NEW DELHI: The largest cohort study of COVID-19 patients in India so far, carried out in Kota, may have an explanation for why hospitals in cities seeing a surge in cases are getting overwhelmed and running out of beds. The study documented details related to 406 patients in the Government Medical College, Kota, and hospitals associated with it. It has revealed that a majority of the patients, 244, who were hospitalized, had no symptoms at all and less than 5 percent had severe respiratory issues requiring ICU or mechanical ventilation.
Experts, including those guiding the Union Ministry of Health and Family Welfare’s response to the pandemic, have been saying that there are unnecessary hospitalizations, leaving those Covid-19 patients who are really in need of medical care in the lurch. A cohort study analyses a group of people with common features without any interventional trial. The study titled ‘Covid 19: 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 “that the disease was milder as compared to other regional reports especially from foreign countries.”
It said of the 406 patients enrolled for the study, only 4.4% patients required ICU or ventilators, eight of whom who 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.
On April 28, the Union Ministry of Health and Family Welfare had recommended that confirmed Covid-19 cases with mild or no symptoms can opt for home isolation under certain conditions but the study indicates that in most states there have been unnecessary hospitalisations happening.
‘There is need to rigorously enforce home isolation’
“This paper confirms my suspicion that Indian hospitals are busy admitting a large number of asymptomatic patients,” said epidemiologist Dr Jammi N Rao, who has worked with the Indian Council of Medical Research in Hyderabad and the National Health Service in the UK.During the peak in Delhi and Mumbai and now in cities such as Bengaluru, there have been numerous reports of serious 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 on Kota, which had seen a major outbreak in April and May, said 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 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.