Timely intervention key to success in Covid battle

KK Talwar

Former Director, PGIMER, Chandigarh

THE timeless aphorism, ‘a stitch in time saves nine’, is certainly true in the medical field. Timely intervention and treatment lead to optimal outcomes. The Covid-19 pandemic has only underscored the importance of this dictum.

For the past two years, the whole world has been grappling with this pandemic. While the search for an effective line of treatment is on, the early availability of vaccines has been a boon for our attempts to minimise the spread and severity of infections and reduce mortality. Unfortunately, viral mutations have created new challenges. The new Omicron variant, with more than 50 mutations, has turned out to be highly infectious. It appears to exhibit immune escape capabilities, not only in relation to the available vaccines but even to the immunity generated by past Covid infections.

Available scientific data shows that the immune protection of the available ‘two-shot’ vaccines administered in our country (Covishield and Covaxin) gradually diminishes over a period of 3-6 months and a third or booster dose is necessary to ensure adequate protective immunity, particularly against this new variant. This is also true of the other vaccines. Data from Imperial College, London, in relation to the AstraZeneca vaccine (administered in India as Covishield), has shown that the administration of the third or ‘booster’ dose reduces the risk of hospitalisation by 79 per cent. In this background, the announcement by the Government of India permitting the ‘booster’ or ‘precautionary’ dose is a welcome and timely step. We do need to wait for around 14 days before the third dose begins rolling out, and the vaccine may take another two weeks from the time of administration of the third dose to stimulate the immune system to reach optimal protective immunity. Nonetheless, there is no gainsaying that a third dose of the vaccine is vital for healthcare professionals, frontline workers and other vulnerable groups.

The Omicron variant appears to demonstrate high infectivity, which is nearly four times that of the Delta variant. Obviously, its spread is rapid. The experience of South Africa, the US and European nations is before us. The variant is already in our country and the infection and positivity rates are rising almost daily in most states. The high incidence of social gatherings during this time of the year, and the inevitable political gatherings in the poll-bound states, heighten the fear of quick spread. It is imperative that we rigorously adhere to Covid-appropriate protocols, and voluntarily minimise social events and gatherings. Proper mask use is essential. It is disappointing to see many people wearing masks only to cover their mouth but not their nose. This greatly reduces the efficacy of masks and may, in fact, be as bad as not wearing one.

It is true that the currently available scientific data indicates that the Omicron variant carries a 50-70 per cent reduced risk of hospitalisation compared to the Delta variant. But this data is not adequate to fully comprehend the virulence of the Omicron variant. Given the rapid rate of spread, we will have to be prepared for potential hospitalisations and the need for ICU care. It is important to identify cases early and provide high-quality medical supervision even at the stage of moderate symptoms/illness. Optimal and timely management and care, at this stage itself, would prevent patients from deteriorating to a critical phase where hospital beds and ICUs become necessary, and avoid mortality. Past experience clearly documents that timely use of oxygen and medicines like steroids and low molecular heparin help prevent deterioration of the patient’s condition. Of course, medical specialists should stick to evidence-based practices and avoid overuse and abuse of drugs. We should not forget the danger posed by mucormycosis, which we witnessed on a big scale principally because of the injudicious use of steroids.

Both public and private healthcare institutions must rise to the challenge and ensure the availability of adequate manpower and infrastructure. Punjab needs to take special care, in view of the high prevalence of comorbidity factors among its population, which increase the risk of mortality. Proper care and management of the comorbid diseases are also important and can be a challenge amid the pandemic. People hesitate to visit healthcare facilities even for medicines and medical consultation for fear of catching the Covid-19 virus. Unfortunately, a large number of health workers being on strike in Punjab at this juncture is a matter of serious concern. It is important for health workers to realise the weight and significance of their responsibilities to the people during these times, as also for the government to address their genuine concerns. During the deadly second wave, even patients from Delhi and adjoining states had approached healthcare services in Punjab for help.

We face some challenging times ahead. Vaccination, timely detection and proper management/treatment on a war footing can see us through — coupled, of course, with an almost religious adherence by all of us to Covid-appropriate behaviour.

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