Behind surge in Punjab, Maharashtra: Delay in getting to hospital

– Occupancy rate of Covid-19 ventilator beds has breached the 50% mark in at least four districts of Maharashtra, triggering a surge in deaths
– Most deaths in Punjab are being reported 48-72 hours after admissions, probably due to delay in hospitalisation
– Contact of positive cases is not being isolated till the final test report, resulting in the spread of infection

These are some of the red flags raised by the Centre on Saturday during the high-level meeting with 12 states and Union Territories reporting a surge in cases.

On Saturday, Maharashtra continued to report the highest daily new cases at 36,902; followed by Punjab with 3,122. Alarmingly, in just the last 24 hours, Maharashtra reported the maximum casualties (112) in the country; followed by Punjab (59).

Union Health Secretary Rajesh Bhushan chaired a high-level meeting with state health secretaries, municipal commissioners, and district collectors of 46 districts, the most affected in terms of rising cases and rising mortality. In the meeting, the Centre highlighted that 90 per cent of the Covid-19 deaths continue to be in the category of those aged above 45 years.

Significantly, of the total 36 districts in Maharashtra, the most affected 25 account for 59.8 per cent of the total cases reported in the country in the past one week.

In the meeting, the Centre spelled out a multi-prong strategy — on effective containment and contact tracing for at least 14 successive days — for the 46 districts, which together account for 71 per cent of cases and 69 per cent of deaths this month.

It also focussed critically on the alarming rate of deaths being reported in Punjab and Maharashtra, sources said.

Top government sources, who were present in the meeting, told The Indian Express that a detailed discussion was specifically held with district magistrates of Pune, Aurangabad, Nagpur, and Yavatmal.

“In Pune, 70 per cent of ventilator beds are already occupied. This is a signal that patients are coming late. The same was true of Nagpur. This number was around 50 per cent in Aurangabad; and around 40 per cent in Yavatmal. The issue of quick identification of cases and quick hospitalisation still remains, in at least these four districts,” the DMs were told, according to sources.

Sources said a similar granular analysis on Punjab deaths was made during the meeting. “For the last three days, Punjab is reporting deaths, which in absolute numbers, are higher than the deaths being reported by Kerala and Karnataka. This is unimaginable. These states, which are higher population than Punjab, are reporting lower deaths,” the state was told, sources said.

Sources said the surge in deaths in Punjab was because patients were not coming to hospitals in time as per the clinical management protocol. “Due to this, most of the deaths are happening immediately on admission to hospitals,” the state was told, sources said.

Sources said the Centre shared the data on patients on ventilators and ICU with Punjab — which reveals a high percentage of patients arriving at the hospitals in severe condition. “We shared data on people on ventilators and in ICUs which shows that as the patient gets admitted in hospital in Punjab, he or she immediately either goes to the ICU or is put on a ventilator. Which means they come when the situation has actually deteriorated. That is why the deaths are happening in the first 48 hours or 72 hours of admission,” sources said.

“The second thing that is happening, in both Punjab and Maharashtra, is that the field people don’t have a clear understanding of containment and contact tracing,” sources said. Both the states are learnt to have told the Centre that they test close contacts on the fourth day. “This is very good. However, when we questioned what the contacts do for these four days, they replied they remain at home,” sources said.

“We told them that SoPs mandate they also have to be under isolation. We also have directed that if they cannot be isolated at home, they should be shifted to Covid-19 care centres. We have to ensure that the contact, who may turn out to be positive, is taken out from circulation,” sources said.

Sources said that inadequate surveillance of contacts ‘micro containment’ zones in Maharashtra was also raised during the meeting. “Maharashtra has gone for micro containment zones. In this type, if in a high-rise building, there are three cases, those floors are converted into containment zones. However, once the floors are made a containment zone, someone needs to check if people are following rules. This is not happening,” the state was told, sources said.

It also emphasised peer-reviewed studies on transmission. “Findings of studies were highlighted which depicted that while 90 per cent people are aware, only 44 per cent actually wear face masks. One infected person could spread Covid-19 to an average of 406 other individuals in a 30 day window without restrictions, which could be reduced to just 15 by decreasing physical exposure to 50 per cent and to a further 2.5 (average) by decreasing physical exposure to 75 per cent,” the health ministry said in a statement.