The COVID-19 case-count for the state of Maharashtra has crossed the 6 lakh mark and the fatality rate has gone past 20,000. As more and more cases are reported each day and the number of patients infected by the virus hits new highs, the time is ripe to reconsider whether the existing healthcare infrastructure and facilities, services available and the existing initiatives or missions are sufficient in curbing the spread of the virus.
Dr Laxman Jessani, consultant, Infectious Diseases, Apollo Hospitals, Navi Mumbai pointed out that it took only nine days for the number of cases to go up by 1 lakh. “This surge is also a result of the increased testing and is mainly being observed in the semi-urban and rural areas.”
Rajesh Tope, Maharashtra health minister, said that the rise in cases in the rural parts of the state due to the return of migrants from Mumbai is a cause of concern. Speaking at an Independence Day function, he highlighted that the recovery rate in the state was still high. As the number of cases in cities like Aurangabad increase, state minister Subhash Desai has called for increased testing in rural areas and has also asked local authorities to expedite contact tracing.
Doubling time shrinks
The number of active cases in Aurangabad is around 5,000, while the total number of cases reported so far has been 27,000 in Kalyan. Thane has reported around 25,000 cases and around 12,000 and 23,000 cases have been reported in the Mira-Bhayander township and Navi Mumbai respectively. According to a report prepared by a group from Mumbai University headed by economist Neeraj Hatekar, the doubling period in some of the western Maharashtra districts are too short. In Kolhapur it is 9.86 days, Ahmednagar 14.77 days and in Sangli-Miraj-Kupwada 14.04 days. In cities like Chandrapur and Nagpur, the rate is as low as 13.55 and 11.31 days respectively.
As the 10-day Ganpati festival begins in the state, isolation wards, ICU and COVID-19 care centres continue to remain full and appeals of not taking leaves are being made to the healthcare staff by the hospital owners. Efforts to set up and build temporary COVID-19 care facilities are being hampered due to heavy rainfall in the state.
Care comes to a standstill?
In this scenario, the state government is lauding the ‘Chase the Virus’ initiative and is providing relaxations through the ‘Mission Begin Again’ initiative, but is also understandably cautious about lifting the lockdown. At the same time, people are not satisfied with the initiatives which are being taken.
“The medical community is doing everything and more to keep up with this. It is creating awareness of early diagnosis and screening. It is also time for individuals to increase their safety and hygiene protocols, as the restrictions may ease, but the virus is still here,” added Dr Laxman Jessani.
Apart from getting infected by the virus, the spread of the virus has resulted in fatigue, fear and lack of dignity amongst the medical community. In addition, the Maharashtra government has taken over around 80% of the beds in private hospitals and has also capped the prices of treatment, resulting in questions about the quality of care being provided in private hospitals during this crisis. As more and more patients are being taken to private hospitals, workers there are facing challenges in maintaining operational standards.
The reasons for the surge in cases in Maharashtra, according to Dr Samrat D Shah, Consultant Internist, Bhatia Hospital, Mumbai could be several. “First, tests for COVID are being easily and readily done in private and government labs. This increase in testing facilities is resulting in [identifying] more and more cases. Second, workers are returning to work from rural to urban areas, leading to an increase in the risk of community spread. Third, the central government is unwilling to take responsibility for the struggling states. No strict action [to enforce] precautions like wearing masks, maintaining social distancing etc is being taken, and lastly, the unsteady approach of the state government — which is seen through multiple changes in the norms and the laws of the state — are resulting in the spread of the disease.”
The situation is even worse in government-run hospitals where many deaths occur every day, hospital beds are shared between many patients and treatment is provided next to dead bodies.
Dr Samrat Shah further said that the increase in the death rate could be due to a “high rate of mutation in the virus, not implementing perfect
triage in fever clinics, ignorance of a healthy lifestyle i.e. lack of exercise, sedentary lifestyle, fast-food diet, uncontrolled sugar and BP and reservation of Remdesivir — the only drug which showed some potential in controlling the replication of the novel coronavirus — for use in late or critical stage and for hospital use only. It should be made readily available for use early on in patients with comorbid conditions.”
Although the state government is focused on reviving the economy from the slump caused by the COVID-19 lock-down and for lifting restrictions in a staggered manner, progress on the fight against the pandemic is at a standstill as the number of active cases gallop at a high speed.
Community spread in Nagpur
Community spread of coronavirus has started in Nagpur city, according to Nitin Raut, Nagpur’s guardian minister.
Nagpur municipal authorities have taken more and more measures to stop the spread. On the other hand, community infection rates in the cities of Mumbai and Pune have started coming down, the minister informed.
Nagpur, which is the winter capital of the state of Maharashtra, had reported only 138 cases till April. The number rose to 403 cases in May, 964 in June and 3,287 in July.
COVID-19 cases started increasing steeply in the district from the third week of July corresponding to the influx of the migrant population from Mumbai and other regions.
Akola is the second most-affected district in terms of cumulative positive cases.
Vidarbha, Amravati, Buldana, Yavatmal, Washim, Gadchiroli, Chandrapur, Gondia, Bhandara and Wardha are other interior regions of Maharashtra that have started witnessing sharp increases in the number of fresh cases.