The second death audit report has analysed all the 545 deaths reported from the first fatality until May 10. While the government has continued to deny community transmission, the death audit report has indicated otherwise. (Representational Image)

A second death audit report, analysing 545 deaths of Mumbai Metropolitan Region, has found that fatalities among Covid-19 patients in the age group of 41-50 increased in the period between April 23 to May 10, as compared to deaths until April 23.

From the first Covid-19 death on March 17 until April 23, only 28 of the total 181 deaths were in the age group of 41-50 years. In the subsequent period, from April 23 to May 10, mortality in the age bracket rose to 76 of the total 364 deaths — an increase of five percentage points from 15 per cent to 20 per cent of the total deaths.

The second death audit report has analysed all the 545 deaths reported from the first fatality until May 10. While the government has continued to deny community transmission, the death audit report has indicated otherwise.

According to the report, 84 per cent of all the patients who died due to the virus had no travel history or no known contact history. As compared to this, the 181 deaths, since the first case in Mumbai until April 23, showed 77 per cent who died had no contact or travel history.

It has also found that while two per cent with international travel history died until April 23, in the next 17 days there were zero deaths of people with international travel history. The trend indicates that several people who died had no known index case, and the transmission was local.

While the fatality rate among those aged above 60 years remains the highest — about 8 of every 100 infected senior citizens die — the audit committee report has found that in absolute numbers maximum deaths occurred in the 41-60 years age bracket — 50.4 per cent of 545 who died were in that group. The infection spread amongst 41-60 years is also higher than other age groups.

“We are trying to analyse case by case the factors behind this. For this we need more medical papers. This age group steps out the most, so more are getting infected. Comorbidity is also a factor,” said Dr Sadhana Tayade, director of Directorate of Health Services and member of the audit committee.

“Younger people who have died had hypothyroid, undiagnosed diabetes, and obesity. Their co-morbidities were diagnosed for the first time,” said Dr Avinash Supe, chairman of the committee.

The death audit report also found that hypertension was the most common reason for Covid-19 deaths in the 41-50 age group. It has made 17 recommendations, of which one was a focus on patients aged 41-50 years and early detection of symptoms.

“For asymptomatic positive patients, app-based daily follow-up for development of symptoms must be done,” the report stated. The committee also recommended compulsory screening for hypertension and diabetes in all private clinics and hospitals for early detection and treatment of co-morbidities. It also advised a uniform treatment protocol to handle Covid-19 and need to rope in drugs like Remdesivir and Tocilizumab for treatment.

The death audit committee had submitted its first report on April 15 analysing 133 deaths in Mumbai and neighbouring regions. It found that on average, patients took 3.76 days to seek hospitalisation after first symptoms emerge. That has now improved to 3.64 days, indicating people were seeking healthcare faster.

Better treatment facilities have also delayed fatality — from 2.49 days on an average between admission and death of a Covid-19 patient until April 15 to 2.55 days now, the report noted.

The improvement is, however, small. Data analysed by the committee also showed of 545 deaths, 55 per cent occurred within two days of hospitalisation, and 28 per cent in 3-5 days after hospitalisation. Only 44 per cent patients get hospitalised within two days of developing symptoms while the rest get admitted between three and more days after symptoms emerge. “Apart from early intervention, we need to have a uniform treatment protocol. Oxygen-supported beds and intensive care units must be increased. Maximum deaths are happening due to delay in these interventions,” a committee member said.

Another member of the committee said, “We have advised triaging patients at the entry point to understand the level of severity. Ground-level health workers must take a call, and that too fast, on who needs hospitalisation.”