New Delhi: Punjab’s persistent high death rates, with some districts reporting over 4 per cent case fatality rate, the dipping test numbers in Assam and Rajasthan, and delayed hospitalisation in Himachal Pradesh that’s leading to most deaths in the state happening within the first 24 hours of admission, were some of the issues that were flagged at a health ministry meeting Monday morning.
The review meeting was for the 10 states that account for 60 per cent of the active Covid-19 cases in the country.
The states include Maharashtra, Rajasthan, Kerala, West Bengal, Andhra Pradesh, Telangana, Haryana, Assam, Punjab and Himachal Pradesh. They active cases range from 3,668 in Himachal Pradesh to 1,07,358 in Maharashtra. Delhi has 41,857 active cases but it was not a part of the meeting as the reviews are mostly conducted by the Union home ministry in case of the national capital.
The review meeting was to draw the attention of the 10 state governments to the problems in their management strategy, senior officials in the ministry of health said.
Among the major issues discussed was Punjab’s case fatality ratio (CFR).
CFR estimates the proportion of deaths among identified confirmed cases. Punjab has had the highest CFR in the country for some time now — currently at 3.15, it is more than double the national average of 1.49. Within Punjab, the CFR is even higher in some districts such as Fatehgarh Sahib (4.7), Roopnagar (4.8), Tarn Taran (4.5), Kapurthala (4.1) and Ludhiana (4.07). It was emphasised during the review meeting that the causes for high fatalities in these districts should be examined by death review committees.
Following a peak of 2,896 cases on 17 September, though, the daily cases in Punjab are on the decline with daily average cases having been around 480 in the last one week.
Tests are dipping in several states
While the dipping daily positives at the national level have come as a relief, testing, as was flagged in the meeting, has also dipped in many states. In Punjab, for example, the daily average tests declined to 18,355 from 26,989 tests in the last four weeks.
Assam, health officials from the state were told during the review meeting, needs to explore the reasons why testing has considerably decreased in the state. “The testing numbers show a sharp fall in Assam,” said a senior health ministry official.
“Our data shows that on 22 October, 42,452 tests were conducted. That number fell to 28,884 on 4 November. Though the number of daily cases has decreased across all districts, the decreased testing is a cause for concern.”
The official added that Rajasthan data also shows that the average weekly tests are decreasing.
In districts like Ganganagar, Alwar, Bikaner, Jodhpur and Jaipur, the sample positivity rate is higher than 5 per cent. The positivity rate nationally stood at 5.4 per cent Monday because the weekend testing dip brought daily tests down to 8,35,401, but it has usually been in the 3-4 per cent range on most days.
Rajasthan has the additional challenge as H1N1 is endemic to the state. Since Covid-19 and H1N1 symptoms are similar, there is a chance of them confounding healthcare workers.
In Himachal Pradesh, 50 per cent of deaths have been found to happen within 48 hours of hospitalisation, most of these within the first 24 hours, said health ministry officials present at the meeting.
“The state needs to strengthen monitoring of home isolated cases and ensure quick transfer to a hospital when the situation worsens. Travelling often takes more time in the hills so that will also have to be factored in,” said a senior official.
Among the districts where CFR is high is Shimla where it is 2, besides Kangra, Kullu, Chamba and Kinnaur where it is 3. In the last week, the CFR has been above 2 in the state. Since September, cases are also being reported from the remote areas of Lahaul, Spiti and Kinnaur.
One striking example among the states remains Kerala where even though the number of active cases is now second only to Maharashtra, the CFR remains 0.3, a fifth of the national average.