Upsurge, despite efforts to contain!

I landed in Srinagar in the last flight from New Delhi, my first visit after 25th March 2020. On getting down besides the pleasant weather we were welcomed by pretty faces in masks, directing us in a very organized way through a channel, where officers observing all the preventive measures were noting down the detailed particulars of all the civilian passengers very courteously.  The personnel from armed forces were taken through a different route.

From this area we were made to go to a different area where again the personal data was confirmed. Those having negative COVID test reports done in the previous 48 hours were allowed to proceed to the baggage claim zone. Others were sent to the quarantine desk. Finally, there was one more checking of the identifications and address followed by taking a mandatory naso-pharyngeal swab irrespective of your previous reports. Everybody who passed through this was told to go for a home quarantine for 24 hours, till the report comes. The system was very systematic and scientifically driven.

For those who travel from Jammu by road. Everyone has to report at their destination as per their districts, where all are tested and quarantined for 24 hours by which time the report comes. If positive they are directed to health centres based upon their clinical picture. Asymptomatic persons more than 50 years of age and co morbidities like high BP, diabetes and previous heart disease are sent to COVID care centres. These centres are equipped with oxygen along with concentrators and pulse oximeters to monitor oxygen saturation. These are level 1 hospitals. One to two in each block of the district. Every block of the district is under a block medical Officer (BMO) who executes the program. Then there are Level 2 hospitals for mild to moderate symptoms like Govt Medical College (GMC) of Baramulla and Anantnag, District hospitals of Pulwama and Kulgam, Sub district hospitals of Sopore and trauma centre of Bijbehara, some of them are being upgraded. Finally, there are Level 3 hospitals: GMC, Chest Diseases and Sher I Kashmir Institute of Medical Sciences (SKIMS) Hospitals Srinagar. All these tertiary care centres are fully equipped with respiratory support systems including ventilators in adequate numbers.

This program is headed by Dr Wasim Qureshi a medical doctor holding the post of Registrar Academics at the Government Medical College, Srinagar. The success of this program is because he is not a bureaucrat and realizes the medical needs. Under his very able supervision the Valley which has 10 Districts is being kept under a strict vigil. We all know that the infection was brought in through travellers from several countries and Indian states.

Because of these strict measure’s COVID figures had nearly flattened. The mortality is around 1.6 % vs around 2.9 % for the country. The figures of positive tests are steadily increasing and the flattening of the curve which was on the verge of happening seems a bit far. Reasons of this upsurge are : widespread testing, repeating the tests earlier than recommended and lot of new populations entering the valley especially from the armed forces. In addition, all the good work is being diluted by the fact that many people still do not observe the preventive measures, on the roads and lanes of the city both in the old and new parts. On my pointing out this to a group of young men they retorted “we are ok without it and I should mind my business”. This attitude is a major problem. Otherwise health conscious Kashmiris were expected to be more responsible especially in view of the media campaigns propagating preventive measures. Public at large is not taking this pandemic seriously. It is very common to see people without masks or masks hanging around their necks and walking without personal distancing . Some of them unfortunately feel sadistic pleasure in defying the dictates of the government machinery.  More than 70 to 80% positives being totally asymptomatic gives a fillip to this. However, the silver lining is that wedding dinners have been considerably modified with a very limited number of guests and buffet arrangements instead of a traditional Wazwan where social distancing is impossible.

Patients without disease need equally good care and going to hospitals and medical centres is being avoided as elsewhere in the country. A group of 200 physicians has taken upon themselves to be available on telemedicine platform to address these issues to the best of their capabilities. They work under the banner of doctor’s association of Kashmir (DAK) lead by Dr Sohail Naik an eminent paediatrician. This has been a great success despite the limitation of the 2G only which makes communications painfully slow.

The administrative machinery is doing a yeoman’s work with excellent contact tracing and widespread testing which has remarkably contained the endemic. This work is commendable and Kashmir should come closer to Kerala model in spite of our limited resources and literacy rate being only 64% in the valley (Srinagar 74%) vs 95% in Kerala. Let Kashmir valley also be a leader in the region in containing this disease and become a trend setter.

Author is a cardiologist, past president of SAARC Cardiac Society , recipient of Dr B C Roy Award and Padmashiri. With inputs from Dr Asif Ali Khanday (posted presently as BMO Sopore) and Dr Sohail Naik President of DAK

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