• O2-dependent patients much higher in current wave: SLMA
• Says community spread confirmed
• Guidelines on self-monitoring O2 levels at home

BY Pamodi Waravita The Sri Lanka Medical Association (SLMA) yesterday (16) said that over 50% of Covid-19 patients receiving treatment at the National Hospital of Sri Lanka (NHSL) in Colombo are dependent on oxygen (O2), while about 25 patients are receiving intensive care unit (ICU) treatment. “Approximately 600 patients are currently receiving treatment at the NHSL, of which about 305 patients are dependent on oxygen. About 25 patients are currently receiving treatment at the hospital’s ICU facilities,” SLMA Intercollegiate Committee Member and NHSL physician Dr. Harsha Sathischandra said, speaking at a press briefing yesterday. He noted that during the previous Covid-19 waves, only about 20-30% of patients required oxygen, but that in this wave, 50% of patients face breathing difficulties and are dependent on oxygen. Responding to a question posed by The Morning, Dr. Sathischandra noted that while the oxygen supply at the NHSL is sufficient at present, “any resource is finite and cannot be stretched beyond its limits”. Meanwhile, SLMA President Dr. Padma Gunarathne, speaking at the same press conference, noted that the virus is at the community level now, and therefore urged the public to take maximum precautions. “There is a 33% increase in the number of new cases that are being reported, based on last week’s figures. Public health inspectors (PHIs) and medical officers of health (MOHs) in rural areas are facing extreme hardships, such as the lack of transport facilities and the risk of facing attacks from elephants while travelling at night to meet patients. We need to exercise as much caution as possible now,” community medicine consultant Dr. Nihal Abeysinghe said. In a similar vein, Association of Medical Specialists (AMS) President Dr. LakKumar Fernando warned that the next two weeks are extremely dangerous. “When the B.1.617.2 Delta Covid-19 variant of Indian origin was first discovered, we warned the authorities and hoped to prevent the exact situation that we are in now. Whatever the decision-makers decide, it is now up to us to make the best decisions for ourselves. If this current situation continues, there is a risk of another mutation and strain of the virus as well,” explained Dr. Fernando. The media also questioned Dr. Gunarathne on the recent comments made by ministers that a lockdown would be initiated if medical experts advise them to do so. In response, Dr. Gunarathne stressed that all necessary advice is passed onto the authorities by the SLMA, including through its latest letter addressed to President Gotabaya Rajapaksa on 11 August. Although the SLMA had sought an audience with the President, Dr. Gunarathne told The Morning that they are yet to receive a response to it. “It is disappointing to see these deaths unfurl before us. Hence, we urge the public to follow the health guidelines as much as possible,” she added.   Yesterday, the SLMA also provided guidelines on how to self-monitor oxygen (O2) levels at home, since the home treatment of Covid-19 patients began last week. Speaking to the media, Dr. Sathischandra provided a number of guidelines for Covid-19 patients who are being treated in their own homes, and added that approximately 80% of Covid-19 patients do not require hospitalised treatment. “Self-monitoring is vital. You must always check if your symptoms like cough, fever, and breathing difficulties are increasing. If you find it difficult to breathe after doing even a small activity like using the washroom, then that is an indication of decreasing oxygen levels in your body,” noted Dr. Sathischandra. He elaborated on a number of breathing exercises that can be done to gauge one’s own oxygen levels. “The usual amount of breaths or the number of times your chest moves up and down per minute is about 12 times. However, if this increases to 20 to 24 times per minute, then this shows that the body needs oxygen. Another indication is provided after standing up and sitting down about six or seven times per minute. Take two minutes of rest afterwards and check to see if you are facing breathing difficulties. If you face abnormal breathing difficulties after walking about 30 or 40 steps, then that is also a signal that your body needs oxygen.” According to Dr. Sathischandra, if an individual is using a pulse oximetre to monitor their oxygen levels, then 96% or above is the normal percentage that the device should be at. Dr. Abeysinghe said at the same press conference that according to the reports that they are receiving, approximately 1,000 to 1,500 patients are receiving home treatment for the virus in Anuradhapura, while 2,000 patients are receiving home treatment in Matale. Meanwhile, the Health Promotion Bureau (HPB) said that it is vital to identify any exacerbation of these symptoms when receiving home-based care in order to ensure the early detection of complications. “Symptoms such as the shortness of breath at rest and during minimal exertion, warrants immediate hospitalisation. Similarly, immediate hospitalisation is required if the level of oxygen in the blood falls below 96% at rest or during minimal exertion. Any patient who is registered in the system for receiving home-based care for Covid-19 who experiences symptoms as described above should immediately inform the relevant medical team. The medical team will then consult the relevant specialists and arrange for the hospital admission of the patient,” the HPB added. The HPB further explained four positions and postures to adopt in order to reduce difficulties in breathing. “It is advisable to change your breathing position every two hours in the following ways – 20-30 minutes on their belly (pregnant women and obese people, however, should not follow this position without medical guidance), 20-30 minutes on their right side, 20-30 minutes sitting up, and 20-30 minutes on their left side.” Furthermore, Dr. Sathischandra explained that if a member of a household tests positive for the virus, they must isolate themselves from the rest of the household as much as possible and wear a mask at home. “Rest as much as possible, and drink about three ot four litres of water per day while eating nutritious meals,” he added. The HPB has established 1390 as the hotline for those in the Western Province to register with in order to receive medical advice. The SLMA has reactivated the “Doc Call” 24/7 helpline service in order to provide medical guidance to patients at home. The MOH of the area should also register low-risk patients in the Patient Home Isolation and Management System (PHIMS). Following this, the MOH will then hand over the responsibility of the patient to the call centre and the medical care team, through the PHIMS. Also, the contact details of PHIs in each district can be found at https://alt.army.lk/phi2/. The World Health Organisation (WHO) has stated that the Delta variant is at least two times as transmissible as the original virus. Sri Lanka is currently facing a severe spread of the Delta variant in all districts. The HPB said that 3,435 new cases and 161 deaths were reported on 15 August due to the virus.