Hospitalisation delays, pollution fuelling Covid-19 deaths in Delhi, say doctors

Delay in admissions, pollution-induced respiratory illnesses, and a surge in number of cases of Covid-19 — coupled with the pressure on hospitals — has led to a higher number of deaths that the capital has been reporting currently, city doctors said.

Delhi has reported over 100 deaths a day for the last five days due to the viral infection, increasing the seven-day average case fatality ratio (CFR) – proportion of deaths among those who test positive — to 1.7% from 0.8% at the beginning of November.

On an average, 115 people died each day in the last seven days as compared to just over 95 the week before, and 70 patients the week before that.

People delaying hospital visits has also added to the current increase in mortality.

 

“The problem is that people have started taking the disease lightly. This is also the time when they have common cold, flare-ups of allergies, and seasonal flu. People attribute their symptoms to these conditions and do not get tested till late. Covid-19 being a viral illness, early treatment is of utmost importance,” said Dr Vivek Nangia, head of the department of pulmonary medicine at Max hospital, Saket.

He says that some patients have bought oxygen cylinders and oxygen concentrators and use them at home to ease symptoms and report to hospitals only when the disease becomes severe. “So, they come in late; about 10 to 15% of the patients are now reaching hospitals when their oxygen saturation has already dropped quite a lot. These measures should be a stop-gap till they get a hospital bed and not be used as a therapy that can be continued at home,” said Dr Nangia.

Even people in their 30s and 40s without comorbidities are getting the disease, the doctor cautioned.

“We have seen a very high number of Covid-19 cases from September through November and the number of deaths reflect that. The number of deaths are likely to remain high for a couple of weeks because there is always a lag in the increase in cases and the increase in deaths – patients go to the hospitals, remain under treatment for weeks, and then succumb. The high number of cases is also the reason that hospitals are seeing an increase in the serious patients who are more likely to die,” said Dr Naresh Gupta, professor of medicine at Lok Nayak hospital, Delhi’s biggest Covid-19 treatment facility.

The hospital has also seen an increase in the number of patients coming in with very low oxygen saturation during the November surge in cases, according to another doctor at the hospital. “We get about 60 new admissions a day, of which around 15 to 20 patients come in a severe condition. These patients are often those who have been referred from private hospitals in the city,” the doctor said.

Patients referred from other states have also contributed to the number of severe cases in government hospitals. “It is difficult to say what percentage, but we certainly get many Covid-19 patients from other states coming to Delhi for treatment. And, these patients are usually in a critical condition by the time they reach our hospital,” said Dr BK Tripathi, professor of medicine at Safdarjung hospital.

In a recent interview, Union health minister Harsh Vardhan pointed out that the Centre had to intervene twice in Delhi as Covid-19 situation was going out of hand. “Delhi is paying the price of casual behaviour of people as you find a majority of them not following Covid-19 appropriate behaviour especially at crowded public spaces. Testing is being doubled in Delhi, and mobile labs are being launched that would go to different locations to collect samples. Contact tracing is another key area. Also, pollution ails Delhi NCR around October, November and December, in turn aggravating the Covid-19 situation,” he added.

The levels of pollution leads to more serious cases and higher number of deaths, doctors said.

“The number of serious cases has increased of the total number of cases in Delhi. This is not unexpected because the respiratory infections become severe during winter season, when the air quality is poor. There is evidence from across the world – from Italy, US, and Germany -- that shows severity of Covid-19 cases goes up with increase in pollution levels. In addition, pollution regulates a person’s immune system making them more susceptible to the virus,” said Dr GC Khilnani, former head of the department of pulmonary medicine at the All India Institute of Medical Sciences (AIIMS).

“There is also a shortage of beds in Delhi, which means people go from hospital to hospital in search of beds, which delays their treatment and adds to the Covid-19 morbidity and mortality,” he said.

The Delhi health minister Satyendar Jain on Tuesday had said that Delhi had one of the lowest case fatality ratios among India’s major cities. “Delhi has least fatality ratio amongst all major cities in India. Rapid addition of ICU beds and other medical facilities have helped us achieve this. We are doing our best to save each and every life,” he said in a tweet. The data attached in the tweet mentions that Delhi’s case fatality ratio (CFR) – proportion of deaths among those who test positive – stood at 1.6%, comparing it to states with the highest CFR -- Ahmedabad’s 4.2%, Ludhiana’s 4%, Mumbai’s 3.9%. As per the data shared by the minister, Delhi was on the 15th place in the list of the cities with highest mortality.