New Delhi: Punjab has been in the news since the last more than four months primarily over its farmers protesting against the three farm laws along the Delhi borders.
As the state has now emerged as one of the epicentres of India’s second Covid-19 wave, Punjab government officials said the two — protests and Covid — could be linked.
The milling crowds at Delhi’s borders and the “roster” system under which farmers assemble at protest sites for a fixed number of days and then go back to their villages could be one of the reasons why the state is seeing a Covid surge.
Between 23 February and 23 March, the number of active cases in the state went up by over 600 per cent — from 3,295 to 19,403. The number of deaths increased from 5,779 to 6,435. This means that over 10 per cent of all deaths in the state since the start of the pandemic a year ago, happened in the last one month.
The case fatality rate currently stands at 2.96 per cent, which is more than double the national average of 1.37 per cent.
“It is a matter of great concern, the coming and going of people (from the protest sites near Delhi). That may have caused much of the spread. The government has been trying to reach out to all sections of people, including the protesters, to motivate them to use masks. That right now is our best vaccine,” Dr K.K. Talwar, advisor to the government of Punjab on Covid-19, told ThePrint.
The protests have been going on since November last year and Covid-appropriate behaviour at these locations are an exception rather than rule.
The state has also now declared that 81 per cent of the samples that they had sent for genome sequencing have tested positive for the more transmissible UK variant of the SARS-CoV-2 virus.
“That variant is more aggressive in terms of infectivity. We have a lot of young people who have become superspreaders… but you must understand that even though our CFR (case fertility rate) is higher, our deaths per million is not high,” added Dr Talwar.
Punjab also took some time to find out about the UK strain.
One of the problems, the state had, said Principal Secretary (Health) Hussan Lal, is that samples that were being sent to the National Institute of Virology in Pune or to the Institute of Genomics and Integrative Biology in New Delhi were taking a very long time to be analysed.
“Finally, when NCDC (National Centre for Disease Control) director Dr S.K. Singh came here as part of a central team and we told him our problem, he agreed to run a full batch only of Punjab samples to clear our backlog. That is how we found out that 81 per cent cases were of the UK strain,” Lal told ThePrint.
Punjab’s top five districts with highest active cases are Jalandhar (2,629), SAS Nagar (2,561), Ludhiana (2,167), Patiala (2,064), and Hoshiarpur (1,833).
The officials said Punjab’s high burden of non-communicable diseases such as high blood pressure and sugar is contributing to its Covid-19 mortality.
The central government, however, refused to accept this argument, saying people in Punjab are dying of Covid as they’re reaching hospitals late.
High burden of non-communicable diseases
The state government has been insistent that part of the reason for the high CFR in the state is its high burden of non-communicable diseases (NCD).
According to data from the National Family Health Survey 4, 20.6 per cent Indian women and 18 per cent Indian men are overweight or obese. For Punjab, the figures are 31.3 per cent women and 27.8 per cent men who are overweight or obese.
An estimated 5.8 per cent of Indian women have high blood sugar as do about 8 per cent of men. In Punjab, 6.1 per cent of women and 6.7 per cent of men have high blood sugar.
About 6.7 per cent of Indian women have hypertension and about 10.4 per cent of Indian men have high blood pressure. An estimated 10.5 per cent of Punjabi women and 17.4 per cent of Punjabi women have hypertension.
All of these are known comorbidities for Covid-19 that make chances of an adverse disease outcome higher.
Dr Talwar also listed alcohol and cirrhosis as some of the other factors contributing to Punjab’s worse Covid scenario.
The NCD burden is a factor that both Talwar and Lal mentioned when asked about the high CFR.
“We have taken a lot of steps. We stepped up contact-tracing to 16-17 per positive case, but now the government says increase it to 30,” Lal said.
“You have to also understand that at no point was our health infrastructure insufficient. We took a lot of steps, including easing of home isolation guidelines. For anybody in home isolation, we are giving them a kit with 17-18 items, including pulse oximeter, digital thermometer, steamer etc,” he added.
Lal said more people are dying in the state in the 50-60-plus age groups.
A senior union health ministry official, who did not wish to be named, said people are dying because they’re reporting to hospitals late.
“In Punjab, people are not dying because they are obese or have high blood pressure. They are dying because they are coming to the hospital late. The biggest proportion of deaths are happening within two days of hospitalisation. Officials in the state have a lot to answer for,” said the official.
Lal, however, does not deny that people are coming to hospitals late.
“We have seen more people dying after two days of stay at the level III (tertiary care) health facilities. Most deaths happen between 2-8 days of hospital stay. People are not reporting to the health facilities on time and then the comorbidities make them difficult to manage. That is why we have hired a monitoring agency to call home isolation patients twice a day to check on their status,” he said.
“Patients too can call the agency any time. We were earlier doing video conferences with secondary and tertiary care facilities twice a week, but now Dr Talwar is doing it every evening,” Lal added.
The state has now ramped up Covid RT-PCR testing, he said, so that just about 10 per cent of its estimated 30,000-40,000 daily tests are rapid antigen tests.
The positivity rate is around 7.5 per cent, but in some districts such as Hoshiarpur and Jalandhar, it has crossed 10 per cent.
The “ideal” test positivity rate, according to WHO, is below 5 per cent.
Officials in the Ministry of Health insisted that it is not just the test positivity ratio, what is crucial is to find out where the tests are happening.
“When faced with a similar situation, Delhi opened up testing in markets, crowded places, etc. Neither Punjab nor Maharashtra (the state with the highest Covid burden) are doing that. Their number of containment zones is also surprisingly constant even though their numbers are shooting,” said the health ministry official quoted above.
Lal, however, refuted the charge.
He said containment zones are dynamic. “Between 5-15 cases, we designate it as a micro containment zone,” Lal said.
Vaccination pace a cause of concern
The Centre is also unhappy with the pace of vaccinations in Punjab.
According to available data, the state has just 90,769 fully vaccinated people, which is a little over 1 per cent of the national total of 81,09,334.
The state has so far administered 6,09,246 doses of the vaccine, while the national total is 5,08,41,286.
In a letter to the Punjab chief secretary on 13 March, Union Health Secretary Rajesh Bhushan wrote, “The Union ministry of health and family welfare has so far supplied to Punjab a total of 12,38,920 doses of vaccine (11,04,840 Covishield and 1,34,080, Covaxin).
“Till 12 March 2021, only 3,58,162 doses have been consumed in the state. You would agree that there is an urgent need to accelerate the pace of Covid immunisation in Punjab. This can be achieved by optimal utilisation of both public and private healthcare facilities and by ensuring that priority age groups are quickly covered by vaccination in your state to control Covid-19 transmission and search in active cases,” he added.
(Edited by Debalina Dey)