Ramping up health infra, keeping Covid fatalities in check: Maha task aheadUpdated: Jul 06, 2020 01:16 IST
Maharashtra’s victory in the battle against the Covid-19 outbreak looks like an uphill task amid the daily spike in positive cases and the mushrooming of newer hot spots across the state. After the state crossed the grim mark of 2 lakh cases on Saturday, it has multiple challenges ahead, including containing the spread of the virus, ramping up the health infrastructure in hot spots other than Mumbai, and keeping the fatality rate in check.
It took 96 days for the state to cross the 1 lakh mark, but the 2 lakh figure was breached within a mere 22 days.
Despite the grave situation in the state, health minister Rajesh Tope is confident that the virus spread will stabilise in a few weeks. However, the minister did not wish to comment if the state is yet to reach its peak. “There is no point in talking about the peak now. I think that the cases in the state will flatten by August,” he said.
According to senior officials, the challenge now is even greater than before, as the state government ‘unlocked’ several restrictions.
Though Mumbai continues to remain the worst-affected city in Maharashtra, the daily surge in the number of cases has stabilised. However, the new hot spots in the rest of the Mumbai Metropolitan Region (MMR) as well as in the cities of Pune, Pimpri-Chinchwad, Nashik and Aurangabad are now witnessing a high number of new cases every day.
In the past two weeks, cities in MMR, excluding Mumbai, contributed over 41% of the cases recorded in the state. Between June 22 and July 4, the region recorded 27,808 cases.
According to Tope, like Mumbai, the satellite cities, too, will witness a decline in daily cases. “Cases had spiked in south Mumbai but have subsided now. Cases from Dharavi and other major slums have also reduced. Now hot spots have resurfaced in north Mumbai and MMR. But the cases will be under control in the next 15 days there also,” he said.
Senior health department officials said that densely populated areas, ease in restrictions on movement, and opening up of businesses, etc., led to the surge in MMR. Laxity in contact tracing further fuelled the surge in MMR’s cases.
“As things have opened up now, the major challenge is to keep the numbers in control. The movement of citizens has increased after Unlock 2.0. Apart from social distancing campaigns, we have enforced closure of areas or selective lockdown now,” state health commissioner Anup Kumar Yadav said.
As areas in MMR do not have adequate health infrastructure, district collectors and municipal commissioners rely on stringent lockdown measures to grapple with the increasing Covid-19 cases here. The situation in Mumbai came under control owing to a strong public and private health infrastructure. However, in the rest of MMR, barring Thane city, the health infrastructure is not as strong, said Yadav.
“We have invested a lot to ramp up the infrastructure. Thane has a strong infrastructure but other corporations are not developed on the lines of Mumbai and Thane. We have conducted the gap analysis and proposed new Covid care centres, there is increased supply of ventilators as well as an increase in quarantine centres. In a short span of time, we are trying hard to supplement the health infrastructure. As of now, there is no shortage of bed or other equipment,” Yadav said.
According to a civic official, around 80% of the positive patients are asymptomatic or have mild symptoms and therefore they recover in their home without burdening the health infrastructure in MMR region.
Tope also acknowledged the lack of institutional quarantine facilities in other parts of MMR.
He said he directed municipal commissioners from the region to put quarantine infected patients at institutional facilities.
Lack of aggressive contact tracing
Senior health department officials pointed out that lack of aggressive contact tracing caused several areas to take longer to control the cases. They added that it has a “cascading effect” which ultimately impacts the chances of survival of a positive patient.
“Data shows that a positive patient comes to hospital on the fifth day of getting infected because tracing did not take place. In the meantime, they develop severe symptoms and the patient’s chances of recovery reduce. They also infect others before they are hospitalised. Ideally, we want patients [who need hospitalisation] to be admitted between 24 and 48 hours,” a health department official said.
Tope admitted that contact tracing ratio in the state is 1:6 as opposed to the 1:15 target (15 contacts per one Covid-19 patient).
Cases seeing surge in other cities too
In the past two weeks, Pune city recorded around 8,112 cases, while the adjoining Pimpri-Chinchwad region recorded nearly 2,000 new cases during the same period.
Nashik and Aurangabad too have been recording cases every day that largely contribute to the state’s cumulative figure. But officials said that since the movement in these areas is not as much as what is witnessed in MMR, cases are not growing exponentially.
“We have adequate health infrastructure in Pune and other rural areas. The state has set up a task force in every district and advice from expert doctors, epidemiologists and virologists are being made available to rural patients with comorbidities,” Yadav said.
Another challenge before the state government is its battle against the rising fatality rate. After the state recorded 295 deaths – its highest ever in a day – the fatality rate in Maharashtra stands at 4.33% on Saturday.
Yadav said the state has stepped up efforts to combat the fatality rate.
“The death rate is largely under control. We have set up task forces, introduced a new clinical guideline, and experts guide the physicians treating Covid patients in rural areas through video conferencing. We also have the necessary drugs, including Remdesivir, and we are getting ventilators also,” Yadav said.