With deaths due to COVID-19 spiralling in Indore, the case fatality rate in the country’s cleanest city touched 8.6% on Tuesday, arguably the highest for any city in the country, even ahead of the rates in Mumbai and New Delhi which had recorded more than three times the number of cases than Indore.
Experts suggest the deaths of 15 patients in Indore until April 7 can be attributed to delayed diagnosis, late admission to hospitals in an unfair general condition, comorbidities, old age, acute respiratory distress syndrome and a high viral load. So far, Indore, the largest and the most populous city of Madhya Pradesh, has recorded 173 cases.
Between March 22, when Indore recorded its first COVID-19 case, and April 7, Mumbai recorded 618 cases and 39 deaths and New Delhi 524 and eight deaths. The case fatality rate is a measure of disease severity which records the proportion of those who die from a disease among all those diagnosed with it over a certain period of time. For Mumbai it stands at 6.3%, and for New Delhi 1.5%. A higher rate reflects a poor outcome.
No travel history
A typical COVID-19 patient would have a contact and travel history, be diagnosed, admitted after which he/she may die or survive. But none of the cases in Indore had an international travel history, explained Salil Bhargava, Head of the Department, Respiratory Medicine, Mahatma Gandhi Memorial Medical College, Indore.
“Most of the patients who died had bilateral pneumonia, which caused acute respiratory distress syndrome (ARDS), eventually causing death,” said Dr. Bhargava. “Their presentation at the hospital has been late, which is one issue, and they are being presented in bad shape and having severe respiratory distress. Once the ARDS settles in, it’s almost impossible to save the patient.”
Furthermore, almost all the deceased had co-morbidities (suffered from another illness that made them vulnerable), he said. “A good number of them had hypertension, diabetes, hypothyroidism and even morbid obesity. It’s not just the lungs which are failing due to COVID-19, but these other illness were causing multiorgan failures and shock”
The recent go-ahead by the ICMR to begin rapid antibody testing may help step up diagnosis.
“Even during swine flu, the fatality rate was quite high for indore, as some areas in the city are crowded and there is an interplay of factors in each case. With more number of diagnostic tools, including the rapid antibody testing, testing will be stronger,” said Dr. Bhargava.
So far, no patient with a “general condition fair” has had a “general condition unfair” later or admitted to the ICU or died, said Dr.Salil Sakalle, Professor, Community Medicine Department at the college. “Those who died had a highly unfair GC, when the respiratory distress was almost uncontrollable.”
Primary contacts of such patients, however, showed no such severe respiratory conditions, so they were responding well, he explained. “For around 30-40% of those who died the COVID-19 positive report came later. They were so serious. There needs to be research around why such patients’ condition has a disposition for COVID-19 reacting so severely in them,” he said. Dr. Sakalle noted some probable causes of the high fatality rate: “They may have a cough and cold for a long duration before they finally approached a health facility. Moreover, from wherever they caught the infection, the viral load could be very high. ”
