A tale of two States and the oncoming monsoon

PT Jyothi Datta | Updated on May 23, 2020

An already stretched healthcare system gears up for the various diseases that will be unleashed during the monsoon

Two States on the same side of the Indian coastline, Kerala and Maharashtra, are just days away from the monsoon lashing their coasts.

They are at diametrically different points of tackling the novel coronavirus (Covid-19), with Kerala topping the chart handling the infection effectively and Maharastra being in a hotspot, with the highest number of confirmed cases.

But both now brace for seasonal rain that will bring with it leptospirosis, dengue, HINI (swine flu) and malaria, to name just a few illnesses — an added stress on an already strained and stretched health infrastructure.

But the worrying aspect this time is whether the rains will cause a surge or dip in the number of Covid-19 cases. And the answer to that is far from comforting, as experts concede that it’s difficult to predict with this little-known virus.

Flood of other cases

Top virologists and doctors from across the country caution that hospitals need to set aside space in anticipation of illnesses that will flow in with the rains. Presently, many hospitals have shut down every other health programme to focus on Covid, says a virologist, on condition of anonymity, given how intensely political the issue has now become.

“Rains are conducive for increased transmission,” says the expert and in India, for example, influenza peaks in the monsoon, except in Srinagar where it peaks in winter. It’s not just hospitals but diagnostic labs too need planning and preparation to have testing kits in advance. By now, States should have made space for the flood of other cases that will come in with the rains, says the virologist.

The Kerala administration and its health minister, Shailaja “teacher”, have received all-round applause for their handling of Covid-19. But their task is far from done, as citizens are being brought in from other countries into the State, says an expert familiar with the region. In addition to the rains expected in early June are concerns on possible floods in the later months and these are all tremendous challenges for the administration, says the expert, pointing also to the recent cyclone that devastated West Bengal and Odisha.

Cluster surges

The other reason transmission of illnesses increases in the monsoon is because people huddle together in large numbers to shelter from the rains, says the expert. Such clusters, and added humidity in the air, could contribute to a surge in cases.

Covid-19 is a respiratory infection and the virus is said to be transmitted by droplets.

A microbiologist points to some literature that suggests that rain could bring down the virus and wash it away from surfaces.

She adds, however, that little is known of the novel coronavirus and it would be unsafe to go by early literature.

Working in Mumbai, also being called “the New York” of the country given the surge in Covid cases, she says the administration needs to have in place a proper system of triage where the patient’s illness, or injury is medically assessed in terms of urgency and who needs attention first.

The city’s labs are already working round the clock, hospitals and quarantine areas are being assigned and, recently, even private hospitals are being taken over in preparation for the projected surge in cases, coupled with the onset of the monsoon.

But then again, she adds, “even as hospitals are prepared and ventilators are being procured, where is the human resource, the lab-technicians etc? Doctors are stretched and their demands for protection and safety of their health are not unjustified.”

But with the reality of urban existence being crowded living and over-stretched health infrastructure, one weary doctor asks, “we are doing all we can. What more can we do?”

Maharashtra has been leading the table of Covid cases due to increased testing, Mumbai being home to many who travel internationally and having urban slums that have a high density of people living together with little chance for hygiene.

In fact, says an expert, States need to stop quibbling over numbers that have little meaning because it is not standardised data and instead invest time and resources into surveillance, to pick up disease trends and undertake targeted treatment.

And while governments set about preparing for the multiple challenges that are imminent, doctors urge administrators to also communicate more, without creating an alarm or talking down to people.

It needs to be participatory, says a doctor, as people need to understand the benefits and dangers they stand to face. Without people’s participation in keeping the surroundings clean or maintaining personal hygiene and a social distance from each other, she says it’s impossible for any campaign to succeed on the ground.

Published on May 22, 2020

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