Bihar’s low testing may impact Covid-19 fatality rate: Central team
Bihar has clocked the lowest testing ratio at 3,423 per million population, while the mortality rate stands at 0.69% to date.Updated: Jul 23, 2020 12:26 IST
The Central team, which visited Patna and Gaya earlier this week on a two-day trip, has shared its inputs about the spiralling coronavirus disease (Covid-19) cases with the state government and has warned that the “very low” testing ratio, as compared to the national average, might impact its case fatality rate (CFR) of the viral outbreak.
Bihar has clocked the lowest testing ratio at 3,423 per million population, while the mortality rate stands at 0.69% to date.
The three-member Central team expressed concern about the spike in Covid-19 positivity rate and cautioned the Nitish Kumar-led government that low testing could lead to a spread in the infection. Besides, it has warned that late detection of the pathogen might lead to a spike in CFR.
The team, headed by Lav Agarwal, joint secretary, Union Ministry of Health & Family Welfare (MoH&FW), which also included Dr. SK Singh, director, National Centre for Disease Control (NCDC) and Dr. Neeraj Nischal, associate professor in the department of medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, visited Bihar on July 19 and 20 (Sunday and Monday) following an alarming rise in Covid-19 cases.
The state has been reporting over 1,000 Covid-19 cases daily since July 12 and 90% of the active cases have been reported in the past seven days – July 16-23 – as there is a 6% daily uptick of new infections.
On Wednesday, Agarwal suggested to the state government to ensure maximum capacity utilisation of existing RT-PCR (reverse transcription-polymerase chain reaction, a confirmatory test for Covid-19 patients) laboratories and also ramp up the daily testing ratio in a bid to flatten the viral curve.
The Indian Council of Medical Research (ICMR), the nodal body under MoH&FW, has approved nine laboratories, including six and three in government and private sectors, respectively, to conduct the conventional RT-PCR tests in the state.
The visiting delegates also urged the state government to conduct rapid antigen detection (RAD) tests in containment zones and hospitals in Bihar and also monitor all symptomatic negative results of RAD tests through RT-PCR.
EMERGING COVID-19 HOTSPOTS
East Champaran, Gaya, Rohtas, and Muzaffarpur districts have been identified as emerging Covid-19 hotspots in the state. While Patna, Nalanda, Nawada, Siwan, West Champaran, Jamui, Bhagalpur, Begusarai, and Munger districts are also under the lens because of the growing number of viral outbreak cases.
The Central team has suggested setting up of temporary field hospitals, as the existing infrastructure was found to be less than adequate.
The recommendations have been made as the case doubling rate in Bihar is at 11 days, and the state could be staring a million cases in another two months if the existing curve holds the line.
The state has reported 30,066 Covid-19 cases until Wednesday.
Covid-19 HOSPITAL MANAGEMENT
The Central team has recommended that dedicated Covid-19 hospitals in the state must ensure capacity building of all healthcare personnel, who are the frontline workers battling the pandemic, and also put in place a mechanism for patient management.
It also asked the state to ensure infection prevention practices, including triaging and effective segregation of suspect and Covid-19 patients in hospitals.
The state authorities have been directed to give attention to logistics management such as an adequate supply of oxygen cylinders in hospitals and enough in their inventory.
“We have written to the Centre for support in providing us with oxygen cylinders,” said Deepak Kumar, chief secretary (CS), Bihar, who was debriefed by the Central team ahead of its departure for Delhi on Monday (July 20).
Special emphasis is being given, as per the Central team’s directive, to motivate doctors and other healthcare personnel, Kumar said.
“Plans are afoot to conduct training programmes for doctors by experts from AIIMS, New Delhi, and also to mentor all state-level health facilities via video-conference links,” the CS said.
The state government, as per the Central team’s advice, is also institutionalising a process for seamless admission of Covid-19 patients in healthcare facilities that would also include the back-up support of ambulances and call-centres, he added.
STRESS ON BETTER MONITORING
One of the most critical inputs shared by the Central team is keeping a weekly tab on CFR for better management of the pandemic.
“Death audit may be taken up to provide inputs to the healthcare professionals for better case management,” said a team member.
The Central delegates have urged the state authorities to keep a strict vigil on a section of the vulnerable population living in containment zones such as senior citizens and those suffering from comorbid conditions.
In a containment zone, access control and strict curbs must be maintained within a kilometre-long radius.
Door-to-door surveillance must be scaled up and healthcare teams have been directed to visit houses on alternate days for improved case management.
Contact tracing of all positive cases must be done within 72 hours.