Lack of facilities, late diagnosis pushed CFR in some Maharashtra districts

Some of these districts showed high CFR, which refers to the number of deaths per 100 cases, also during the second wave

Mumbai: Maharashtra’s Ratnagiri, Sindhudurg, Satara, Solapur, Beed, Malegaon, and Akola recorded a high case fatality rate (CFR) compared to districts with a higher caseload even with fewer infections during the Omicron variant driven third Covid-19 wave, an analysis of the state’s death audit committee for January and February has found. Some of these districts showed high CFR, which refers to the number of deaths per 100 cases, also during the second wave. Fewer mortalities were recorded during the third wave compared to the first two.

(HT PHOTO/Representative image)

The state recorded 4,763,050 cases and 86,406 deaths in 2021 with a CFR of 1.81. In the first two months of 2022, 1,183,406 cases and 1,957 deaths were reported with a CFR of 0.17. Mumbai recorded 501,534 cases and 5,261 deaths in 2021 with a CFR of 1.05. In the first two months of 2022, 269,963 cases and 311 deaths with a CFR of 0.12 were reported.

Avinash Supe, who headed the committee, called for a community-based study to understand why some districts clocked a higher CFR. “There can be many factors such as community behaviour and vaccination status.” He added 65% of patients who succumbed suffered from comorbidities, and 45% showed respiratory symptoms.

District health officer (Satara) Radhakrishna Pawar, who was earlier posted in Beed, cited an analysis of deaths in the two districts and said they found comorbidities to be a major reason behind the high CFR. “...there has been a lack of specialty services and absence of physicians.” He added these districts even under-reported deaths, which came to light when applications for the ex-gratia went up. “We had to investigate and add the numbers.”

Amitav Banerjee, an epidemiologist, said CFR is linked to the availability of medical services and patients reaching healthcare facilities on time. “Many patients do not have access to hospitals or nursing homes, so a late diagnosis may also be a factor.”

Shashank Joshi, a member of the state’s Covid Task Force, said a lack of infrastructure and late diagnosis could be the reasons for high CFR. “We need to look into the causes.”

The state’s second vaccination dose coverage is 71.2% Beed, Akola, Nanded, Solapur have under 70% coverage. “...most of the people who succumbed in the third wave had not taken the vaccine or taken only one dose,” said Joshi.

The CFR for those aged above 60 in January-February was 7.7% (179,169 cases and 1,381 deaths). In 2020, it was 8.75% (349,829 cases and 30,612 deaths). It was 5.7% (788,313 cases and 44,943 deaths) in 2021. “Predominantly, Covid deaths among senior citizens are because of multiple underlying comorbidities, making them prone to complications,” Joshi said.

Supe said this age group has a weak immunological system. “Comorbidities such as diabetes and hypertension become additional risk factors.”

In its report based on the analysing of the death rate patterns of the three waves, the committee said the highest weekly deaths were reported in 2020 ( 3,561) between September 12 to 18. The average number of daily deaths that week was 508.71. The highest deaths (540) were reported on September 13. The highest weekly deaths reported in 2021 were 9,444 between April 23 to 29. The average number of daily deaths in this week was 1349.14. In 2022, the highest single-day deaths (76) were reported on January 24.