Ensuring first point of contact with the health system on time, making test results available at the earliest , early identification of at risk individuals, early initiation of treatment, close monitoring for trigger signs and making all treatment modalities available in all districts are the critical nodes in the trajectory of prevention of COVID-19 mortality.
These are the key recommendations in the death audit report of the first 22 COVID 19 deaths in Kerala, put out by the Health Department.
The data was reviewed, analysed and the report prepared jointly by the State Medical Board and State Prevention of Epidemics and Infectious Diseases (PEID) Cell. .
At each of these critical nodes, multiple action points would need to be worked out in each district, the report says.
Common symptoms
COVID-19 epidemic in Kerala had resulted in 4,442 cases and 25 deaths by July 1. The case fatality rate is 0.5%. Fatigue, breathlessness and fever were the most common symptoms among patients who succumbed to COVID-19.
Tiredness or fatigue may actually be signalling breathlessness or lowering of oxygen saturation levels in the body, one of the vital indications of a patient going into COVID 19 complications. Hence it is important to include this in the awareness campaigns on COVID 19, so that ‘at risk’ individuals can be picked up early, the report says.
Among the 22 patients who died, 19 had pre-existing co-morbid conditions (86%), while three did not have any co-morbidity (14%).
There were three patients who were brought dead. Of the remaining 19 patients, 18 had two or more COVID related complications (95%). ARDS, pneumonia, Cytokine Release Syndrome, acute kidney injury and myocarditis were the common complications.
Co-morbidities
In the order of frequency, the co-morbid conditions are diabetes (32%), hypertension (23%), cancer (14%), coronary heart disease (14%), congenital heart disease (4.5%), hypertrophic cardio-myopathy (4.5%), chronic kidney disease (4.5%) intracranial bleeding and chronic liver disease (4.5%). Ten patients had multiple co-morbidities (45%).
The experts have also recommended that reverse quarantine should be strengthened.
It should be ensured that all modalities of treatment, including convalescent plasma therapy, are available in all districts and that regional plasma banks be set up to avoid delay in plasma administration.
Acute coronary events and sudden deterioration in some patients during treatment or during period of convalescence need to be addressed.
Another key recommendation is that pulse oximetry be made available at hospitals/ the points of swab collection/field/mobile units so that silent hypoxia can be identified at the earliest. Pulse oximetry should be performed in all patients seeking care for ILI/SARI/ARI.