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Tuesday, June 22, 2021

‘Our prime concern now is whether declining trend of cases will continue after lockdown’

According to Chief Medical Officer (CMO) Dr Jasjeet Kaur, the second wave is something that still needs to be understood and researched so we may know how it will behave in the coming days.

Written by Pallavi Singhal | Panchkula |
May 27, 2021 7:54:05 am
Covid-19 vaccination at Civil Hospital in Panchkula. (Express Photo: Jasbir Malhi) 

Panchkula IS seeing a decline in Covid cases. What has led to this, have the cases peaked? The district’s Chief Medical Officer (CMO) Dr Jasjeet Kaur speaks to PALLAVI SINGHAL about the impact of the second wave on Panchkula:

Do you think second wave is over since cases have started coming down?

The wave is on a decline now. We cannot say it is over as yet but a declining trend has been seen in Panchkula. But we still have apprehensions about how this wave will end because this one has been quite different from the first wave where cases came down to almost single digit figures. We do not know if we will see that or not, but for now, cases are coming down and we are quite hopeful.

Is it the result of the lockdown or do you think the cases have peaked?

Lockdown has definitely played a role. Our prime concern right now is whether the declining trend will continue after the lockdown. We are keeping our fingers crossed because the virus this time has behaved in a completely erratic way, everything about this wave was unexpected, be its spread, its virulence or its overall impact. The way we struggled with everything including the severity and number of cases, the transmissibility — it was all pretty unexpected.

We had a second wave in the west and had realised this may happen but such sudden mutation with the kind of rampant variant we saw, nobody could have expected that. This wave is something that still needs to be understood and researched so we may know how it will behave in the coming days.

The number of deaths in this wave has remained high. What could be the reason?

If you look at the absolute numbers since the beginning of pandemic, the deaths reported were at their highest in the past two months of April and May. Even in the peak (of the first wave) in September last year, the deaths were not as high. But if you look at the figures in view of percentage amounts, the death toll still remains about 1.1 per cent overall. In May as well, it had grown to 1.3 percent. What I am trying to say is, number of cases is also much much higher…If we look at data from last year, nowhere we had reported 3,000+ cases within a week, but we crossed well past that in April and May. As per it, the total fatality rate remains in that margin itself.

We have reported that several covid deaths have gone unrecorded as per data accessed via crematoriums. What would you like to say to that?

There are two reasons. The first one is that the cremations taking place are not only of the bodies from Panchkula, whereas we are only reporting deaths of people from Panchkula in the bulletin. People from Western Command, three private hospitals and even GH6 who do not hail from Panchkula pass away, their death reports are sent to their respective districts but their bodies are cremated here. That gap is that of almost double. So while we have reported some 300 deaths from Panchkula, around 600 bodies have gone to the crematoriums – as per the last data I went through almost a week ago.

Secondly, the data from general deaths has also increased. As I look at them I realise that probably there were deaths which were from Covid, but were never tested and thus never added to the Covid toll. Especially in rural areas, people are reluctant to get tested. Many elderly refusing to go to hospitals may have succumbed to Covid but never got added to Covid deaths.

This is a high possibility as there is an overall increase in general deaths this April and May as compared to that last year.

The reason for non-reporting is not that they are not being reported consciously, but because some of them never knew they had Covid or never got reported.

What is the current situation of beds, oxygen?

Because the number of cases have gone down, we are comfortable in today’s position as far as number of oxygen beds as well as oxygen supply, we have adequate amount of both. When it comes to ICU beds, especially ventilator beds, ICU has two kinds, one with high flow oxygen, biPAP and the second is ventilator. We have sufficient high flow oxygen facilities, biPAP we have been able to procure and install sufficient numbers but we still lack ventilatory support. In case the kind of peak we have had recently happens again, I am afraid we do not have adequate number of ventilators.

For now, availability exists and we are not turning back people.

Few deaths of people in home isolation were reported. Was it a miss on the part of the administration?

There have been seven deaths in home isolation. Some of those are of people who were under our observation, who deteriorated very quickly and could not be picked up. For example, a death in Pinjore; our home isolation team had visited the person’s home twice. He was fine and suddenly deteriorated the next day, succumbed even before we could reach there. There are two deaths in every seven.
In the remaining cases of deaths while in home isolation, they got tested at a private facility but were never reported to us or fell out of our network somehow.

A patient of sector 15 got tested in Manimajra, his name was not in the line listing. Even if they reported we got it very late and by the time the person was already too serious to be saved. Similar death had happened in Kalka. A young woman got tested at a private facility but it did not come to our notice. By the time we got to know, it was too late.

There has been an issue with the private labs as well, some labs’ reporting time is too long. By the time we get the report, more than 5-6 days have passed. In our lab we try to get every sample processed within 24 hours.

But yes, home isolation at such a large extent is a challenging task. We tried to get people to come to our community isolation. At least in slum areas, where living conditions are not appropriate, I have tried for the past week to get people to come to our quarantine centres. But people are not willing. That is another thing we need to look into, about the IEC communication drives. Even in isolation centres we set up in rural areas inside their schools, nobody wanted to come. We tried to get them to BRS. Home isolation and home containment was the only option we had then.

How did the serious covid cases progress this time? What must one look out for?

Two things different in this wave were:

# Prolonged fever. Earlier people had low grade fever and would recover in 2-3 days, but in this wave even in younger patients, fever went on for 10 days, 13 days and high grade fever going up to 101-103.

# In this wave, cases started showing symptoms as they extracted the virus unlike last time when it would take a week. This time, first few days patients experience mild symptoms but on the fourth and fifth day sudden deterioration would happen with all their markers going up, resulting in sudden breathlessness, saturation going down. We even lost patients who were almost about to be discharged and felt fine but next moment they deteriorated and in a day or two they expired.

Now it not about pinpointing the right time to give the right medication.

How was the shortage of Covid drugs managed?

There was no shortage of drugs. Maybe in the market but not in the system. Even though the process to get them was long as a person had to apply at one place and then a committee would sit to judge it, I am happy to say we gave the medication to almost all cases requiring it and saved many lives. By the end of it, we were actually running in surplus with Remdesivir. It was given to everyone who required. We even provided to patients in private hospital. But how much these drugs helped is yet to be debated upon.

There have been several cases of black fungus and shortage of Liposomal Amphotericin B. Why is there a rampant growth in these cases?

Fungal infections are always common in immuno-suppresent people, be it diabetics, cancer, organ transplant patients et al. The chances to extract these infections also rise with age as our immunity response goes down. But an irrational use of steroids in Covid cases as well as the duration which was not monitored properly has led to this kind of an epidemiological increase in post-Covid mucormycosis patients. Thus now suddenly we can see a rise. This is very natural and should have been expected.

Three prime reasons are immunosuppression — be it because of the disease or the medication. Secondly, ICU care, a place where humidifier is use along with long-term ventilatory support or biPAP, chances of fungal infections because of the availability of right environment to the fungal spores to form which, when inhaled, settle in lungs or sinuses. It is a common effect of long-term ventilator care.
Third would be the diabetics along with underlying conditions, which leads to a weak immunity system.

People on steroids, diabetics and have suffered from Covid and were in ICU for some duration; multiple factors together have attributed to it.

Civil Hospital Sector 6 is not taking these cases, as specialized care is needed. We do not have an entire setup with eye surgeon, ENT surgeon, anaesthetist and thus tertiary care would be more suitable. We are sending patients to Maulana Medical College where ample Liposomal drug vials are being supplied by the state government. For stock of the drug at Panchkula administration, we do not yet have any vials currently in the district but we have demanded from the state for the treatment of such cases in private hospitals. State has already floated the tender and is in the process of procuring the drug.

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