Updated: April 17, 2020 7:55:25 am
Struggling to contain the spread of coronavirus in Mumbai, the Brihanmumbai Municipal Corporation has gone for a change in testing protocol as well as procedure for reporting deaths caused by COVID-19.
On Thursday, the BMC decided that it will only selectively test asymptomatic high-risk people (that is, close contacts of positive cases). This is different from the Indian Council of Medical Research (ICMR) guideline to test all asymptomatic high-risk contacts, such as family members, between fifth and 14th day of suspected exposure.
In another change since Wednesday, the BMC decided that a suspected coronavirus death will be subjected to an audit before being confirmed as one.
Mumbai has so far recorded 117 deaths. While it saw an average of 10-14 deaths per day last week, on Wednesday and Thursday, it reported two and three deaths respectively. New cases fell by 47.5% over the past two days, from 204 to 107.
The BMC will now decide which asymptomatic high-risk contacts need testing at the end of a 14-day quarantine period. Incidentally, at least 70% of coronavirus cases in Mumbai till now have been asymptomatic, detected either because they were close contacts of confirmed cases or present in hotspots.
Earlier, on April 12, the BMC had decided to stop testing asymptomatic people altogether, except for pregnant women, senior citizens, cancer and kidney patients. A civic official said private laboratories too had been instructed to only test symptomatic people now.
As per fresh guidelines issued Thursday, the BMC will test only symptomatic people (suffering from cough, cold, fever, breathlessness), pregnant women, dialysis patients, patients on chemotherapy, healthcare workers, senior citizens, symptomatic high-risk contacts, and some asymptomatic high risk-contacts.
BMC Additional Municipal Commissioner Suresh Kakani said the testing protocol was modified to “better utilise” manpower and resources. “Earlier, only 4.5% of those tested in Mumbai came out positive.” On Wednesday, with narrower testing protocols, the positivity rate stood at 11%.
The ICMR had earlier advised testing for symptomatic people with travel history, contacts of confirmed cases, health workers and respiratory distress patients. On April 9, it widened the scope to symptomatic people in COVID-19 hotspots and migrant clusters.
Dr Subhash Salunkhe, Chief Technical Advisor to the Maharashtra Chief Secretary, said the government has to differentiate between essential and non-essential and focus on the former. “Those symptomatic are essential for us, in order to be treated.”
On the apprehension that Mumbai was trying to project lower numbers, Salunkhe said, “For us, the numbers of how many are positive do not matter anymore. Saving lives does.”
Anup Kumar Yadav, Director, National Health Mission, Maharashtra, said, “Mumbai has tailor-made its testing protocol based on the cases and transmission pattern.”
With the new protocol in place for COVID-19 deaths, the BMC on Wednesday listed just two deaths against five recorded in various hospitals. The three other deaths will now be assessed by a committee, which will look at co-morbidity factors such as heart and lung ailments and kidney condition.
AMC Kakani said in 85% of the coronavirus deaths, co-morbidities were responsible and not the infection directly. “Once confirmed that COVID-19 is the direct cause of death, it will be reported,” he said.
Earlier, the BMC was reporting deaths of all infected persons as COVID-19 deaths.
A senior official in the Union Health Ministry said, “If a person has tested positive and dies, it is a COVID-19 death, but of course the main reason could be co-morbidities. We find 86% had co-morbidities.”
About the decision to restrict testing, a senior civic official said, “This was taken to judiciously use available kits. Also if asymptomatic people test negative, it creates a false sense of security. We came across cases where they later tested positive.”
A case in point was of the 85-year-old woman who died due to coronavirus complications at Dr L H Hiranandani Hospital on March 30, days after she had tested negative for COVID-19.
Officials said the change in protocol would also prevent deaths. Earlier, the focus was to test both symptomatic and asymptomatic contacts, which meant many with cough and cold but with no known contact were not getting tested.
Dr Avinash Supe, Director of Hinduja Khar Hospital, who heads the committee to audit coronavirus deaths, also welcomed the decision. “Our aim is to prevent mortality. Testing symptomatic people will help provide early treatment.” However, he advised that the high-risk asymptomatic people be strictly quarantined even if they are not being tested.
Mumbai has a capacity of about 10,000 tests a day. It plans to introduce rapid testing for health workers, civic staff, BEST drivers and conductors soon, with only those who have generated antibodies against the virus to be allowed back to work. With 5.7% case mortality rate so far, Maharashtra does not qualify for pool testing.
While West Bengal is already auditing deaths to see which qualify as COVID-19 deaths, Uttar Pradesh plans to start this soon. Earlier, Rajasthan had refused to count an Italian tourist who had tested negative for coronavirus after hospitalisation and died of cardiac arrest as a COVID-19 death, though he never came off the ventilator.
Auditing and then reporting a death was also done during dengue and H1N1 outbreaks.
There is a debate on in other countries as well, including the US, UK and Spain, regarding how to count COVID-19 deaths. In the US, all deaths with coronavirus are being counted as COVID-19 deaths, with New York’s fatalities shooting up after it included several “presumed” cases as well in its toll. Spain is in the process of recounting its dead.
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