It has been 100 days since SARS CoV-2 hit Maharashtra on March 9, when a Dubai-returned couple first tested positive in Pune. The State has now clocked 1,10,744 cases and 4,128 deaths, the highest in the country. A task force of senior doctors formed in mid-April has been the guiding force to tackle the deluge of infections. The Hindu speaks to Dr. Shashank Joshi, member of the COVID-19 task force, on the current scenario:
Three months down the line, what have been the crucial learnings about the disease?
The virus is predictably unpredictable and its transmission route is not just droplet but can be airborne and gastrointestinal, therefore masking becomes mandatory. Most treatments are supportive, and for asymptomatic or pre-symtomatic, home-based care is possible if a person has a room and toilet to quarantine and has digital connectivity with a doctor. Most people with COVID-19 recover and do well except the vulnerable groups. Obesity, diabetes, hypertension and chronic illnesses are the main co-morbidities for COVID-19. We also learnt that patients can be discharged from the hospital if they are asymptomatic for three days and they don’t need to do a test later as the virus becomes non-replicative in about 10 days.
You had been vocal about Mumbai being at its peak at the end of May. Why does the city continue to see an average of 1,300 cases every day if we are past the peak?
Mumbai was past the peak from May 14 to May 31. Many deaths now are of that time who got infection then. A second peak may come after unlocking. It’s now for people to cooperate, as the government and doctors have done their bit.
One of the key tasks of the task force was to bring down the mortality rate. However, the average deaths have gone up rapidly in Maharashtra as well as Mumbai. What are the reasons?
No, they have not gone up. In fact, if you notice, a lot of old records have been streamlined and the numbers are of the last three months and during the peak. The mortality rate, which was around 10%, dropped to 3% by some strategic interventions. The task force’s mandate to drop the mortality rate was ensured by aggressive treatment and judicious use of oxygen therapy, which emerged as the key intervention. A clear myth buster was ventilators don’t save lives but high flow nasal oxygen and prone position do. The task force ensured that vulnerable populations from slums like Dharavi were checked for oxygen saturation and were taken to COVID care facilities if the saturation was below 92%. This helped save lives. Also, lifesaving medicines used in right time made all the difference like antivirals, IL6 blockers, and plasma therapy.
Are deaths being under-reported in Mumbai?
Deaths in Mumbai are under stringent audit and scrutiny. In fact some may be even over-reported. COVID-19 possibly and sadly shortened lives of some terminally ill patients like those suffering from cancer, chronic kidney disease, and chronic liver disease.
What have been the key contributions of the task force so far?
The task force has focused on screening oxygen protocols, field hospitals protocols as well as mortality and standard of care protocols, which are adaptive to locoregional needs. Our primary aim is to save lives.
Has the task force started focussing on areas outside Mumbai which have a high mortality rate? For example, Jalgaon, Malegaon, Dhule and so on.
In Maharashtra hotspots, through regular videoconferences, the task force helps make the best of the currently available resources and the government has focused on ensuring they have the right medicine and equipment. The task force has a live document which is constantly updated on what’s published globally and what’s possible locally.
What is your prediction of the disease here on?
Clearly, we have to live with SARS CoV-2. We will get better treatment and vaccines in the next two years. We will mindfully gradually unlock and start fresh again.
Published - June 16, 2020 02:19 am IST
