Ludhiana: Despite adequate health infrastructure, no shortage of oxygen or drugs, Punjab’s Case Fatality Rate (CFR) still stands at 2.6 per cent, the highest in the country, with doctors, health experts, even administrators blaming the state’s “eating habits, lifestyle and callous attitude” for it.
ThePrint collected data from Patiala, Ludhiana, Faridkot and Amritsar, the districts reporting the maximum number of deaths in Punjab, and found that more than 60 percent of those who died of Covid here were either obese, diabetic or were suffering from hypertension.
Other prevalent illnesses were heart problems, kidney issues and alcoholic liver diseases.
According to data accessed by ThePrint, between 1 January to 21 May this year, Punjab has reported 8,963 Covid deaths for a CFR of 2.6 per cent against the national CFR of 1.3 per cent. CFR is the proportion of deaths among confirmed cases.
In contrast, Maharashtra has a CFR of 1.8 per cent, Karnataka has 1.2 per cent, Delhi has 1.7 per cent, Gujarat has 1.2 per cent and UP has 1.3 per cent.
In the same period, Patiala recorded 1,019 deaths, accounting for 11 per cent of Punjab’s death toll. At the Patiala Medical College, there have been 867 Covid deaths, of whom 501 people were diabetic, obese or hypertensive.
Similarly in Ludhiana, of the 625 deaths reported as of 21 May, 327 had either of the three conditions. In Faridkot, of the 284 deaths, 190 were of those who had these conditions and in Amritsar, 274 of the 502 people were of people who had these three conditions.
Doctors say “the diet in Punjab is very heavy, rich in fats and high in salt and sugar”, which is leading to obesity, diabetes and hypertension in the population.
According to a 2019 study by the Postgraduate Institute of Medical Education Research (PGIMER), four out of 10 people in Punjab are suffering from hypertension, making the state the one with the highest number of such patients in the country.
An earlier PGIMER report also showed that over 40 per cent of Punjab’s population is overweight or obese, and the prevalence rate of diabetes in the state is five per cent higher than the national average.
Other major reasons for a high CFR, according to doctors, are patients reaching the hospital “very late”, vaccine hesitancy, a dependence on quacks for treatment, reluctance to get tested on time and thinking of the virus as a “conspiracy of the government to make money”.
Experts also said that “fair reporting of deaths” has also led to the high CFR.
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‘Punjab has a high-risk population’
Dr K.K. Talwar, advisor to the Punjab government on health, said it was a “fact” that the high CFR in Punjab was due to its “high risk population”.
“Punjab has the highest prevalence of obesity, diabetes, hypertension. Call it the eating habits, lifestyle, lack of exercise, it is a known fact and no doubt it has led to a high CFR in the state,” he said.
Dr Bishav Mohan, cardiologist at the Dayanand Medical College, Ludhiana, said most patients coming to the hospital were “obese with uncontrolled diabetes”.
“People here do not just have diabetes, but uncontrolled diabetes along with obesity, which became a major hindrance in their recovery and led to so many deaths,” he said. “If they are asked to cut down on sugar, they say ‘let me eat one piece of mithai, i’ll pop in a sugar pill after that’. The diet is high fat, which includes butter, ghee, oil and more than required intake of these lead to health issues.”
“We kept thinking that we were doing everything right, then why so many deaths? And that is the reason,” he added. “When such high-risk patients with these conditions get infected with this virus, the chances of recovery are less.”
Dr Harnam Singh Rekhi of the M.S. Rajindra College, Patiala, said that patients who died within 75 hours of being admitted to the hospital were those with these comorbidities.
“Every second patient we got was either obese, had diabetes or hypertension or all three. It became a big challenge for our team of doctors,”he said. “We were seeing over 35 deaths a day in mid-May, and 65-70 per cent of patients were those suffering from these conditions. This has played a major role in increased CFR in Punjab.”
Such is the extent of the problem that the Patiala administration is now profiling men and women who suffer from obesity, diabetes and hypertension so that they can be tested and given medical care at an early stage.
“There were instances when we could not turn the patient on their stomachs in prone positions because of them being obese. Proning was proving to be difficult,” Patiala Deputy Commissioner Kumar Amit said. “This is a major concern for us now, and while preparing for the third wave we will be profiling people with these conditions, so that they can be given early care.”
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Affluence, overindulgence leading to diseases
According to Ritu Sudhakar, chief dietician at DMC, Ludhiana, “affluence, availability and over indulgence” is what has led to an increase of these lifestyle, non-communicable diseases among Punjabis.
“It is a state of affluence where people can afford to buy ghee, butter, take a protein rich diet and that is what has led to over indulgence,” Sudhakar said. “People eat more and there is no physical exercise. Although many Punjabis are involved in agriculture, none of them are really working in the fields themselves as they all have hired labour for it. So, while there is no labour intensive work, the food habits have remained the same leading to obesity, diabetes.”
Consumption of alcohol, Sudhakar said, was another factor. “People, both men and women, consume a lot of alcohol in the state, along with high fat food, which leads to obesity, diabetes,” she added. “In many cases that come to us, high alcohol consumption is a major factor.”
Prof J.S. Thakur of the Department of Community Medicine, PGIMER, who led the 2019 study, told ThePrint that a “nutritional shift in Punjab is making things worse”.
“Even youngsters and children in Punjab are suffering from obesity and hypertension,” he said. “That is because instead of eating more vegetables, fruits, they are consuming more pizzas and burgers. This along with their already rich diet in fat.”
Doctors say the problem of obesity and diabetes among children may put them at grave risk in the third wave.
Dr Bishav Mohan, the cardiologist at DMC, Ludhiana, told ThePrint that Punjab is the highest-ranking state when it comes to obesity and hypertension in even children.
“It is almost 5 percent, which is very high. We had also conducted a study which concluded that 49.2 percent of people in Punjab are suffering from obesity which makes them vulnerable to so many other diseases,” he said.
Come to hospital very late, trust quacks
Another dominant factor for a high CFR in Punjab, doctors said, was people coming to the hospital very late.
The doctors across four districts told ThePrint that most people relied on “quacks” for initial treatment and head to hospitals only after their condition had worsened.
Dr Rekhi of the Rajindra College, Patiala, said, “In most patients who were critical when admitted, we found that they took medication without any supervision.
“These were people who went to the quacks when they fell sick and were given medication for typhoid. These were people who took medication at home and came to the hospital only at the last stage, when their SpO2 level fell below 50.”
Dr Bishav Mohan said that this is the reason why a majority of the deaths in Ludhiana were reported from people who were at home, than at hospitals.
“The behavior of people here is a big issue. They do not want to go to the hospital until it is too late. Many believe only the quacks,” he said. “We analysed and saw that the numbers of deaths that took place at homes were much more than the ones that took place in the hospitals.”
Moreover, what led to deaths at government hospitals was that many private hospitals turned patients, who were critical, away, doctors said.
“The private hospitals refused to admit critical patients and that is what increased the load on us and also wasted a lot of time. By the time they would reach us, they would be extremely critical,” Dr Rekhi said.
A senior official in the Patiala administration also confirmed that the private hospitals did indeed refuse to take patients who were critical. The official said that the administration now plans to take strict action against any private hospital which refuses admission.
Another factor that dissuaded people from coming to hospitals were “rumours” that Covid was just a “conspiracy” and the government was making money out of every patient admitted to the hospital.
“People thought that the government is earning money out of making people positive. Also, the anger against the government because of the farm laws played a role as people refused to get tested or come to the hospital for treatment, which led to a lot of damage,” Dr Bishav Mohan said.
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CFR also depends on positivity rate
Doctors across Punjab also explained that despite the high CFR, the deaths per million in Punjab have been less than Delhi or Maharashtra.
Dr Talwar told ThePrint that the CFR has also to do with the number of tests conducted and the positivity rate. The more the positive cases, the less the CFR.
“Other states are doing more RAT tests, which is why their number of tests and their positivity rate is high. These also include patients who are asymptomatic and low risk,” he said. “In Punjab, we have relied on RT PCR tests, which are mostly symptomatic and high-risk people. Had we also done more RATs, our number of tests would be more, the positivity rate would be more and the CFR would be low.”
Dr Mohan also said that transparent reporting of deaths was another factor.
“The deaths in Punjab were accurately recorded and the data was put out in a transparent manner, which has also led to a high CFR,” he said. “There may be many states wherein the number of deaths may be much more, but the data is not available.”
Lack of patient care
Lack of patient care at the hospitals has also allegedly led to a number of deaths in Punjab.
In Patiala, the attendants of patients admitted at Rajendra hospital alleged that the doctors on duty did not enter the Covid ward fearing that they may catch the infection, leaving their loved ones unattended.
Although the hospital authorities denied the allegations, speaking to ThePrint, doctors inside the hospital confirmed that the patients, indeed, were ignored.
Moreover, a doctor on condition of anonymity confirmed to ThePrint that the staff who had no experience of emergency care were posted at the ICUs. Also, doctors made several complaints about staff not taking patients to the washrooms or changing their diapers.
(Edited by Arun Prashanth)
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