FATAL DELAY: 31% DEATHS IN 24 HRS OF ADMISSION

Failure to identify symptoms resulted in patients reaching hospitals too late

Thirty-one per cent of corona deaths in Mumbai occurred within 24 hours of hospital admission, according to the Covid19 death audit committee. Health officials have attributed these deaths to delay in identifying the infection and, in most cases, to the serious condition of patients being admitted to hospitals.

An analysis of 5,200 of the 7,690 fatalities by the committee reveals that 1,615 patients succumbed within 24 hours, while the rest died within four to five days of hospitalisation.

Dr Avinash Supe, head of the committee, said most patients who lost their lives to coronavirus were not able to identify the symptoms, resulting in delayed hospitalisation. “In the initial days, patients were not able to understand whether they had symptoms of corona or other illnesses. Most of them preferred to consult their local doctors or physicians. Subsequently, their condition deteriorated and they succumbed within 24 hours of being hospitalised,” he said.

He further informed, they had now switched to weekly data analysis, as opposed to looking at

the cumulative numbers since April, a month after Mumbai reported its first Covid-19 death.

Data analysed for the period of August 27-September 2 shows Mumbai’s mortality rate was 2.42 per cent, much lower than the city’s cumulative death rate of 5.19 per cent, with 1.48 lakh cases and around 7,724 deaths. The weekly mortality rate in July fluctuated between 4.9 per cent, 4.68 per cent and 4.3 per cent.

Dr Supe said it was now important to take into consideration the weekly mortality rate, instead of the cumulative mortality rate being looked at since April because the former gave an idea of the more immediate situation. “In April, the death rates were high, the management and understanding of the disease were poor. But now patients are referred well in time, treatment protocols are in place and everybody has understood the disease. So, we look at the weekly mortality rate,” he said.

Dr Supe said that intensive supportive therapy, oxygenation and physiotherapy are the keys to reducing mortality rate, but warned that unnecessary use of medicines like Tocilizumab and Remdesivir must be avoided.

Cur rently, in eight of the 24 wards of BMC, mortality rates are higher than 6 per cent, resulting in Mumbai's overall death rate being the highest in India. According to the BMC dashboard, L ward covering Kurla (west), Andheri Sakinaka and Powai has the highest mortality rate, at 7.44 per cent, followed by B ward (Dong ri, Masjid Bunder) at 7.37 per cent, H-East ward (Bandra, Khar and Santacruz) at 7.21 per cent and M-West ward (Chembur), at 7 per cent.

However, G-South ward, covering Worli and Prabhadevi, M-East ward, covering Chembur-East, K-East ward covering Marol and Andheri East, G-North, covering Dadar, Dharavi, Mahim and Parel, all have registered death rates ranging between 6 and 6.7 per cent.

Additional Municipal Commissioner Suresh Kakani said the mortality rate in key hospitals is now in single digits. “The treatment protocol has been amended and we are also focussing on judicious use of medicines like Tocilizumab and Remdesivir. The involvement of senior doctors is also a crucial factor,” he said.

Kakani said he has assistant commissioners and medical officers note the date of swab collection, date of the test report and the amount of time the patient spent in home isolation before being admitted to a hospital. “We must see if patients are being referred to hospitals late. We will also analyse why some wards are registering high death rates,” he said.

Infectious Diseases expert Dr Om Shrivastava said there were many factors behind Mumbai’s high mortality rate - 5.17 per cent, as compared to that of Maharashtra - 3.04 per cent. “In the initial days, more patients were succumbing to the SARS-CoV-2 virus as they were not able to identify the symptoms, thereby delaying treatment. Moreover, more than 50 per cent of patients who lost their lives had comorbidities. But now, deaths are under control, as the average number of deaths in the city is 31, as compared to 70-80, earlier,” he said.