Even as there are increasing concerns that the emergence and rapid spread of the COVID-19 sub-variant of the Omicron lineage, JN.1, can lead to a spike in cases in the State, Kerala will carefully monitor the current situation of increasing respiratory illnesses and follow the combined ABC approach to the management of influenza-like illnesses (ILI), according to Health department officials.
COVID cases have been showing a spike in Kerala since October end and many private hospitals had insisted on bringing back non-pharmacological interventions within their premises so that spread can be contained. Testing suddenly went up, which also reflected in the increase in Covid numbers.
The latest circular issued by the Health department suggests mandatory masking, especially for the elderly and those with co-morbidites. It states that all those admitted with symptoms of influenza-like illnesses and severe acute respiratory illness (SARI) in hospitals are tested for COVID-19. Those with symptoms who test negative in Rapid Antigen Test should be tested by RT-PCR.
It also states that COVID/ILI patients be admitted in separate wards in hospitals and that all healthcare workers, patients and their companions wear masks necessarily within hospitals to prevent hospitals becoming transmission points.
Hospitals have been directed to restrict the number of visitors and to test all healthcare workers and caregivers of patients if they display influenza symptoms.
In the current situation in Kerala, when there is co-circulation of various viruses – Influenza B and A (H3N2 and H1N1), respiratory synctical virus (RSV) and adenoviruses – along with Covid-19 and it is difficult to clinically distinguish between these viral infections merely on the basis of symptoms, the State will follow the new integrated guidelines issued in June this year on the management of those with symptoms of ILI/COVID.
These guidelines, “Combined ABC approach to ILI in the context of co-circulation of SARSCoV 2 and Influenza”, clearly states that those with symptoms of COVID or Influenza will be tested and treated, especially if the individuals belong to the high-risk of vulnerable category ( those with co-morbidities, serious chronic diseases, the elderly or pregnant women).
In the past four years since the first appearance of SARS CoV 2, many virus variants have emerged. However, the management of those afflicted by COVID/ILI, regardless of the nature of the virus variant, have been on the basis of red flags – drop in oxygen saturation, breathlessness, fall in blood pressure etc. An individual’s risk of developing serious disease or complications will differ, depending on his comorbidities.
Because of the high burden of diabetes and hypertension in the population and the high proportion of elderly, the State’s vulnerabilities remain high. Health experts stress that the emphasis has to be on prevention and that testing those with symptoms and treating early, augmenting non-pharmacological interventions to prevent respiratory illnesses – masking, avoiding crowded places and cough hygiene in public places – is the way to go forward.
The department has also decided to increase genomic surveillance of COVID-19 once again and has directed that RT-PCR-positive samples from sentinel sites across the State and hospitals be sent to the Rajiv Gandhi Centre for Biotechnology. Each district has been asked to send at least 15 samples every fortnight.
