Delayed diagnosis, reluctance to take booster dose pushing severe cases up

Patients are turning up many days after onset of symptoms, say doctors

Delayed diagnosis, deferred treatment, and reluctance to take the booster shot are factors contributing to the serious rise in the number of Covid cases in pockets, say doctors.

Deaths have risen in pockets -- Mumbai and Kerala are cases in point.

In the past 15 days, in Mumbai there have been 31 Covid-19 deaths among the 1,370 people hospitalised. The city has reported 26,615 cases in the fortnight.

This means around 2.2 per cent of those hospitalised have died, and around 5 per cent of the infected people required hospitalisation.

Viswesvaran Balasubramanian, consultant interventional pulmonologist at Hyderabad-based Yashoda Hospitals, said there had been serious cases of hospitalisation among the relatively young people.

“In the past 10 days, we have witnessed a rise in Covid-19 cases. This time, unlike the Omicron wave in January, we are seeing many people with lung infection. In Omicron mostly people had an upper respiratory tract infection,” Balasubramanian said.

He added in this latest surge, people were either not testing or delaying tests. Many are also opting for home antigen test kits, which are unreliable. “Delayed testing or diagnosis is another reason we are at times getting cases in which the disease has progressed far,” he said.

“Recently we had a case of a 45-year-old man without any co-morbidity from Karnataka, who had severe bilateral pneumonia and had to be put on ventilation. The patient died,” Balasubramanian said. The patient’s samples were sent for RT-PCR testing after admission (he had not done it), and the results are awaited. The doctors, however, feel it is most likely a case of Covid-19 pneumonia.

Balasubramanian said there might be several mutations of the virus, causing a variety of symptoms in those infected.

Doctors in Mumbai have responded similarly.

Rajesh Sharma, head of the department, Pulmonary Medicine, Sir HN Reliance Foundation Hospital in Mumbai, said he was getting patients who had persistent coughing.

“Most of these patients say they had fever and flu-like symptoms some time ago, and they recovered on their own. Now they are visiting doctors because they have persistent coughing,” Sharma said. Most of the tests are positive, and negative results are possible if tests are done 10-15 days after the onset of symptoms.

Sharma said there were people who were not vaccinated, or had taken one dose.

“Most of those hospitalised are people who have serious co-morbid conditions, and deaths would also be mostly among such people,” Sharma said.

Another key symptom noticed during the current surge is that many patients have gastro-intestinal troubles.

Sonam Solanki, consultant pulmonologist, Masina Hospital, said many patients had something similar to viral gastroenteritis.

Other than Mumbai and the rest of Maharashtra, Kerala is one area that is seeing a spike in the number of cases and deaths. During the past 15 days, the state has seen an average of 3,323 cases and more than nine deaths a day.

“Hospitalisation is very low in the country. In most of the hospitals the admission rate is 0.5 per cent. More than 90 per cent of the deaths are due to high co-morbidity and other associated issues like hypertension and people on chemotherapy,” said Dr J A Jayalal, national president of the Indian Medical Association (IMA).

A Kerala health department official said: “The state is seeing a massive spike in cases. A majority of the cases are coming from districts like Ernakulam. We have given arrangements in all government hospitals, but compared to the last wave hospitalisation and death rates are low. A majority of the deaths are among the aged or those with other diseases.”

The state government on Tuesday came up with an order to strictly enforce Covid safety guidelines, including the re-introduction of masks. People who do not wear masks in public places or even in vehicles will be fined. The test positivity rate was 18.33 per cent on Monday.

Though Tamil Nadu has not reported any deaths, the rise in the number of cases has forced the government to make wearing masks mandatory in public places and those not wearing masks may be fined. On Monday, the state saw 1,461 fresh cases.

“We are not seeing a major increase in the number of deaths or a rise in hospitalisation. However, we are taking a cautious approach and making masks mandatory,” said T S Selvavinayagam, director of public health and preventive medicine, Tamil Nadu.