild and moderate cases will be discharged 10 days after the onset of symptoms, only if the patient has no fever or symptoms for the last three consecutive days before being discharged.
• All sever cases will be discharged after complete clinical recovery and only if their repeat COVID test results are negative.
• After being discharged, the patients will be advised home quarantine and self-monitoring of health for another 14 days.

Ambulances for shifting COVID patients

The district administration has allotted separated ambulances for shifting COVID patients:

• Dial 108 for Arogya Kavacha ambulance to shift patients
• Dial 1912 if a government or private hospital denies bed

The author, Dr Rouchelle Tellis, MBBS, MD, PhD is the head of Infection Control and Consultant Microbiologist at Yenepoya Medical College Hospital at Deralakatte. She is also a part of the hospital core group working closely with COVID- 19. For further queries she can be contacted on 9449075102 or email rctellis123@gmail.com.