Covid-19: Trend of decline in daily deaths offers glimmer in Maharashtra

The daily death figures reported by Maharashtra so far have included deaths that may have occurred over the past several days or weeks, making it difficult to gauge the precise number of fatalities that occurred on each day. (Express file photo by Prashant Nadkar)

The number of daily deaths from Covid-19 in Maharashtra has been declining for over a fortnight now, government data analysed by The Indian Express show.

This declining trend contrasts with the continuing rising trend in the number of daily new Covid cases, and could indicate the impact of several relatively recent policy interventions in the battle against the pandemic.

The availability of larger numbers of oxygen-equipped beds, early testing, requisitioning of more beds in private hospitals, use of newer drugs, and prompt medical intervention overall, could all be reasons for the dip in daily fatalities, experts said.

Maharashtra carries India’s heaviest Covid case load and death toll, having reported close to 1.52 lakh cases and 7,106 deaths until Friday. The first case in the state was reported on March 9.

The data on daily deaths accessed by The Indian Express show the numbers spiking sharply around the middle of last month — it went past 100 first on May 15 (102) and remained in three digits on each day until June 14, peaking on June 7 and 8 (170 each).

The number dropped sharply to 122 on the following day, however — and has maintained a generally declining trend thereafter. On each of the six days from June 20 to June 25, the state has had fewer than 100 deaths — and on Thursday, this number fell to 33.

As a trend, the 10 days from May 15 to May 24 saw a total 1,188 Covid deaths, or a daily average of 118.8; over the following 10 days, from May 25 to June 3, 1,434 deaths occurred, an average of 143.4 deaths every day.

In the 10 days after that, from June 4 to June 13, the number of deaths fell to 1,388 – a daily average of 138.8. And in the next 12 days until June 25, the numbers added up to 977 – an average of 81.4 deaths every day. This last number, however, is likely to increase somewhat as some daily figures this week are updated.

In contrast, numbers of new cases have risen consistently – between May 15 and May 24, 2,287.3 new cases were recorded each day on average; this number rose to 2,463.3 between May 25 and June 3; to 2,968.8 between June 4 and June 13; to 3,444.2 from June 14-23.

The daily death figures reported by Maharashtra so far have included deaths that may have occurred over the past several days or weeks, making it difficult to gauge the precise number of fatalities that occurred on each day. This is the first time that the government has provided a date-wise break-up of death data.

While figures of some recent days may be updated slightly as a few deaths that may have gone unreported are reported, the overall trend in the data suggests a clear decline in the numbers of daily deaths.

Dr Subhash Salunkhe, technical advisor to the state government, cautioned that the declining trend in daily deaths did not mean the pandemic had passed its peak in Maharashtra.

“We have not reached the peak yet, that is evident with rising cases,” Dr Salunkhe said. Instead, he said, the clinical treatment protocol had evolved over the last three months, and doctors and nurses were now better equipped. “We are using a new cocktail of drugs and providing early intervention,” he said.

Dr Archana Patil, additional director in the Directorate of Health Services, said the state had not yet analysed what the fall in death figures could mean. “We are still reconciling the data,” she said.

The latest available data show Mumbai now accounts for less than half the total deaths in Maharashtra — 47.2 per cent — and Thane and Pune for 20 per cent and 12 per cent respectively.

In Mumbai, a massive scaling-up of hospital beds has happened since May. The Brihanmumbai Municipal Corporation (BMC) scaled up to 5,000 oxygen-supported beds by June 11; this figure is expected to touch 9,000 by the end of this month.

The number of ICU beds has increased from fewer than 800 to more than 1,200 in a month in Mumbai.

“Bed availability was a big issue earlier,” state epidemiologist Dr Pradeep Awate said. The gamechanger, he said, has been the improved bed referral system in Mumbai, and the availability of a larger number of oxygen beds.

He said daily monitoring indicated that the number of critical patients was declining, and the number of mild and moderate patients was rising. “Earlier 4-4.5 per cent of patients required intensive care support; over the past few days, this is in the range of 3-3.5 per cent,” Dr Awate said.

Health Secretary Dr Pradeep Vyas said: “Mumbai has more or less stabilised when it comes to new cases and deaths. More people are under home isolation.”

There were over 63,000 active patients in Maharashtra as of Friday. The exodus of migrant labour had reduced both the case count and fatalities in the state, Dr Vyas said. Maharashtra has over 2.8 lakh beds for Covid patients.

Dr Sanjay Oak, chairman of the State Task Force appointed to advise on strategies to reduce deaths, said a multipronged approach had helped. “We have been capturing patients early, put them on oxygen, and using several drugs. We have insisted that the government test more.”

An indication of the trend of early hospitalisation came in the second death audit report in May in Mumbai — it found that people were being admitted to hospital within 3.64 days of developing symptoms, from 3.74 days in the period until April 15.

In KEM, Sion and Nair hospitals, the three major civic hospitals in Mumbai, the number of critical patients seeking admission has reduced. “This indicates that people are getting admitted sooner. The drugs tocilizumab and itolizumab have saved so many lives. We got access to these drugs about a month ago,” Dr Hemant Deshmukh, dean of KEM Hospital, said.

Dr Awate, however, cautioned against any lowering of the guard. Both case numbers and deaths were expected to rise again in the monsoon, he said. The state epidemiology department expects Covid-19 case numbers to peak by the end of July or the beginning of August.