These days, when one is informed of a death of someone known, the first question one asks is "Was it COVID?", as if there is consolation over a death where COVID is not the culprit.
That is because deaths due to COVID are linked to horrifying experiences and visuals of stricken patients struggling to hold on to dear life, literally begging for help to breathe; of helplessly desperate families zipping from one hospital to another looking for beds to save their dear ones, and failing; of hospitals running out of life-saving oxygen, and patients dying in droves; of patients, even in home isolation, collapsing and becoming a mere number in the daily health bulletin's list of deaths; of guilt haunting the survivors and of sheer grief and depression among family members that loosen the grip on the will to live and carry on after a death in the family due to failure to save the one fallen to the dreaded SARS-CoV-2 virus.
It is to wish that a deceased person and his/her family members did not have to go through all that, that the question is asked ("Was it COVID?"), and some consolation obtained when the answer is in the negative.
Karnataka has so far seen 21,434 deaths where such consolation has eluded. Of this number, 12,000-odd have occurred in the first wave which raged for about a year from March second week in 2020 to February-end.
But 9,000-odd have occurred in just two months from mid-March (when the second wave kicked in) until now. Since mid-March, the COVID toll shot up by 72.89 per cent from 12,397 on March 15 this year to 21,434 on May 15.
However, the mortality rate came down from 1.28 per cent then to 0.98 per cent now - which is explained by the massive additions in fresh COVID cases day after day (50,112 on May 5), taking the tally to 21,71,931. The manner in which deaths started spiraling is shocking.
The highest single-day deaths witnessed during the first wave was 179 on September 18, 2020 (the peak of the first wave). But during the second wave, April 23 this year saw that record crossed with 190 cases, after which, apart from April 25 when 145 fatalities were reported, all subsequent days have reported deaths higher than the highest in the first wave. In fact, the highest single-day deaths during the second wave was 596 on May 10, followed by 592 on May 7, and 517 on May 12.
Experts say the accelerated fatalities in the second wave are due to a much more virulent double mutant of the SARS-CoV-2 virus infecting the state's population; the state government being caught off guard amid the euphoria of having got the better of the first wave, including the lack of preparation with adequate oxygen supply; the government opening up everything to the public without paying heed to desperate alerts by the Technical Advisory Committee (TAC); and people’s lack of Covid-appropriate behaviour.
Karnataka is still grappling with meeting the rising demand for medical oxygen from hospitals and homes across the state, which points to a certainty of deaths remaining high in the coming days — unless stringent steps are taken to break the trend.
WHY ARE DEATHS HIGH?
A combination of a new virus variant, state government's inadequate preparedness that has led to shortages in medical infrastructure as well as drugs and vaccines, and people's lack of awareness on what to do when symptoms surface is being blamed by experts for the high number of deaths.
Dr GB Sattur, diabetologist and cardiologist, and a member of the COVID Task Force, says the mutant coronavirus, called double mutant variant, is extremely virulent and that is why more people are getting infected and developing health issues.
Senior epidemiologist Dr Giridhara R Babu from the Indian Institute of Public Health and a member of TAC, says that since overall cases have increased, even if 1 per cent of the population is at high risk then mortality will be high.
Dr Lokesh, Chief Medical Officer, Madikeri COVID Hospital, says, "Delayed reporting of patients to hospitals is a reason. There have been instances where patients were brought dead after being infected by the virus for a prolonged period."
A change in emergency care strategies too has compounded the situation. People with comorbidities are found to be more severely affected in the second wave. "Earlier, those with comorbidities were referred from district hospital to hospitals in Mysuru for super specialist care. But not anymore. These patients require such care apart from COVID treatment and since they don’t get it, deaths have increased," he says.
He also points out that COVID cases in the second wave are unpredictable and many have turned fatal even after 14 to 15 litre of constant oxygen supply. A senior doctor involved in COVID management, informs, "Increasing burden on ICU/oxygenated beds and ventilators is forcing many critically-ill patients to go without beds and they end up trying to get admitted to several hospitals and dying in transit, or just after getting admitted, when it’s too late."
WHAT CAN BE DONE?
Dr Giridhara Babu says, "The best way to reduce rising deaths is only through early triaging mechanisms and ensuring that needy get beds in time, even if the patient is in moderate distress. It has been seen that young people tend to neglect their health and when they get affected, it becomes really bad. People assume respiratory illness with mere weakness and neglect it."
He advises everyone to regularly check one’s own oxygen levels and monitor their health. Home isolation kits should be strictly abided by and if the oxygen level drops below 94, they should have a back-up, he says.
Dr Ravindra Mehta, chief of pulmonology and critical care, Apollo Hospitals, says, "The best way to reduce mortality in the coming days is for the government to get sufficient supplies and undertake aggressive vaccination drives."
"The entry and exit at hospitals need to be streamlined. Once a patient’s condition improves, he should be shifted from the ICU bed. Home isolation norms, too, should be strictly followed and even with a slight symptom, early testing and early medication should be done," Dr Mehta adds.
Dr Sattur says that to reduce deaths, COVID Care Centres should be set up rapidly and infected should be shifted. "The service of Ayurvedic and homoeopathy doctors and staff can be utilised in the centres for primary level of treatment which will reduce severity among the patients and also the burden on ICUs and oxygen beds," he says.
"Early detection and treatment will reduce the spread and also the number of severe patients, which will bring down deaths. The government could have planned oxygen production and other required facilities much earlier and it did not, which is unfortunate. But it is very difficult to handle things in a country with a 130 crore population," he adds.
Dr Ashok H, Dakshina Kannada district nodal officer for COVID, says his team carries out death audits to understand why a fatality has occurred, pinpoint the factors, and then ensure prevention. "Despite having symptoms or worsening circumstances, some refuse to get hospitalised which is one of the main reasons for the deaths," he says.
(Inputs from: Bosky Khanna, Karthik KK, Prajna GR, Arunkumar Huralimath, Ramkrishna Badseshi and Raghu Koppar)