Goa’s Covid toll hits 500, state’s deaths/month still highest in India

PANAJI: Goa touched a new low on Saturday after its Covid mortalities touched the 500-mark. The tiny state’s deaths per million, 323, is also among the highest in the country.

Goa, with a population of 15.49 lakh, took 143 days to reach its first 100 deaths in the initial days of the pandemic. However, the mortality rate has since risen rapidly, with 100 deaths now reported every fortnight. Goa’s positivity rate, too, has also touched a worrying 30%.

This puts Goa’s figures far higher than the national average. On Friday, TOI reported that the national positivity rate is 8.2%, and while Goa has seen 323 deaths per million, the John Hopkins Coronavirus resource centre puts India's national figure at around 79.
Even as deaths continue to spike — including those who are “brought dead” without knowing their Covid-19 status — the state has drastically dropped its testing.
From aggressively testing an average of 5,300 samples a day in July, Goa’s number fell to 3,000 in August and 2,000 in September. This month, the state is testing even fewer people — an average of 1,600 per day, with its expensive machines lying unutilised, contrary to the strategy of test, track, trace and treat.
“Several patients being brought dead or coming to hospital with Covid pneumonia don’t know their status, and have never been tested,” said a doctor working in casualty.
“The only way to decrease mortality is to aggressively test, isolate and treat people. Contact tracing to test and isolate contacts and break the chain of transmission is very important.”
From conducting solely RT-PCR tests — the gold standard for Covid testing — the state now relies heavily on rapid antigen testing, known for a high percentage of false negatives. Thus, the state misses out on many asymptomatic cases, who end up spreading the infection.
Goa medical college’s (GMC) head of pulmonary medicine, Dr Durga Lawande, attributes the deaths to many patients reaching hospital late due to stigma, fear of the consequences of being labelled a Covid patient, or silent hypoxemia — a unique phenomenon to Covid where a patient doesn’t appear breathless or uneasy despite blood oxygen saturation dropping.
Many of the patients who have succumbed have been elderly with several comorbidities, besides being tested positive for Covid. “Some are complicated cases of diabetes, hypertension, ischemic heart disease and kidney disease,” said Lawande. “In addition to these, they have Covid, and as a result, their deaths are sometimes fast forwarded. Although Covid is only one of the causes, their deaths are labelled as Covid deaths.”
The younger are not being spared either. “Several young patients take Covid lightly and stay home for even eight days with a fever, not believing it could be Covid,” she said. “Once they come in, they have already developed severe bilateral pneumonia, and it’s difficult to save them.”
Some experience worsening of symptoms but don’t give importance to it because they get a false sense of security after having tested negative on the antigen test, she added.
On Friday, chief minister Dr Pramod Sawant said that the mortality rate from April to September was similar to the same period last year. However, he didn’t take into account the sharp drop in road accident deaths during the lockdown.
Sawant also attributed 95% of Covid mortalities to co-morbid conditions, and the other 5% to late reporting.
A doctor who worked on the Covid frontline said that if this is the case and the state is allowing home isolation, there must be strict monitoring of persons with comorbid conditions.
“Goa has a high incidence of lifestyle diseases, and if co-morbidities are responsible for the deaths, there must be a blanket rule that anyone with co-morbidities must be admitted in a Covid care centre or Covid hospital, where their parameters can be closely monitored,” the doctor said.
Aggressive treatment and medication in the first week of infection will also ensure that it doesn’t progress, and bring down mortalities, IMA-Goa president Dr Samuel Arawattigi said. “We are lacking somewhere when it comes to identifying patients who are going from mild to moderate to severe,” he said.
Once patients with moderate to severe Covid infection are brought in, oxygenation and ventilation have to be started vigorously the moment they reach casualty, said consulting physician Dr Oscar Rebello. “Oxygen therapy is the key and has to reach a patient in time to save lives. They cannot be kept waiting in casualty,” he said. Rebello also said the high Covid mortality figures in the state could be due to better death reporting.