Odisha is knocking at 1 lakh cases and has recorded 553 Covid-19 related deaths. Still far from peaking, the way forward for the state should be, according to experts, laying a treatment protocol and minimise deaths. The State Government has, so far, declared 523 deaths, including 53, who died of diseases other than Covid, while audit is underway in rest 30 cases.
August alone accounted for 260 deaths of which, 76 fell victim to the disease without having any comorbidity. In last 24 hours, the single day highest death of 14 persons came in. Going by Health and Family Welfare department, as many as 411 patients had comorbidities and 142 persons died without any underlying conditions.
Age-wise Analysis
An age-wise analysis of deaths shows that over half the fatalities occurred among senior citizens, while 48.6 per cent deaths was recorded in the 40-60 age group. The oldest person to die was an 88-year-old woman of Bhadrak who had pyrexia with acute kidney injury and metabolic acidosis. The youngest was a one-year-old boy of Cuttack district who died of gastrointestinal haemorrhage, hemolytic anaemia and sepsis, the Health Department says.
Among the comorbidities that caused death, around 50 per cent patients were suffering from diabetes, 35 per cent had high blood pressure, 15 per cent had cancer and five per cent each were suffering from chronic liver and kidney disease and chronic obstructive pulmonary disease. At 0.53 per cent , the case fatality ratio (percentage of deaths from among all confirmed cases) in Odisha is one of the lowest in India and less than the national average of 1.91 per cent. At least 79.75 per cent of all deaths were among men.
Interestingly, as the government depends heavily on antigen tests, health experts now say that RT-per cent R test must be given priority as it records the viral load and helps adopt the treatment protocol to contain fatalities. A member of the technical committee formed by the Government to monitor Covid-19 treatment mechanism, senior cardiologist Prof UK Pattnaik said most of the deaths among the Covid patients occur due to comorbidities and decreased oxygen saturation level leading to multi-organ failure.
“Patients who do not have any underlying diseases should be treated with extra care. In such cases, treatment is guided by oxygen saturation level. Treating doctor should also know the viral load to treat such patients. It is difficult to know the viral load unless a patient undergoes RT-per cent R test. In antigen tests, we can only know whether a patient is positive or negative with very less accuracy level in case of negative,” Dr Pattnaik points out.
Monitoring Treatment
With Covid-related deaths on the rise despite several measures, the State Government has constituted seven technical committees comprising senior professors of medical colleges to monitor the treatment management and guide doctors in Covid facilities for reducing fatalities further. Altogether 41 senior professors of seven Medical Colleges and Hospitals (MCHs) have been divided into seven panels and assigned all 30 districts to visit, give guidance and technical input to the treating doctors.
The committee formed with doctors of SCB MCH has visited more than 15 Covid Hospitals and Covid Care Centres. Dr Pattnaik says the Government has made elaborate arrangements for patients, but they would suggest more focus on treatment and availability of anti-viral drugs. “Patients with complications need to be attended immediately. Those who are in isolation ward in hospitals should also be shifted to Covid hospitals without delay once they are tested positive. The condition of many is deteriorating in the isolation. They should not be made to wait,” he adds.
The technical committees will also take stock of deaths and review infection prevention control protocol, sanitation, food, body disposal and other arrangements in all Covid treatment facilities besides interacting with patients and collect their feedback and suggestions. The committees will report to the Government on the discrepancies and recommend corrective measures.
Delayed Reporting
Additional Chief Secretary of Health department PK Mohapatra attributes death of people without underlying diseases to the patients not coming forward to report early. “The main reason for the rising death is that people are reporting very late or only after they started experiencing severe complications. During door-to-door screening health workers are appealing people to inform immediately once they develop symptoms,” he says.
Citing instances of patients coming for tests or treatment nearly a week after developing symptoms, a health official said there are cases in which surveillance teams failed to trace people, who went into hiding after availing preliminary treatment from periphery hospitals, for days together. “What will we do in such cases? This only aggravates their condition and they die without having the comorbidities,” he points out.
ACS of Health department said the technical committees have been asked to guide treating doctors with special focus on rational and timely use of new drugs and plasma therapy as a measure for reduction of case fatality. “We will definitely take steps after the committees submit their comprehensive reports on each facility after visit. The state government will also plan further course of action basing on the reports,” Mohapatra adds.
What’s Cytokine storm?
According to Director of Health Services Dr Bijay Kumar Mohapatra, patients succumbing to are either victims of cytokine storm or ventricular arrhythmia. In cytokine storm, the body starts attacking its own cells rather than fighting off the virus. Similarly, if a patient develops ventricular arrhythmia, it will be difficult to save him.
In ventricular arrhythmia, abnormal heartbeats originate in lower heart chambers and causes heart to beat too fast, which prevents oxygen-rich blood from circulating to the brain and body resulting in cardiac arrest. Citing that there is no simple answer for what causes death in Covid-19 patients without comorbidites, a senior virologist Dr Tirumala Chowdary underlined three conditions for the deaths.
“People are dying due to lack of enough oxygen (hypoxemia) or direct effect of viral infection on heart wall besides severe damage to brain due to inflamatory cytokine burst and renal failure. These are possible reasons for death even when assisted ventilation and ICU support is given. But, if ICU and ventilator support is not given, it is penumonia that causes death,” said Dr Chowdary, a Reader in School of Biological Sciences, NISER, Bhubaneswar.
Technical committee member says focus is on treatment and availability of anti-viral drugs. Patients with complications need to be attended immediately and those in isolation wards of hospitals must be shifted to Covid hospitals without delay once tested positive
Experts say
Over half the fatalities occurred among senior citizens, while 48.6 per cent deaths was recorded in the 40-60 age group RT-per cent R test must be given priority as it records the viral load and helps adopt the treatment protocol to contain fatalities