Timely care vital in reducing Covid mortality

Dr KK Talwar

Former Director, PGIMER

The rate of mortality is an important parameter to judge the severity and impact of a disease. As regards Covid-19, while most patients are usually mild-to-moderately symptomatic, around 4-5 per cent may develop symptoms like severe hypoxia and other system involvement. Of these, a significant number may not survive. The mortality rate of this disease is measured either by the ‘case fatality rate’ (CFR) or deaths per million people. In Punjab, the CFR is among the highest in the country, and this has been a matter of concern. It is important to appreciate the factors which affect the mortality rate, particularly the CFR, to address the situation.

CFR is defined as the number of deaths divided by the number of people confirmed for Covid. With more testing and identification of a greater number of asymptomatic and mildly symptomatic patients, the CFR would reduce. On the other hand, the metric of ‘deaths per million population’ is not affected by the number of performed or positive tests. Thus, ‘deaths per million population’ is a better and more reliable index while comparing the spread, mortality and effectiveness of the health infrastructure of a region, state or country.

As an illustration, the deaths per million population in Delhi is 296, whereas in Punjab it stands at 134, i.e. less than half. At the same time, the CFR is 3 per cent in Punjab but 1.9 per cent in Delhi. Since Delhi has performed more tests per million population than Punjab, the CFR figure is lower in Delhi as compared to Punjab, though the number of deaths per million population is more than double in Delhi than in Punjab.

Increased testing is of importance since it helps identify more positive cases that need isolation/quarantine in order to control the spread of the disease. But the number of tests being performed in any area will depend on a number of factors, including the state of the healthcare infrastructure and availability of resources. Social attitudes, social media rumours against testing, education and affordability also play a role. States like Punjab have limitations on account of these factors and testing is avoided unless a person falls ill.

To reduce mortality, we need to scientifically identify the factors responsible for higher mortality. Mortality in Covid-19 cases has, so far, been seen to be dependent on various factors, including the association of comorbid diseases, virulence of the virus, environment and timely availability of healthcare. It is important to address these issues to reduce mortality.

Timely seeking and availability of healthcare for optimum management of the patient is the most vital factor, the importance of which is often inadequately emphasised in discussions on mortality rates. A key lesson learnt the world over is that early detection and management go a long way in controlling this disease. The first three to seven days of the onset of the disease are the ‘golden period’ for treatment and optimal outcomes.

Lack of awareness and even a casual attitude, along with lack of quality healthcare facilities in many districts with large rural populations, are an impediment in the battle to manage Covid. Most people ignore the initial symptoms of hypoxia (main presentation of the disease) and approach hospitals only as a last resort once the situation of the patient substantially deteriorates. In the process, precious time is lost. It is imperative to understand the importance of timely interventions, and take steps to create awareness in this regard. Increasing the availability of quality healthcare facilities offering affordable care is also a must to generate confidence among people.

The experience worldwide has also shown a high mortality rate among those with certain associated comorbid states, like old age, heart failure, diabetes, hypertension, chronic kidney diseases, cancer, and chronic lung diseases. These patients are not only more prone to catching Covid-19 but also have higher chances of mortality. Thus, this group needs special attention to ensure the prevention, early identification and therapy. Again, states like Punjab which have a higher prevalence of these comorbidities need to focus on healthy behaviour change communication, apart from improving their healthcare programmes and infrastructure.

The importance of adopting internationally accepted best practices for Covid prevention and care cannot be overemphasised. Both for controlling the spread and reducing mortality, measures such as the use of masks, hand hygiene and social distancing practices are of critical importance. But, along with imposing penalties for not wearing masks, we need to spread awareness and change mindsets.

Covid-19 is among the most serious health crises in modern times. It has highlighted the shortcomings of our healthcare systems and the current state of medical science. Despite the massive efforts being made to find an effective treatment, no medical solution seems likely to emerge in the short term.

A few drugs showed promise, but their impact on mortality rates is heavily dependent on their timely administration. There also does not appear to be any clarity in regard to the time frame for the availability of a safe and effective vaccine. These are challenging times for governments, administrators and medical professionals. Only concerted and sustained efforts by all can help reduce the prevalence and spread of Covid-19.