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Kerala braces up for tripledemic

Dileep V. Kumar/ Thiruvananthapuram, Dec 25

Kerala is fearing ‘tripledemic’ as Christmas/New Year fever grips people. To tackle the same, the state is set to reintroduce non-pharmaceutical interventions (NPIs) among its population. 

The ‘tripledemic’ scare, which includes, influenza, respiratory syncytial virus [RSV] infections, and SARS-CoV-2 cases is being planned to tackle using NPIs like masking, physical distancing, hand hygiene, cough and sneeze etiquette and optimizing indoor ventilation.

Releasing a 10-point advisory on December 24, the state health department underscored that the state at present is dealing with a ‘twindemic’ – co-circulation of SARS-CoV-2 and influenza viruses and chances of ‘tripledemic’ are high. 

“Considering the festive season, a spike in fresh Covid-19 infections and importation of highly immune evasive variants to the state is being expected,” reads an excerpt from the advisory. 

It further added, “Moreover, other respiratory viruses with the same transmission dynamics like influenza and RSV are presently circulating in the state. In this regard, augmentation of NPIs is essential to bring down the burden of respiratory infections.” 

The 10-point advisory 

1. Universal masking, physical distancing, and hand hygiene is desirable and should be ensured. 

2. Elderly and those with co-morbidities should practice mandatory universal masking, physical distancing, and hand hygiene.

3. Cough and sneeze etiquette should be followed by everyone. 

4. Respiratory virus transmission dynamics is closely related to the 3 Cs

> Closed spaces with poor airflow like lifts

> Crowded places like markets

> Close contact settings with face-to-face contact

While in 3C settings, to decrease respiratory virus transmission NPI should be strictly adhered to.

5. Children with influenza-like illnesses should not be sent to school.

6. All elderly and those with co-morbidities should ensure that they have received COVID-19 precautionary dose as vaccination can decrease COVID-19 severity and mortality.

7. Ensure proper indoor ventilation. This can reduce surface contamination by respiratory viruses.

8. People with uncontrolled diabetes have an increased risk of severe disease, ICU admission, and mortality. Poor glycaemic (presence of glucose in the blood) control is associated with worse outcomes. Hence to decrease the morbidity and mortality due to respiratory viruses, ensure that the co-morbidities are addressed and glycaemic status and blood pressure are controlled.

9. The management of diabetes in patients hospitalized for COVID-19 is similar to all inpatient diabetes management. As Kerala is having a higher prevalence of diabetes screening for undiagnosed diabetes must be done in all patients with COVID infection.

10. Ensure a healthy lifestyle.

What’s NPI? 

An official with State Covid Monitoring Cell, on condition of anonymity, said that NPI is the most effective intervention against Omicron variants like BF.7 and recombinant variants like XBB and XBB.1, which have very high antibody evasive potential. 

“The effectiveness of NPIs is of proven one. The European Centre for Disease Prevention and Control had itself stated that after vaccination, NPIs are the most effective public health intervention against Covid-19,” said the official. 

According to the official, there is nothing new with the NPIs as the state has been following them for quite some time. 

“The population is aware of facemask usage, maintaining social distancing, practicing respiratory hygiene and hand hygiene, and the importance of ventilation. We are asking them only to repeat the same,” added the official. 

According to the Centers for Disease Control and Prevention (CDC) of the United States, NPIs, which are also known as community mitigation strategies, are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses. 

According to CDC, NPIs include Personal NPI, Community NPI, and Environmental NPI. 

– Personal NPIs are everyday preventive actions, that can help keep oneself and others from getting and spreading respiratory illnesses like the flu. They include, staying home when one is sick, covering coughs and sneezes with a tissue, washing hands with soap and water, or using hand sanitizer when soap and water are not available and others 

– Community NPIs include social distancing and closure. In this part, ways to increase the distance between people in settings where people commonly come into close contact with one another like schools, workplaces, events, meetings, and other places will have to be explored. Temporarily closing child care centers, schools, places of worship, sporting events, concerts, festivals, conferences, and other settings where people gather also could be explored. 

– Environmental NPIs include routine surface cleaning that helps to eliminate the virus from frequently touched surfaces and objects, such as toys, refrigerator handles, desks, and door knobs in homes, childcare facilities, schools, workplaces, and other settings where people regularly gather.

Covid-19 situation in Kerala 

According to the health department, “Over the last seven weeks, the total number of cases and deaths due to SARS-CoV-2 have been steadily declining in Kerala. Most of the deaths due to SARS-CoV-2 in the state are now occurring in people above 60 years and those with co-morbidities.”

The deaths among the co-morbidity population were mostly seen among those who suffered from chronic kidney disease, chronic liver disease, coronary artery disease, cerebrovascular disease, cancer chemotherapy, immunocompromised, uncontrolled hypertension, diabetes, and others. 

“The vulnerable population will benefit from a pre-cautionary dose of the COVID vaccine. The precautionary dose uptake among the vulnerable population in the state is suboptimal. All vulnerable patients must strictly adhere to NPI at all points of time,” highlighted a document of the health department released recently. 

However, the health department remained mum on the vaccination stat among the population. The last time the state health department shared the details of vaccination was on September 9, 2022. 

At the same time, the Union Health Ministry’s data shows that as on December 25, a total of 2,215,334 people had taken the precautionary doses in the state. However, this includes healthcare workers, frontline workers, and 60 plus population. 

The state at present has 1,410 active cases. 

The other day, taking note of the evolving Covid-19 situation, state health minister Veena George had given directions to restart the operation of the State Covid Monitoring Cell. 

The cell is entrusted with the task to monitor hospital admissions, active cases, and death cases. The state while starting surveillance at airports and seaports had also started random post-arrival testing among two percent of the total passengers on arrival. It also gave directions to districts to send samples for whole genome sequencing. 

Earlier, on December 23, in the wake of recent upsurge in Covid-19 cases in countries like China, Japan, Brazil and the United States, the health ministry had urged States to strengthen the surveillance system for whole genome sequencing of positive case samples to track the variants through Indian SARS-CoV-2 Genomics Consortium (INSACOG) network to ensure timely detection of newer variants, if any, circulating in the country.

Chairing the meeting, Union Health Minister Mansukh Mandaviya said that irrespective of the new COVID variants, ‘Test-Track-Treat-Vaccinate & Adherence to COVID Appropriate Behaviour’ will continue to remain the tested strategy for COVID management. Representing Kerala, health minister Veena attended the meeting.