Behind capital’s Covid-19 death spike: Steep peak, late admission, ICU crunch

The death rate continues to stay on the higher side at 1.89% based on the last 10 days data.

Delays in admission, dangerously low oxygen saturation levels at the time of hospitalisation and unavailability of ICU beds are some of the reasons behind a rise in the number of fatalities in Delhi over the last few days, experts in the capital have said.

The city, which saw 2,330 deaths in June — the highest in a month so far — has already reported 2,110 deaths in November, with over 100 each for the last five days. On Tuesday, Delhi reported 6,224 new cases and 109 deaths, taking the total number of cases to 5,40,541 and the death toll to 8,621. The death rate continues to stay on the higher side at 1.89% based on the last 10 days data.

Delhi’s Health Minister, Satyendar Jain, maintains the case-fatality ratio in the capital is the lowest among major cities. “Rapid addition of ICU beds and other medical facilities have helped us achieve this. We are doing our best to save each and every life,” he tweeted, along with a chart which said that the death rate in Ahmedabad was 4.2%, followed by Ludhiana at 4% Mumbai at 3.9% and Amritsar at 3.8%. In Delhi, according to Jain, it is 1.6%.

But with no let-up in the number of cases and a much higher peak this time round — November saw a high of 8,593 cases in a day as opposed to June when the peak hovered around the 4,000 mark — the healthcare setup and doctors at frontlines have found themselves more stretched than ever before.

Experts who have been monitoring the disease’s pattern feel that patients in a worse condition are being wheeled into hospital this time round. “Earlier, since the concept of home isolation was new, most patients rushed to the hospital even with minor symptoms. This time, we are getting relatively sicker patients. The concept of home isolation is playing two roles here — firstly, it helps reduce the burden on the healthcare system; however, many are reaching hospital in a severe condition,” said Dr D S Rana, chairman of board, Sir Ganga Ram Hospital.

Many patients, doctors said, are reaching hospitals with hypoxia — a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level. The adequate oxygen saturation level is considered to be above 95%.

Said a senior doctor from GTB hospital, which falls under the Centre, “Patients are reaching the emergency department when the oxygen saturation levels are 50-60%. In such cases, there is not much scope left with the treating physician — and if the patient is elderly and has a pre-existing condition, the situation becomes even more severe.”

The crunch being faced in terms of availability of ICU beds has also meant many patients who would be shifted there at the first sign of a deterioration in health are being kept in the wards longer. “Many patients are under home isolation and, when needed, are being shifted to ICUs. Unfortunately, ICUs in many hospitals are full, which is also leading to the increased fatality rate. It is important to monitor patients under home isolation,” said Dr Rana.

Data shared on Delhi government’s Delhi Corona App shows that 86% of ICU beds with ventilator are occupied at the moment, and even the facilities without ventilator are 74% full.

Dr Desh Deepak, the nodal officer for Covid-19 at Ram Manohar Lohia Hospital, said that hospitalisation “becomes tougher when cases are on the rise”.

“For instance, if everyone in the family is ill, it is not possible to reach a medical facility early, which then leads to delayed admission and can add to the severity of the disease. It is a natural corollary that whenever cases are high, the number of deaths are bound to increase,” he said.

Amid a festive rush and with people disregarding social distancing and mask hygiene, November has seen the worst of it. Between October 21 and November 1, Delhi’s case fatality ratio was 0.83%. On Monday, the ratio over the past 10 days stood at 1.83%. The city’s overall case fatality ratio is 1.59%.

Data shared by the Union Ministry of Health and Family Welfare on Tuesday also showed that Delhi is at the top of 10 states and UTs that have reported 74% of new deaths in the past 24 hours, surpassing Maharashtra and West Bengal. “Delhi saw the maximum casualties (121) followed by West Bengal and Maharashtra with 47 and 30 daily deaths, respectively,” the Ministry stated.

The government has meanwhile said higher Covid numbers are a result of increased testing — almost 60 lakh tests, both rapid antigen and RT-PCR, have been conducted in the city since March.

Dr Anjan Trikha from the department of anesthesiology and critical care, who is also chairman of the clinical managerial group at AIIMS Trauma Centre, also echoed the point of people reaching hospitals in a sicker state than before. “The patient profile coming to our centre has completely changed over the last few months. We are getting sicker patients with more comorbidities, needing ICU care… Patients with Covid and other diseases of liver, kidney and heart tend to remain in the hospital for a longer time, leading to shortage of beds and also more morbidity,” said Dr Trikha, adding that in the last two months, about 65% of patients who have died at the trauma centre have been above the age of 60.

 

 

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