A new study on Covid-19 patients from Singapore highlights why it is important to refine science-based treatment and hospitalization policies.
Bloomberg News reported on Sunday that a joint document from the National Center for Infectious Diseases and the country’s Academy of Medicine showed that patients were no longer contagious 11 days after infection. In other words, they had enough viral load to return a positive test, but not enough to infect others. Bloomberg quoted from a Straits Times report as saying the country’s health ministry will now see if these results should be “incorporated into its clinical patient management plan.”
This is an important finding for two reasons. First, most scientists now accept that the main way in which coronavirus disease is spread is from person to person. This, despite the enormous obsession of researchers for surface transmission and the reams of literature on what is safe to touch and what is not.
A little digression is essential here: your journal is perfectly safe. As I sent a message to a friend in the neighborhood who asked if he should allow delivery of the papers to his house: “It’s probably safer than a lot of other things that you do; there is no record anywhere in the world of a person infected with a newspaper; and in the worst case you become the first person in the world to get infected with the newspaper, then you will be a person of interest to science. In fact, I didn’t use the term “person of interest in science”; I said “medical wonder”.
Second, if follow-up studies show that the results of the Singapore study are accurate and universal, people can be safely released after 11 days, even if they continue to give positive results. The current discharge policy in India is that a person must be tested negative twice before being released. A change in this policy may mean less pressure on health care resources. It also means that people who have physically recovered from the illness or asymptomatic people who have never fallen ill can now be discharged 11 days after their first positive test.
India has now reached a stage (138,474 cases on Sunday evening; 3,949 dead), where it must begin to examine whether its health care resources are sufficient to cope with the pandemic. They are probably at the aggregate level – not at all hot spots of infection.
For example, Mumbai’s healthcare resources are weighed down by the high volume of suspected and suspected cases (anyone with symptoms is admitted to hospitals). In the seven days before Saturday, the city recorded 1,185, 1,411, 1,372, 1,382, 1,751 and 1,566 cases – an average of 1,444 cases per day. Of course, many of these people are likely to be asymptomatic people who are sent to a quarantine facility or who are asked to isolate themselves at home, but at least some of them will need hospitals. Then there are those who have symptoms of Covid-19 who have been tested and are awaiting results, or have yet to be tested (and need to be hospitalized).
On average, between Monday and Saturday last week, 807 suspect Covid-19 and Covid-19 patients were admitted to Mumbai hospitals. The highest was Saturday 1059 and the lowest Monday 678.
Delhi has averaged between half and a third of the number of cases in Mumbai in the past few days, but the city has been lucky so far as many of the positive cases did not go to hospital . Between Monday and Saturday, for example, the number of people requiring hospitalization increased by only about 114 (the number does not take into account the number of people who died or were discharged, and is therefore an approximation). It also does not include suspected cases admitted to hospitals. However, if a direct comparison of Delhi and Mumbai figures is not possible, the data clearly shows the pressure on the health system in Mumbai.
This should serve as an early warning to planners in Delhi, Chennai and Ahmedabad. They may never have to face a situation similar to what Mumbai is currently experiencing, but they should be prepared.