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Is Maharashtra in stage three of outbreak? Govt says not yet

By Surendra P Gangan and Swapnil Rawal, Mumbai
UPDATED ON APR 09, 2020 09:37 AM IST

Has Maharashtra moved on to the dreaded stage three (community transmission) of the coronavirus outbreak, which means the source of the infection cannot be traced?

While the state government maintained that Maharashtra is still in stage two, where disease transmission is limited to those with travel history to affected countries or those in contact with the infected person, experts feel that the next few days are crucial, against the backdrop of the infection’s steep upward curve in the past eight days.

From April 1 to April 8, the state has recorded 833 cases and 62 deaths from the coronavirus disease (Covid-19), 73.39% and 86.11% of the state’s tally and toll respectively.

Nearly 11% of them have no source of infection established, which has prompted the phase three question.

State public health minister Rajesh Tope on Wednesday said the state is yet to enter stage three. The minister also said that although the numbers are increasing, they are not multiplying.

On Wednesday, Maharashtra recorded 117 more patients and eight deaths, taking the tally to 1,135 and toll to 72. Of the eight deaths, five are in Mumbai, two in Pune and one in Kalyan-Dombivli.

Two of the victims are above 60 years of age, while the remaining six were between the ages of 44 and 59. As of Wednesday, Mumbai has 714 patients, the highest in the country, followed by Pune at 166.

A total of 25 patients are linked to the Tablighi Jamaat programme organised in Nizamuddin in New Delhi last month and which has emerged as the largest hotspot of cases in the country. Of them, eight are in Latur, six in Buldhana and two each in Pune, Pimpri-Chinchwad and Ahmednagar.

Most of the state’s cases are from densely populated areas, such as Dharavi, Worli Koliwada in Mumbai and Gultekdi, Market Yard in Pune, where maintaining social distancing has become a herculean task. The state government is now worried if its machinery falls short in containing the spread in the slums.

Tope, however, said that they have been able to trace index cases in positive cases from these areas. “If we have reached stage three (community spread) or not will be decided by the World Health Organisation(WHO). Daily data is sent to WHO through the Indian Council of Medical Research (ICMR). Based on the data we have collected, we have not reached stage three,” Tope said.

Medical education minister Amit Deshmukh said the picture will be clearer early next week. “Yes, we have 10% of cases without contact history, but that does not mean we have reached the third stage. Sometimes, the patients are not able to trace their contact links, leading to difficulty in establishing the contact. We are hopeful that we do not slip into the third phase as the timely lockdown in the state has worked. We are way better than other countries like Spain, United States of America (US), United Kingdom (UK) and can easily say that community spread has not started yet,” he added.

Dr Om Srivastav, infectious diseases specialist, said that the data can establish if we have reached stage three. “To prove if the virus is present in the community and it’s leading to the community transmission, aggressive testing is required. Only then can we contain the spread in the hotspot. If the government is claiming that we are still in phase two, based on data, we will have to believe it. As far as the current spike is concerned, there is nothing surprising and it is as per the trend witnessed in other countries,” he said.

The state government has now intensified its strategy by monitoring the hot spots at a micro level. “We are targeting at least 5,000 people around every positive case in the densely populated area and then treat them accordingly. We have also putting more restrictions in these areas to ensure that there is no rapid spread. In some areas, ‘curfew’ has been imposed by restricting movements for even essential services. The rapid testing being introduced will help in establishing the vulnerability to the Covid-19 infection and the portable clinics started in Mumbai will help us identify more cases,” said an official from Mantralaya.

Tope, too, attributed the high mortality rate in Maharashtra to comorbidities in Covid-19 victims. The mortality rate in the state is 6%, which is more than double the country’s fatality rate. “The Covid-19 deaths are in a higher percentage in old patients with comorbidities,” he said.

The official said that though the number of tests conducted in Maharashra is highest among all states, non-availability of kits is another reason the labs are not running to their full capacity. He said that portable testing centres and the rapid testing facility will, however, help in screening more suspected cases. “Still we are not in phase three, which sees the multiplication of cases on a day-to-day basis. Here we are witnessing a rise of just 10% or so. It is true that the mortality rate is high, but it’s because of a delay in admissions and comorbidity among patients,” he said.

Tope said the health department has categorised hospitals and patients will be admitted in these hospitals, depending on the severity of the case. The health department has marked five hospitals where asymptomatic and mild Covid-19 cases will be treated. The severe and critical cases will be treated at four dedicated hospitals, where specialist doctors to tackle comorbidities in patients will also be stationed.

“Asymptomatic patients or those who show mild symptoms will be admitted at Sushruta Hospital, Bombay Hospital, Poddar hospital, Lilavati Hospital and Sai Hospital. Severe and critical cases will be admitted to SevenHills hospital, Kasturba hospital, Nanavati hospital, and Saifee Hospital. All these hospitals will have tertiary care to treat people with other issues. The idea is to try and lower the mortality rate,” Tope said.

Tope said the lockdown should be strictly followed in Dharavi, which has seen 13 cases and two deaths. He said that he has instructed the police and officials of the Brihanmumbai Municipal Corporation (BMC) to take all necessary care to reduce crowding and maintain social distancing in the area.

“It is a matter of concern as Dharavi is a densely populated area…I have visited Dharavi yesterday. I have informed the home department, local DCP, and Praveen Pardeshi that social distancing should be followed strictly in Dharavi. The crowding in public toilets should be avoided to curb the spread of infection. I do not think there is any need for a lockdown today. Whatever lockdown is there, should be implemented properly in Dharavi,” he said.

“We are monitoring how the number of cases are increasing in districts. We are also looking at the advisories of the Centre. Based on that, we can decide to relax lockdown in areas where there are no cases. However, the process to lift the lockdown has to be scientific and a protocol has to be followed,” he added.

The state health department, in conjunction with the Indian Medical Association, is also planning to start “rakshak” clinics at taluka level and “mobile clinics” in urban areas.

The minister said that the Centre did a flip-flop on the clearance for commencing rapid testing or antibody tests. “The Centre once said yes for the testing, later said not to do it. Now again it has given its clearance. One thing is that the rapid tests cannot give 100% result on coronavirus cases. We cannot rely on it completely. We are awaiting kits, once they provide it. we can start it in Mumbai and Pune,” he said. He added that the state has sought a time frame from the Centre to procure personal protective equipment (PPE) kits, N95 masks and ventilator. Tope said that if there is going to be a delay, the state government will ask manufactures in Maharashtra to increase its capacity and provide these types of equipment

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