MUMBAI: The high mortality rate due to covid-19 in Mumbai has got the Maharashtra government worried. The state on Monday formed a nine-member task force of specialist doctors from public and private hospitals, led by Sanjay Oak, to finalise a protocol for better clinical management of the critically-ill patients.
The task force will also recommend a uniform drug protocol and work towards bringing down the mortality rate in the city. It has been asked to submit its recommendations to chief minister Uddhav Thackeray at the earliest.
The state government has ordered that chief medical officers of all hospitals where covid-19 patients have died will have to submit a report to the committee. Despite Mumbai city corporation’s containment efforts, the number of positive cases and related deaths are rising every day. Maharashtra’s infection and death rate are far higher than any other state in India, with the fatality number firm at 6.5-7%.
As on Monday, Maharashtra had reported 160 deaths against 2,334 infected cases, a mortality rate of 6.9%. Against this, other states that have crossed the 1000-mark in positive cases have much lower mortality rates. Delhi has reported 28 deaths against 1,510 infections (mortality rate of 1.85%) and Tamil Nadu has reported 11 deaths against 1,173 infections, with a mortality rate of 0.93%.
Explaining the possible reasons for the high mortality rate in Mumbai, state health commissioner Anup Yadav told Mint, “Prima facie, we’re seeing that in the majority of covid-19 cases, the manifestation of the virus is slightly different. The patient appears to be doing fine but suddenly collapses within one-three hours of bringing them to the hospital and they become critical. Because Mumbai has very high number of cases, the majority of death is also happening here. We’re seeing that patients who have mild symptoms initially tend to ignore it but suddenly manifests into a more critical condition and patients succumb quickly, particularly when they have co-morbidities like diabetes and hypertension.”
“The government formed the committee to study the patterns and reasons for the high number of deaths. These are doctors who are specialists in pulmonary and infectious diseases,” Yadav added.
In a press release dated 13 April, the Municipal Corporation of Greater Mumbai (MCGM), the city’s administrative body, said 87% of covid-19 deaths in the city had co-morbidities such as diabetes, hypertension and heart disease, while 7-8% were in the high-risk age group.
More worryingly, patients are dying soon after hospital admission. According to data from the MCGM, of the nine deaths in the city on Sunday, three had been admitted to the hospital earlier the same day and two the previous day. The pattern holds true for most covid-19 deaths reported in the city every day.
Speaking to Mint, Shivkumar Utture, president of the Maharashtra Medical Council, said extreme congestion in Mumbai has made containment much harder than elsewhere in the country.
“The only way to contain the disease is by social distancing and you need to achieve that to break the spread. But social distancing in slums like Dharavi is impossible, where seven-eight people live in a 10*10 ft house. Asking them to stay indoors all the time is difficult. The lanes are so small barely one person can pass through at a time. Toilets are shared between many homes and contact is very high, so contact tracing is also very difficult to complete,” Utture added.
Utture’s council and various local medical associations are working voluntarily in slums–Worli-Koliwada, Mukund Nagar and Dharavi–offering free consultation to patients and aiding the MCGM.
“What we are seeing is that there are several asymptomatic carriers of the virus who are not aware that they are spreading the infection,” Utture said.
“This virus spreads faster than the common cold and it is difficult to protect vulnerable populations who either have co-morbidities or lack strong immune systems because of poor nutrition. You need strong immunity to fight a viral disease. We’re still not seeing many young patients die but if that starts to happen, Mumbai’s medical infrastructure will be overwhelmed. The best hope is that we will develop herd immunity soon,” Utture added.