Corona pandemic has ravaged nearly whole world with morethan 180 countries experiencing epidemics at lower or higher levels. Evencountries with advanced health care facilities failed to stop deaths. Whathappened to Italy, Spain, France and Iran is not a secret now. Britain ispointing towards eminent failure so is the thrust on healthcare of USA.Manufacturing new ventilators and creating experienced manpower is yet anotheraspect of this critical situation faced by even the highly developed countries.
Present Indian health care system is no match to these longdeveloped countries so we need to devise a situation specific solution thatsuits our needs eying that our patient demographics is quite different fromrest of the world. As such our solution must be based on available experienceof the countries who lost a significant number of people to this disease.
From the data available as of now most of corona deaths canbe predicted being usually from high risk group. Age more than 60 years,patients suffering from diabetes, cardiovascular diseases, kidney failure,cancer, cirrhosis, autoimmune diseases etc., whereas most of the other patientswho get corona infection recover safely.
Keeping in view Indian statistical data on populationdemographics high risk group in India constitutes approximate 20 crores (Table )
Total population (2020) approximately……………1,340,000,000
| S. No. | Risk factor | Total number (million) |
| 01 | Age > 60 years 8% of population | 107.20 |
| 02 | Diabetics | 031.70 |
| 03 | COPD | 030.00 |
| 04 | Rheumatoid arthritis/ | 007.00 |
| 05 | Cancer | 003.00 |
| 06 | Other Immunocomprised like SLE | 000.50 |
| 07 | Cirrhosis of liver | 000.10 |
| 08 | Miscellaneous | 001.00 |
| Total | 180.50 |
Even after adding other statistical factors like imperfectdata, our number of high risk group is not going to exceed 200 million ….20Crores
if the worst comes to the worst Indian corona epidemic isexpected to kill this high risk group of 20 crores with others getting curedeither by own resistance or medical intervention. High risk group of patientscould not be saved by most of the countries with much developed healthcare ascompared to that of ours. Means even if we treat this group with whatsoeverresources we have or develop a fresh, will not be able to save them all. Does thatmean we leave this precious high risk group to die without treatment? That willnever remain a humane choice as has happened in most of countries who wanted tosave them after getting infected but failed. Our only choice of saving thishigh risk group can be achieved by keeping them in Prophylactic Home Quarantinethus saving them from getting this infection that is the only way to save themwithout getting to hospital even. There is a universal saying “if you are notstrong enough to fight against killer, be strong enough to run away”. Withhiding this high risk group from corona there will be no extra burden put oncompromised health care facility of country. Even if we procure thousands ofventilators and create make shift hospitals we will fail to save this group ashappened in other countries. The only way to save their lives remainspreventing them from getting infected and the only proper way for that remainsprophylactic home quarantine.
Rest of community constituted of low risk group can continuedaily routine but maintain use of tips for avoiding infection. Like usinghandkerchief or tissue paper while sneezing, washing hands frequently with soapor sanitizer, not shaking hands etc. etc. We need to educate all people as howto save their own lives and that of their dear ones. Low risk group must take apledge of keeping high risk group in prophylactic home quarantine. Give themtips on managing these people at home. At present administration is facingthrust in maintaining lock down on whole population, comparatively maintaininghome quarantine of only 20 crores will be a lesser thrust and manageable toperfection.
Identification of this group is easy and they can be easilyrecognized by locals and police for punishment or fine whatsoever necessary toenforce theirs home stay.
In cricket when a hard hitting batsman is not respectingfast bowlers we switch to spin bowling so as to contain the aggression of bat.In football a deadly offender is blocked by 2 to 3 players of opposition torender the talent ineffective. Just like in cricket and football defenseamounts to death same way we need to devise a mechanism of defense and offenceadmixed together to contain corona epidemic so as to win the game against allodds.
Our defense will be home quarantine of high risk group. Ouroffence will be allowing low risk group to work and earn to save lives of theirown and that of patients and prevent country from dipping into a recessionwhich will take us at least 30 years back.
Of the low risk group, people who get corona infection (eventest positive) let us home quarantine them to save others. Give them someincentive for staying back till they are recovered fully. In case of gettingill at home these patients will need hospitalization and unburdened resourcesavailable there will be utilized for this low risk group. Many lives from thispotential group can be saved and our death rate from corona will come down tonegligible levels.
With this mechanism we will not require to continue lockdownbeyond a small period of 3 weeks as devised by India already. Continuing thislock down too long will destroy economic structure of country to a level thatdeaths resulting from such meltdown may surpass the numbers of even worstproportion killed by corona in whole world.
To summarize:
- Prophylactic home quarantine high risk group.
- Home Quarantine travelers and even corona positives (latest Italian appeal that hospitals become main source of spreading infection needs consideration.
- Reason for many people avoiding hospital quarantine is the phobia of getting infected from other people harboring infection.
- Educate family as how to deal with the infected person and how to save high risk group from getting infection.
- Admit only those patients to hospitals who get complications on home quarantine.
Positive Outcome:
- Death rate will be negligible using proper use of resources
- Infrastructure and manpower will not get overloaded to a stage of failure like Italy.
- No need to develop new hospitals or buy ventilators and manpower.
- Economy will not suffer but to a negligible extent as compared to 100% lockdown.
- Family will maintain economic balance to carry on treatment of infected ones or else family will lose both economic balance as well as infected person.
Negative Outcome:
- Infection rate expected to rise in community even after we home quarantine corona positive patients.
- As such most of the population getting infected but same belongs to low risk group (knowing that high risk group is already saved by prophylactic home quarantine).
- No need to worry because low risk group can fight against disease by itself or through medical aid.
- Knowing that only a fraction of this low risk group will need hospitalization as per course of epidemic in other countries….they can be well managed by available health care resources, hence no need to develop new hospitals or buy ventilators and manpower.
Dr. Sanaullah Kuchay is Head of Department, RadiationOncology, GMC Srinagar.