How has Covid-19 affected the nation's more vulnerable, unseen communities?
My observation in this fourth wave is that many more people from the lower socioeconomic classes are getting infected, coming to the hospital very late and then dying, perhaps due to a lack of awareness that the disease can be a silent killer. They seek help a lot later than they should— usually until such time that their oxygen level has dropped.
Other groups that have been badly affected by the pandemic are the migrant workers, the refugees and prisoners. Many clusters have arisen from workplaces as a result of poor living conditions for these workers. Likewise with prisons. Overcrowding in prisons has seen
22,295 inmates with 21 deaths, and 1,112 staff with one death as of May 2021.
In terms of HIV programmes and access to treatment, disruption has not been that bad because hospitals adapted very quickly to tele-medicine and re-organising appointments. Thankfully, our community partners have really stepped up to ensure that needle syringe programmes and delivery of anti-retroviral treatments continue.
This is certainly reflective of the experience globally, where community organisations have mobilised to ensure that services aren’t disrupted too much. Despite that, projections have shown that Covid-19 will reverse the gains made in the global HIV response in terms of death and new diagnosis.
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What's at the top of your priority list right now?
To ensure that we reduce the number of deaths and brought-in dead; to ensure better management of Category 3, 4 and 5 Covid-19 patients, and to ensure that non-Covid patients are not being neglected. We need to get better at using technology and digital tools to manage those who are in Categories 1 and 2 at home so that don’t progress to more severe categories. There are treatments that can be given to them once they progress to a more severe stage of disease. The issue is identifying these patients and treating them quickly so they don’t progress further to the point of needing ventilation and ICU care.
Drugs such as corticosteroids and immunomodulators such as tocilizumab and baracitinib have been shown to reduce progression to severe disease and mortality. The trick is to give these drugs at the right time. So monitoring patients carefully and knowing who is more at risk of progressing is very important. These individuals include those above the age of 60, males and patients with diabetes, hypertension and are overweight or obese.
Effective testing and contact tracing are vital so that when we open back up, we don’t go through yet another cycle of lockdowns and not being able to detect people who are infected.