FOCUS IS ON REDUCING FATALITIES, SAYS CENTRE

Union govt suggests surveillance of the vulnerable; improved speed to care; less triage time at hospitals

NEW DELHI: The Narendra Modi government wants states that are seeing a large number of coronavirus disease (Covid-19) cases not to lose sight of the main objective in the rush of numbers -- keeping the death rate, or the case fatality rate low.

Top government officials familiar with the thinking in the Prime Minister’s Office (PMO) said that while aggressive testing, door-to-door surveys to track Covid-19 cases, and efforts to strengthen infrastructure will continue, there will be a renewed focus on keeping the death rate low. A detailed action plan has already been chalked out, they added.

NEW DELHI: The Narendra Modi government wants states that are seeing a large number of Covid-19 cases not to lose sight of the main objective in the rush of numbers -- keeping the death rate, or the case fatality rate low.

Top government officials familiar with the thinking said that while aggressive testing, door-to-door surveys to track Covid cases, and efforts to strengthen infrastructure will continue, there will be a renewed focus on keeping the death rate low. A detailed action plan for this purpose has already been chalked out, they added, and Prime Minister Narendra Modi may even raise the issue in his meeting with chief ministers on Tuesday and Wednesday.

Even as India’s average death rate has remained low at 2.9 -- the global average is 5.4% -- the concern, the officials said, is that over 80% of total deaths in the country are from just five states: Maharashtra, Delhi, Gujarat, West Bengal and Madhya Pradesh.

“We have also noted with concern that 65 districts of India have more than 5% fatality rate. And the largest chunk, 19, of those districts are in Madhya Pradesh, followed by 11 in Gujarat and 10 each in Maharashtra and Uttar Pradesh,” said one of the officials who asked not to be identified.

In Madhya Pradesh, Mandla, Sehore, Umaria and Chhindwara are among the districts; in UP, Lalitpur, Jhansi, Meerut and Agra; and in Maharashtra, Nandurbar, Jalgaon, Dhule, and Aurangabad.

Gujarat’s Porbandar, Anand, and Ahmedabad, Punjab’s Kapurthala, and Haryana’s Jind are also among districts with a CFR of at least 5%.

The official added that the CFR issue was discussed at length at the meeting called by the PM on Saturday. The meeting was attended by home minister Amit Shah, health minister Harsh Vardhan, and key bureaucrats who are members of the empowered groups tackling the Covid crisis. The meeting also discussed the spike in cases and deaths in Delhi and laid the ground for the meeting with the CMS.

“The broad idea is that states should be encouraged to not suppress numbers; they will be told that the prime focus should remain on reducing the death toll. India’s death toll is already less than half of that some advanced western countries,” said a second official who asked not to be named.

The emphasis on lowering death rates is in keeping with the government’s new strategy of not so much flattening the curve (of infections), but living with the virus. According to the officials, the Centre wants to focus on “fatality mitigation” and “end-to-end case management” to reduce the CFR and is aware that the number of positive cases is rising sharply (and will continue to), largely because of the return of millions of migrant workers to their homes in the hinterland, and the resumption of economic activities.

HT reported on June 10 that states that have received the majority of migrants are seeing a spike in cases.

The Centre’s suggested fatality reduction efforts include: active surveillance of the vulnerable population such as senior citizens or people with comorbidities; improved “speed to care” which involves faster ambulance services; and less triage time in the hospitals. “We are asking states to do an assessment of how many people called for ambulances, how many were rejected and what time it took for the patient to reach hospital in an ambulance,” said another official, “and also ensure that when a patient reaches the hospital he or she should not spend more than 45 minutes in triage.”

Triage is essentially a decision taken by health care workers on the order or priority of treatment and is used to indicate wait times.

The Centre is also asking states to ensure preference in hospitalization for co-morbid or elderly patients, timely referrals on escalation of symptoms, improving clinical practices, and providing on-call specialist care.

Under the end-to-end case management, the Centre is stressing on the importance of providing all solutions starting from surveillance to ambulance service to treatment, even referrals. They have also pointed out that it is critical to “smoothen transition points” which includes test confirmation to hospitalization to ambulance coordination and its uptime.

Last week, Amit Singh, associate professor at the Centre for Infectious Disease Research, Indian Institute of Science, Bengaluru had said, “I think mortality per million population is a much better metric to judge how Covid-19 has affected us. The case fatality rate can change depending on the denominator of the number of people who are tested and turn out to be positive.”