April 15, 2020 4:20:52 am
An analysis of the first 50 COVID-19 deaths in Mumbai that account for 62.9 per cent deaths (112) in the state, shows that just over half of them died within hours or a day of hospitalisation. In almost half of these cases that led to deaths, the patients tested COVID-19 positive after or just before their death.
The state government is holding an experts’ meeting to conduct a death audit in each case to understand why these patients died so soon after admission and address possible gaps — delay in admission, testing and their experience of being turned away by hospitals.
Simultaneously, a nine-member task force has been set up in Mumbai on Monday to formulate a treatment protocol for critical patients. Six hospitals have been designated to treat critical patients in Mumbai on Monday.
Of the first 50 deaths analysed by The Indian Express, based on data from Brihanmumbai Municipal Corporation and Maharashtra government:
* 14 patients died within hours of hospital admission.
* 26 deaths happened within a day of admission.
* In 11 cases the test result came positive after death, in 14 cases it came positive barely hours before death.
* 39 were men and 11 women.
Experts and officials point to several reasons that could explain this: some had to do the rounds of several private and public hospitals before they were finally admitted, not all cough and cold cases were immediately tested, and several patients opted for home treatment until their health worsened.
“We noticed patients wait for 3-4 days after developing symptoms and try to hide suspected Covid infection due to fear of being stigmatised before they approach a health care facility,” said Suresh Kakani, additional municipal commissioner, BMC.
Daksha, Shah, BMC’s deputy executive health officer, said 85 per cent of the deceased also had hypertension, heart disease, or diabetes. “These patients deteriorate quickly by the time they reach our hospital. Worldwide data shows patients’ lungs sink very fast, and the heart is also affected by coronavirus,” she said.
The Indian Express, however, came across cases where patients were also forced to visit multiple hospitals from the time they developed cough till they died leading to treatment and testing delay. An illustrative case is that of a 27-year-old pregnant woman who visited four hospitals before she died in Nair hospital on April 4, the son of a 67-year-old patient visited five hospitals before KEM agreed to admit his father. Twelve hours later, the patient died. Mumbai has 14 private and public testing centres.
Dr Tanu Singhal, infectious disease expert in Kokilaben Dhirubhai Ambani hospital, said it takes five to six days after developing symptoms for a person to feel fatigue, experience low saturation levels, and suffer a drop in oxygen levels. “Patients deteriorate quickly after that. The testing strategy is lopsided. We have to test patients with fever and cough, and test them early to provide intervention before they slip into critical stage. Our aim is to ultimately save lives,” she said.
In KEM hospital, 13 deaths have been recorded between April 3 to April 12. Dean Dr Hemant Deshmukh said, “Most cases are of senior citizens with co-morbidity, they coming to us in critical condition and there is little scope left to save them.”
Of the first 50 deaths, 42 were aged above 50 years and 85 per cent had comorbidity. Experts said these people come in high risk group and must be tested early.
BMC officials said they were following the Indian Council of Medical Research guidelines that allowed testing only for four categories until April first week: symptomatic people with travel history, people with severe acute respiratory distress, health workers, and close contacts of confirmed cases. Kakani said they realised “they were missing several from the net” and decided to broaden the testing criteria in Mumbai. “We now test every high risk person who comes under a containment zone. This will include elderly with co-morbidity,” he said.
Maharashtra epidemiologist Dr Pradeep Awate says while testing is important, he disagrees that testing earlier will help save lives. “Even if we test, it makes no difference in treatment protocol as COVID-19 has no known treatment, only symptomatic care.”
But Awate also said that if private hospitals started admitting and treating cough and cold cases early, several deaths could be prevented. “Government hospitals are already overburdened and have to follow triage to admit and test only high risk group,” he said. In Japan, government is asking younger asymptomatic population to remain at home and testing senior citizens with co-morbidities to provide early treatment. Awate said that this model could be helpful for India. “But we need support from private hospitals for that.”
A doctor from a private hospital said they are scared to admit cough and cold patients because if staffers got infected treating Covid-19 patients, the entire hospital faces the risk of being declared a containment zone. In Mumbai, BMC has already declared 10 private hospitals containment zones after hospital staffers tested positive.
Dr Om Srivastava, infectious disease expert in Jaslok hospital who is part of death audit committee, said, “It is also the immune response that is killing patients. We are not seeing a uniform pattern in deaths. There are people of same age group with same co-morbidity who are reacting differently to the virus,” he said.
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