‘Need to bring fatality rate in city to below 1%’

Although the city’s Covid-19 cases have plateaued, the fatality rate, hovering at 5.63%, continues to be a cause for concern, and experts are now stressing the need

Although the city’s Covid-19 cases have plateaued, the fatality rate, hovering at 5.63%, continues to be a cause for concern, and experts are now stressing the need to bring it to below 1%. HT spoke to Dr Shashank Joshi, a member of the Covid-19 task force formed by the state, on the way ahead. Excerpts:

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What has been the learning curve while tackling the outbreak nearly four months after we went into a lockdown?

As the pandemic evolved, we learnt about its transmission and impact. There are three major learnings: when the first few cases were detected, wearing masks was not mandatory, as we believed that Covid-19 spread through droplets, sneezing etc, for which we advised social distancing. However, now we know that the virus is also airborne and hence wearing masks are mandatory. We also learnt that social distancing is not possible in a closed cluster, spaces with poor ventilation and at offices as central air-conditioning can aggrevate the risk of spreading the virus.

Initially, we thought this pandemic is a life-threatening disease. But as the pandemic evolved, we found that 85% of the infected patients are asymptomatic, pre-symptomatic or are mildly symptomatic. Of the 15% critical patients also, only 3 to 5% would require intensive care. Earlier we though many patients will require ventilators, but now we know that most of them just require oxygen support.

Why are Mumbai’s daily cases hovering in the 1,000-1,500 range (barring a few spikes or decline) for around two months now?

In Mumbai, Covid-19 cases started getting detected from March-end and the city’s peak was probably from May 15 to May 31. The cases have now plateaued in the city, though the case burden is still existent. With testing being liberalised, there has not been much change in the daily number of cases. The recovery and doubling rates however, have improved, but Mumbai has still not managed to bring down its fatality rate. Now, a lot depends on how we handle the monsoon-related infections as well as the Covid-19 outbreak in the coming days.

Why is the city’s fatality rate high and how can it be tackled?

Many deaths which had taken place earlier, which were added up quite later. Due to this, the fatality rate is not accurate. The other reason being that patients are reaching hospitals late and many of the patients who died also had comorbidities. However, we need to save lives and Mumbai should bring the mortality rate to below 1%.

We have rapidly built our health infrastructure, including providing life-saving drugs, which has not happened in Mumbai before. However, we ought to continue making more and better arrangements and must be on our vigil until the vaccine arrives.

Which are the areas where the city should have done better?

Like I said, we have a liberalised testing policy now, so anyone can go and get tested without prescription. But I feel we should have taken this step much earlier, though the testing protocols are driven by ICMR [Indian Council of Medical Research]. I also think that we should have done better at ensuring that patients reach hospitals early. In March and April, there should have been better emergency healthcare facilities such as ambulances. We could have also conducted better at tracing and quarantining people. But let me also add that the entire responsibility does not lie just with the administration, and that citizens are also responsible. In several parts of the city, citizens did not follow the lockdown in true sense.

What is the role of Covid-19 task force and what has been the contribution of the task force until now?

The task force had two mandates: one was to draw out the treatment protocols and the other to strategise on reducing the fatality rate. We tried to have better treatment protocols, brought about a strategy to reduce the fatality rate and implemented protocols for critical patients’ care. We also gave inputs on Covid-19 hospitals to the authorities. Another thing we did was to draw up strategies for the ‘chase the virus and save lives’ initiative.

We continue to be in a state of lock down. When do you think the city can open up local trains, restaurants, malls, gyms etc?

Our unlocking needs to be very mindful. Malls, trains and theatres are crowded, have poor ventilation and can therefore become transmission hubs. If at all they are to be opened, we will have to look at restricted timings, restricted access and social distancing norms. All these services can be opened up only gradually to avoid a second spike. We don’t want to do a repeat of what happened in Delhi.