The Kerala government has revised guidelines for testing, quarantine, and hospital admission as the state sees a spike in coronavirus cases. The state currently has 21 active cases of COVID-19.
A circular dated March 12 states that patients with mild symptoms are advised not to come to hospitals for both testing and treatment. “Testing is not going to change either the clinical course or management of the patient with mild symptoms,” states the revised guidelines.
The state government’s strategy is based on the evidence that 75% to 80% of those affected by the coronavirus develop only mild symptoms and not do not require hospitalisation. Severe infection and mortality are seen only in high-risk groups like the elderly and those with chronic, underlying health issues.
To begin with, the guidelines define a suspect case as a patient with acute respiratory illness (fever and cough or shortness of breath) and travel history; a patient or health worker with any respiratory illness and having been in contact with a confirmed COVID-19 case; a patient with severe acute respiratory infection and requiring hospitalisation and with no other cause to display such symptoms; a case where COVID-19 is inconclusive.
The state government also provides a definition for 'contact' and classifies them into high-risk and low-risk. This is important in light of contact tracing that health officials carry out after a positive COVID-19 case is confirmed.
A high-risk contact is anyone who has contact with a confirmed case of COVID-19; travelers who visited a hospital where COVID-19 cases are being treated; travel to a province where COVID-19 local transmissions are reported; touched bodily fluids of patient; had direct contact with body of patient without protective equipment; touched or cleaned the clothes or dishes of a patient; been in close contact (within 1 metre or three feet) of a patient; co-passengers in an airplane/vehicle seated in the same row or three seats in front and behind of a confirmed case.
A low-risk contact is defined as anyone who has shared the same space (classroom, workplace and not having high risk exposure to the confirmed or suspected case); travel in the same train or bus (not in the same row or within the three-zone radius); and any traveler from abroad not satisfying high-risk criteria.
Redefining clinical categorisation
As per the guidelines issued by the state, suspected COVID-19 patients are grouped into one of three categories depending on the symptoms they are showing. Depending on the severity of their symptoms, individuals are classified as ‘high risk’ and ‘low risk’.
Category A has been defined as those with low-grade fever, mild sore throat, cough, rhinitis and diarrhoea. Those who also have lung, liver, heart, kidney, or neurological diseases, blood disorders, pregnant women and individuals older than 60 also fall under Category A.
Those with more aggressive symptoms such as high-grade fever and or severe throat and cough are classified as Category B.
Category C has been defined as breathlessness, chest pain, drowsiness and fall in blood pressure etc; children with influenza-like illness; high or persistent fever, inability to feed well, convulsions, respiratory distress etc.
In addition to the symptoms that someone is showing, if they have any underlying medical issues such as diabetes, hypertension (or any other ailment which may be aggravating the individual’s condition) these are also factored in while categorising people.
Testing and treatment
As per the new guidelines, those belonging to Category A do not require testing. These patients are advised plenty of warm and nourishing oral fluids, balanced diet, adequate sleep and rest and saline gargle for sore throat.
The guidelines mandate that patients under Category B and C require testing. Furthermore, the guidelines also state that those who have viral pneumonia with no clear cause, COVID-19 testing may be considered even if the patient is not from a country or area with local transmission.
As far as treatment of these COVID-19 patients is concerned, the guidelines state that those under Category A, should inform the DISHA helpline, but need not come to the nodal health centre. These patients should remain in home isolation.
Patients who fall under Category B should come to designated treatment centres after informing the helpline. The patient will be admitted in the hospital for treatment or advised home isolation based on the clinical assessment. The patient will also be started on symptomatic treatment based on the assessment.
Category C patients - who are those most susceptible to the virus - will be admitted in the designated COVID-19 treatment centre.
Travel advisory for foreigners
The Kerala government has also issued a health advisory for the travel and tourism sector.
Foreign nationals coming to Kerala too have been grouped into three categories, A, B and C.
Category A: This includes travellers coming from a country with local transmission of COVID-19 in the last 14 days. They have been asked to quarantine themselves in the place of stay itself. High-risk contacts have been advised 28 days quarantine and low-risk contacts have been advised 14 days quarantine.
Category B is travellers coming from a country which has reported COVID-19 in the last 14 days but there has been no local transmission. These travellers should be quarantined in the place of stay. High-risk contacts should remain in quarantine for 28 days and low-risk contacts should avoid non-essential travel and social/community contact.
Category C: This includes travellers coming from countries which have not reported COVID-19 in the last 14 days. These travellers should be quarantined in the place of stay itself. High-risk contacts have been asked to stay in quarantine in 28 days and low-risk contacts avoid non-essential travel and social/community contact for 14 days.
Category D: This includes local residents like hotel staff, travel agents, drivers, waiters, etc. who work around people coming from countries with reported local transmission contact. These people have been advised to avoid non-essential travel and contact for 14 days.
The government has stated that if the test for COVID 19 comes back negative, then the foreign national will be allowed to travel out of Kerala. Along with the test certificate, the traveller will also be given a certificate that the traveller is found to be negative for COVID 19 test but “this will no way guarantee that the traveller will not contract the infection on the way to the country of origin or in the country of origin itself or from any other source."
In all the categories, travellers have been asked to reach out to the DISHA helpline if they develop symptoms. (DISHA 24x7 phone number: 1056, 0471-2309250, 0471-2309251, 0471-2309252, 0471-2309253, 0471-2309254, 0471-2309255)