They suggest rapid antigen testing for large clusters, genomic surveillance, improving the quality of patient care
There has been a slow and steady fall in fresh COVID-19 cases over the past few weeks in Tamil Nadu. As the State gradually gets on the track towards normality, experts outline the measures that should be among the focus areas in the coming months. These should include introduction of rapid antigen testing (RAT) for large clusters, genomic surveillance, improving the quality of patient care and ensuring adherence to the safety protocol.
The Health Department has planned to increase sero-surveillance across the State, step up genomic sequencing to ensure early detection of new variants of SARS-CoV-2, the virus that causes COVID-19, and early identification of cases and initiation of the protocol-based treatment at the primary care level, according to a presentation by Health Secretary J. Radhakrishnan.
Prabhdeep Kaur, deputy director of the Indian Council of Medical Research-National Institute of Epidemiology, said, “We need to become self-reliant in oxygen [production], which was a big challenge in the second wave. We need to strengthen hospitals in smaller districts, while overall Intensive Care Unit (ICU)-capacity needs to be improved.”
The quality of care needs to be improved, said Jayaprakash Muliyil, epidemiologist and former principal of Christian Medical College (CMC), Vellore. “COVID-19 is a painful disease for many, though a large percentage of persons had sub-clinical infections. I think there should be a continuous audit of the quality of care… For instance, in an ICU, there should be constant monitoring whether the correct quantity of oxygen is given and whether the steroid dosage is right,” he said.
Is the emergence of new variants of the virus a cause for concern? Dr. Kaur pointed out, “We know that the virus is constantly mutating. As it continues to spread, it will continue to mutate. What we have learned is that new variants will keep emerging for which we need to have surveillance.” Genomic surveillance would be one way, she said. “As of now, 80% of the cases are of the Delta variant and a few cases are of the Delta Plus variant. We need to see if the new variant is replacing the older variant. So, we need to test a fixed number of samples every week. We should look for unusual patterns or sudden increases in cases and do genomic sequencing of samples lifted from such clusters.”
Dr. Muliyil added that all variants had so far respected immunity. As for the third wave being predicted by some, he explained, “In a place like Chennai, a high percentage of the population has already been infected. A large percentage of susceptible population is required for a wave to occur. There may be clusters, but a wave is unlikely.”
T. Jacob John, retired professor of clinical virology, CMC, said a third wave would be very unlikely for epidemiological reasons. “I am not saying do not prepare for any eventuality. The State is already on alert. People should follow COVID-19-appropriate behaviour, wear masks, keep others at arm’s length and avoid crowding. If a meeting is held indoors, ensure that the place is well ventilated,” he said. Vaccination should be as fast-paced as it could be, he added.
Dr. Kaur said that for better containment, rapid antigen testing should be introduced, especially in large clusters, so that immediate testing and isolation could be done. “This way containment measures will be faster as the turn-around time for RT-PCR test results is at least two days.”
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