A new study on Covid-19 patients from Singapore highlights just why it’s important to refine treatment and hospitalisation policies on the basis of science.
Bloomberg News reported on Sunday that a joint paper by the country’s National Centre for Infectious Diseases and the Academy of Medicine showed that patients were no longer contagious 11 days after infection. In other words, they had enough of a viral load to return a positive test, but not enough to infect others. Bloomberg cited a report in the Straits Times to say that the country’s ministry of health will now see if these findings need to be “incorporated into its patient clinical management plan”.
This is a significant finding for two reasons. One, most scientists now accept that the primary way in which the coronavirus disease spreads is person to person. This, despite the huge obsession researchers have had with surface transmission and the reams of literature on what’s safe to touch and what isn’t.
A minor digression is in order here: your newspaper is perfectly safe. As I messaged a friend in the neighbourhood who asked whether he should allow the papers to be delivered to his house: “It’s probably safer than many other things you do; there are no records, anywhere in the world, of anyone getting infected by a newspaper; and, in the worst-case scenario that you become the first person in the world to be infected by the newspaper, then you will be a person of interest to science.” Actually, I didn’t use the term “person of interest to science”; I said “medical marvel”.
Two, if follow-up studies establish the findings of the Singapore study to be accurate and universal, people can be safely discharged after 11 days, even if they continue to test positive. The current discharge policy in India is that a person has to test negative twice before being discharged. A change in this policy may mean less strain on health care resources. It also means people who have physically recovered from the illness, or asymptomatic people who never fell ill, can now be discharged 11 days after they first tested positive.
India has now reached a stage (138,474 cases as of Sunday night; 3,949 dead), where it has to start looking at whether its health care resources are adequate to deal with the pandemic. They probably are at the aggregate level — not at all hot spots of infection.
For instance, Mumbai’s health care resources are straining under the weight of a high volume of cases and suspected cases (anyone with symptoms is being admitted to hospitals). In the seven days to Saturday, the city saw 1185, 1411, 1372, 1382, 1751 and 1566 cases — an average of 1,444 cases a day. Sure, many of these are likely to be asymptomatic individuals who get sent to a quarantine facility or be asked to isolate at home, but at least some of them will need hospitals. Then, there are those with Covid-19 symptoms who have been tested and are awaiting results, or are yet to be tested (and have to be in hospital).
On average, between Monday and Saturday last week, 807 Covid-19 and suspected Covid-19 patients were admitted to Mumbai hospitals. The most was on Saturday, 1059, and the least on Monday, 678.
Delhi has been registering, on average, between half and a third the number of cases in Mumbai over the past few days, but the city has been lucky so far in that many of the positive cases have not needed hospitalisation. Between Monday and Saturday, for instance, the number of people requiring hospitalisation increased only by around 114 (the number doesn’t factor in the number of people who either died or were discharged, and is therefore an approximation). It also doesn’t include suspected cases admitted to hospitals. Still, while a direct comparison of the Delhi and Mumbai numbers isn’t possible, the data clearly shows the pressure on the health system in Mumbai.
This should serve as an early warning for planners in Delhi, Chennai, and Ahmedabad. They may never have to cope with a situation akin to what Mumbai is going through right now, but they should be prepared.