With three more deaths in the last 24 hours, Indore is now looking at a case mortality rate of nearly 10%, more than three times the national average. The number of dead in the largest city of Madhya Pradesh stands at 26, of the state’s total of 36.
Indore, that got its first case on March 23, also accounts for 235 of the state’s total of 451 cases. In comparison, Bhopal with 116 cases has one death.
The worrying numbers come at a time when almost the entire top health bureaucracy had to remit charge after testing positive. Madhya Pradesh continues to be without a health minister, with Chief Minister Shivraj Singh Chouhan functioning as a one-member Cabinet.
More than 45 state health officials are currently in hospital and at least two isolated at home — a result both of negligence in declaring travel histories and in observing coronavirus isolation protocol set by the department itself.
Another spot of worry for the state is Ujjain, where five of 15 cases have died and no patient has recovered so far. However, the numbers have remained low, with no new case reported Friday.
Dr Jyoti Bindal, Dean of Indore’s MGM Medical College, which analysed the city’s 23 deaths till Thursday, said, “Co-morbidity and late reporting were the main reasons. We had patients with tuberculosis, HIV and severe diabetes. Most of them came so late that they had to be put straightaway on ventilators.”
MGM is one of Indore’s main COVID-19 hospitals.
An analysis by college and hospital experts says, “All the patients had extensive irreversible disease in both the lungs that was not responding to the best of ventilation strategies. All the patients had severe oxygen deficiency at the time of admission… Though ventilation started immediately on admission, their oxygen levels could not be improved.”
The report estimates that most patients had “more than eight days of respiratory symptoms”. “There was a delay in seeking medical care.”
In relatively young patients, “cytokine storm (fast flare of disease)” due to coronavirus was identified as the major cause of death. “The storm led to rapid progression of ARDS (respiratory failure) as evidenced by raised WBC (white blood cells) count, raised lever enzyme levels and requirement of inotropes (low BP). There is more than 90 per cent risk of mortality in patients with cytokine storm.”
Indore Chief Medical and Health Officer Dr Praveen Jadia said people are reporting so late that recovery becomes difficult. “Some deaths have occurred within four hours and two days of admission. There was no time for treatment.”
A second doctor, 65, died of COVID-19 in Indore on Friday. Like the physician who died Thursday, he was not involved in treating coronavirus cases.
So far, 29 patients from Indore have recovered. Dr Jadia said 20 more are likely to be discharged in a day.
In the midst of this, the negligence at the top is striking. The infected bureaucrats include two IAS officers who were part of the core group to tackle the COVID-19 crisis, as well as Principal Secretary (Health) Pallavi Jain Govil.
Sources said most officials were reluctant to move to hospital. Four of them moved into the Academy of Administration.
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