How asymptomatic contacts shaped seventh-day testing plan

How asymptomatic contacts shaped seventh-day testing plan


GURUGRAM: It was an aberration in Haryana’s Covid-19 cases that led to its fast recovery rates. The state, with a 67.63% recovery rate, is doing much better than the national average (20.52%).
The case doubling rate, at 17 days, is also much lower than the week-long rate nationally. The road that led here started with a problem — most people eligible for tests through contact tracing either had no symptoms or no travel history.
“It was a challenge. When a person is asymptomatic but has the infection, the immune system may fail to protect the body from the virus,” said Dr Suraj Bhan Kamboj, director of Haryana health services. Besides, data shared by the health department till April 17 showed 9% of those who tested positive had no travel history at all and 34% had only travelled within the country. This meant cases could go undetected unless large clusters showed up or cases turned serious.
To make sure things didn’t go that far, the state changed its testing strategy. First, it started quarantining everyone with any travel history, irrespective of whether they had symptoms. Then, it cut short the testing period by half. The most widely followed protocol is a 14th-day testing plan based on the incubation period of the virus known so far — those quarantined are tested on the final day. The Indian Council of Medical Research (ICMR), in its last guidelines for testing, had recommended a seventh-day testing plan for those with influenza-like illness in hotspots, clusters and areas with large gatherings of migrants or evacuees. But Haryana adopted the approach for every case.
“We conduct tests on suspected Covid-19 patients on Day 7 of isolation instead of Day 14 as prescribed by ICMR,” said Dr Dhruv Chaudhary, nodal officer for the state’s response to Covid-19 and head of the department of pulmonary and critical care at PGIMS, Rohtak. It was the institute which started the seventh-day tests in the early days of the outbreak, later adopted by all districts. If the first test on Day 7 comes back positive, the person is sent to the isolation ward of a hospital right away — cutting short what would have been seven more days of waiting for contact tracing, sealing, sanitisation. If the test is negative, the person stays on in quarantine but is tested again on Day 14.
In addition to testing faster, the state has also been testing wider.
As of Friday, it had conducted 743 tests per million, much higher than the national rate of 434 tests per million. It has put 34,122 people under surveillance so far, of which 17,998 have completed their surveillance period. It already has six government labs and six private labs, and is preparing to add five more — in Nuh, Hisar, Karnal, Rohtak and Panchkula.
When it comes to treatment, Haryana has customised that as well. Since there is no known cure of the novel coronavirus infection, treatment focuses on alleviating symptoms. That usually entails a cocktail of antibiotics and flu medicines. “We didn’t follow the textbook pattern. Each case is different. So instead of defining a standard operating procedure, we administer treatment on a case-by-case basis. Each patient is different and the disease manifests in different ways. This has also helped fast recovery,” Dr Chaudhary said. In fact, not one of the 86 active cases in the state has needed medical attention for more than 14 days.
That also has to do with the age profile of patients. The latest data on patients in the state, till April 17, shows most of the patients have been between 10 and 30 years old — 65 of the 181 till then. Those between 50 and 70 accounted for 54 cases and those between 30 and 50 made up the base for 53 cases. The number of cases has gone up to 275 as of Friday, but the trend remains the same.
“In Haryana, it is mostly young people who have been infected with Covid-19. So they have recovered quickly,” said Dr Kamboj.
Then, the state has been fast setting up the health infrastructure needed for Covid-19. As of now, it has six dedicated hospitals for Covid-19 cases — in Rohtak, Khanpur Kalan, Sonepat, Nuh, Karnal and Agroha. It is setting up exclusive Covid wards in 27 other hospitals. And it has asked all hospitals in the state — government, aided and private — to set aside 25% of the beds for Covid-19 patients. “I would say it has worked so far,” said Dr Kamboj.

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