NEW DELHI: The largest cohort study of COVID-19 patients in India so far, carried out in Kota, suggests that most of them are being unnecessarily hospitalized, leading to hospitals in many cities being overwhelmed and running out of beds.
The study, which documented details related to 406 patients in the Government Medical College, Kota and hospitals associated with it, has revealed that a majority of the patients -- 244 -- who were hospitalized had no symptoms at all and less than 5 per cent had severe respiratory issues requiring ICU or mechanical ventilation.
Experts, including those guiding the Union Health Ministry's response to the pandemic, have been saying that these unnecessary hospitalizations are leaving COVID-19 patients who are really in need of medical care in the lurch.
The study titled COVID19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent published in the Journal of the Association of Physicians of India said “the disease was milder as compared to other regional reports especially from foreign countries.”
It also said that of 406 patients enrolled for the study, only 4.4% required ICU or ventilators, eight of whom died. The rest with symptoms were treated with standard therapies or oxygen in some cases and most of them recovered within six days on an average.
The study which documented case details from April 5 to June 2 also underscored that shortness of breath and chest pain was not common but was usually associated with ICU admission or requirement for oxygen inhalation.
The Union Ministry of Health and Family Welfare, on April 28, had recommended that confirmed COVID-19 cases with mild or no symptoms can opt for home isolation under certain conditions but the study indicates what experts have been saying for long -- that in most states unnecessary hospitalisations have been happening.
“This paper confirms my suspicion that Indian hospitals are busy admitting large numbers of asymptomatic patients,” said epidemiologist Dr Jammi N Rao who has worked with the Indian Council of Medical Research in Hyderabad and the NHS in the UK.
During the peak in Delhi and Mumbai and now in cities like Bengaluru, there have been numerous reports of seriously ill patients struggling to secure hospital beds.
Rao's views were echoed by a senior member of the operations research group of the National COVID 19 Task Force.
“We have been worried about it and the main concern is that the situation could be worse off in private hospitals which would be deliberating taking on mild cases for commercial reasons. Hospitals may also be taking advantage of panicked patients,” said the member who did not want to be quoted.
“Therefore there is a need to rigorously enforce home isolation of full households to ease pressure on hospital bed capacity.”
Meanwhile, the study from Kota, which had seen a major outbreak in April and May, also said that only 210 patients had a history of contact with positive patients while only 16 had a history of travel to disease hotspots and/or attending mass gatherings -- indicating that the majority picked it up from the community.
Nearly 65 per cent of the patients were brought to the hospitals by the rapid response teams deployed for contact tracing and 79 patients had associated comorbidity, most commonly hypertension closely followed by diabetes mellitus-2.
Those symptomatic at the time of presentation mostly had fever, dry cough and body ache but some patients also had complaints suggestive of rhinitis, headache, nausea, vomiting and occasionally diarrhoea.
Researchers also said that every COVID-19 positive patient was treated with anti-malaria drug hydroxychloroquine and antibiotic azithromycin, barring those who had any contraindications or side effects.
This might be in contravention of the earlier clinical management protocol by the Centre which had suggested the combination for only severe cases but later dropped the antibiotic and now suggests HCQ for mild cases.
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