Nearly every fortieth Covid patient in Punjab has succumbed to the infection. The figure is scarier for Amritsar, where every twentieth patient died due to Covid-19 and related complications. The numbers have forced a rethink in the Pu njab government which has now directed all its district heads to increase the efforts to save more and more lives.
As of July 11 evening, Punjab had recorded 195 Covid fatalities while the total number of patients in the state was 7589. It converts into a case fatality rate (CFR) of 2.56 per cent. Among the districts, Amritsar with 51 deaths out of total 1040 cases detected tops the list with 4.9 per cent CFR, followed by Kapurthala with 4.7 per cent CFR (6 deaths, 126 cases).
Hoshiarpur (7 deaths, 194 cases) is placed at the third spot with a CFR of 3.6 per cent, followed by Bathinda 3.1 per cent (4 deaths, 129 cases), Pathankot 2.86 per cent (7 deaths, 244 patients) and Sangrur 2.85 per cent (18 deaths, 631 cases). Among the other districts, Moga has a CFR of 2.79 per cent (4 deaths, 143 cases) closely followed by Gurdaspur 2.78 per cent (8 deaths, 287 cases), and Barnala 2.70 per cent (2 deaths, 74 cases).
As per the details shared by the government, of the total 195 victims, 25 had no co-morbidities while the rest had one or more co-morbidities. Dr Rajesh Bhaskar, state nodal officer, Covid-19 said, “In five cases, samples were taken for testing following the death of a person and returned positive. In several cases, the report of the samples taken came after the patient died. In short, you can say that in many cases, patient died within 24 hours of being admitted to hospital, which clearly indicates that patients reached the hospital very late”.
Information secured from different sources reveal that in case of 40 deaths reported from private hospitals in the past few days, patient died in less than five days of his or her admission to the health care facility — in many cases on the day of admission. “Patients report to hospitals for kidney, heart or sugar related ailments, but during treatment they are tested positive and die of co-morbidities,” said Bhaskar.
One of the reasons behind Amritsar reporting most deaths is that the Government Medical College in the district acts as a referral centre for patients from other districts. The GMC has has a tertiary care facility available too.
Kapurthala and Hoshiarpur districts, however, have level 1 and 2 treatment facilities and they depend on Jalandhar, Amritsar and Ludhiana for treatment in case tertiary care facility is needed. Bathinda has a number of private hospitals, but health authorities have not entered into a tie up with any of them and hence Covid patients need to be sent to Faridkot Medical College and Hospital, some 70 km away. Same is the case with Gurdaspur and Pathankot which depend on GMC Amritsar for tertiary care. Most of the causalities of Pathankot and Gurdaspur have happened in Amritsar only. Sangrur sent many of its patients to Patiala, 60 km away. Many patients on their own go to private hospitals in Ludhiana while government doctors refer them to Rajindra Medical College, Patiala.
At a meeting that Chief Secretary Vini Mahajan had with deputy commissioners last week and where the high CFR was also discussed, it was suggested that if patients report to doctor within 24-48 hours of setting in of symptoms, better treatment could be provided.
On the treatment being provided to patients, Dr Bishav Mohan, a cardiologist at DMCH and convenor for the committee which formed Covid guidelines for the state, said, “ If patient has mild symptoms but has co-morbidities or is pregnant, we treat them as mild high-risk patient or moderate high-risk patient. Hydroxycholroquine is given in both cases but it is not prescribed in critical cases. Steroids are given to crtical patients apart from ventilator support . We use sedation and nutrition therapy as per the existing guideline. ”
Ludhiana, the largest of the 22 districts in Punjab, has the maximum number of positive cases (1316 as of July 11 evening) and has reported 31 deaths at a CFR of 2.35 per cent. Jalandhar (25 deaths, 1187 cases) has a CFR of 2.1 per cent.
Three districts have reported zero CFR — Mansa, Fazilka and Faridkot. all in Malwa region with 57, 105 and 152 cases, respectively. Nawanshahr, which reported the first Covid case and death in Punjab in March did not report any more fatalities even though it recorded 190 positive cases. It has a CFR of 0.51 per cent. Only two other districts reported I death each Muktsar (0.69 per cent CFR, 144 cases) and Ropar (0.80 per cent CFR, 124 cases).
The meeting last week focused on early detection of cases, quicker initiation of treatment with availability of bed and right set of treatment protocol. “The core is to save lives and do early detection. It states that we should not worry about positive cases. Positive cases show that contact tracing is working. The focus is to reduce the number of deaths,” said Ghanshyam Thori, Deputy Commissioner, Jalandhar.
Dr GB Singh, civil surgeon, Barnala and Sangrur, said, “As CFR in Barnala and Sangrur stands at 2.70 per cent and 2.85 percent, respectively, hence our focus is on reducing it. If more positive cases are coming, they should be provided the right treatment. One should not panic over the growing number of cases. Any increase in CFR, however, is a cause of worry.”
The meeting also discussed on how to reduce infection spread for which it was suggested to reduce number of persons at social gatherings to 30 from existing 50. Other suggestion included strict checking of marriage palaces and closed spaces for proper ventilation. The place should be closed for two days in case of first violation. Online grievances portal should be given priority instead of manual submission of grievance, it was suggested alongwith mandatory FIR for violation of social distance norms during any dharna, protest or gathering.
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