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The revised home isolation guidelines released by the MoHFW on 5 th January 2022 is a landmark document from a public health perspective.
1. Introducing the concept of self-counting of breaths by a COVID patient to identify early signs of distress, reflects a long-overdue shift from sole focus on prevention of COVID infection to a simultaneous focus on early identification of warning signs to prevent worsening of COVID and resultant deaths. Since 2020, when the pandemic struck India, the government has focused on strategies to popularize measures to prevent infection with COVID (which constitutes the primary level of prevention). Our population became familiar with measures such as masking, distancing and vaccination (which protects against severe disease and death, even if the infection does occur). However, as expected in a pandemic situation in a densely populated country such as ours, these measures did not stop crores of people from becoming infected with COVID. Once infected, without adequate awareness regarding how to prevent the disease from worsening, lakhs of people developed severe disease, requiring hospitalizations, thus overwhelming the tertiary healthcare infrastructure leading to severe scarcity of hospital beds, oxygen, ventilators and certain drugs. This caused widespread chaos and panic, and drew attention of the government and the masses to tertiary level of prevention, which comes into play when the disease has progressed to an advanced level, and aims to prevent death. The intervening secondary level of prevention, which constitutes measures to prevent deterioration once the disease has occurred, was lost somewhere in all the noise around primary and tertiary levels of prevention. India paid a heavy price for this disregard by failing to reap maximum advantage of its favourable demographic dividend in the last two waves. Data shows we lost more lives than we should have, taking into account COVID’s age-specific case fatality rates.
2. The introduction of self-counting of respiratory rate by a person, who is home isolated with COVID, reflects a conscious step towards introducing secondary level of prevention as a major public health weapon in the battle against COVID. The secondary level deals with early identification and treatment of a disease, which has already occurred, with the aim to prevent further disease progression, deterioration and complications. If appropriately utilized, it effectively prevents majority of diseased persons from needing tertiary level of care, hence protecting the tertiary healthcare from getting overwhelmed. It also helps avoid unnecessary crowding of healthcare facilities by ensuring that those who have a mild disease do not go the hospitals. In the current scenario, where we are witnessing possibly the steepest rise in cases since the beginning of the pandemic, owing to the increased transmissibility of the Omicron variant, it is imperative to have a public health strategy to identify moderate cases at an early stage, before they turn severe. From a clinical perspective, respiratory rate could be considered an inferior indicator of respiratory distress as compared to measurement of oxygen saturation (Spo2), which until now was at the centre of monitoring guidelines for home isolated patients. However, promoting counting the number of breaths per minute (counting one rise and fall of chest as one breath) in a home isolated COVID patient (confirmed or suspected) is the ideal public health intervention due to the following reasons:
- Raised respiratory rate (more than 24/minute) is an early warning sign of respiratory distress. Appropriate medical intervention at this stage is not resource intensive and can prevent deterioration to a stage where intensive care would be needed hence avoiding the need for ICU admission, ventilators, oxygen, expensive drugs etc.
- It is an easy-to-learn skill and can be done as a part of home monitoring by the patient or the caretaker without any medical training.
- It is free of cost, unlike oxygen saturation monitoring which requires a pulse oximeter, which majority of the households in our country cannot afford.
However, including breath counting in the home-monitoring guidelines is not enough. It needs to be promoted urgently and aggressively among the masses. Just as masking and vaccination have become concepts that are familiar to the masses, similarly “Count Your Breath” needs be popularized. Official government communication to the masses must include this strategy. In addition, the healthcare providers, right from ASHA workers to intern and resident doctors and senior consultants should be sensitized about the need to counsel the patients and relatives about the same.
Spending a few extra seconds in the outpatient department, explaining home monitoring and respiratory rate counting, and giving a home-monitoring sheet to each patient will contribute immensely to avoiding a situation where our health infrastructure is completely overwhelmed. The history of public health is testimony to the fact that prioritizing public health perspective, even when it apparently contradicts the clinical perspective, saves more lives in a public health crisis. The on-going COVID-19 pandemic is no different.
These pieces are being published as they have been received – they have not been edited/fact-checked by ThePrint.