Chandigarh: With Punjab displacing Gujarat to record the highest Covid case fatality rate (CFR) in Indian states, the Amarinder Singh government has blamed patients for coming in too late for treatment, among other factors.
As of Friday, Punjab recorded 72,143 Covid cases and 2,149 deaths — the highest CFR in the country at 2.96 per cent, ahead of Gujarat and Maharashtra. Just over the past 24 hours, the state recorded 2,464 new cases and 88 deaths.
While the national CFR — the proportion of those who died among confirmed cases — has seen a continuing decline to sit at 1.7 per cent currently, Punjab is the only state where this number is rising.
The state government attributed this worsening situation primarily to patient behaviour, but also to a disinformation campaign about public hospitals. Officials also said that CFR is not the ideal metric to judge the situation as confirmed cases are much lower than actual infections, adding that comorbidities are playing a role in these figures.
Experts somewhat agreed with this assessment, saying the lifestyle in the state affects immunity, but added that blame game is meaningless.
The Opposition, though, called the public hospitals “horror” centres, holding them responsible for why patients were shying away. It also said the government is not interested in improving quality of healthcare in the state.
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‘Misinformation, delay in reaching hospital to blame’
Hussan Lal, principal secretary, health, Punjab said, “The prime reason is that patients are coming in for treatment when they are extremely sick. By which time, there is very little that a healthcare facility can do.”
Of the 1,206 tertiary hospital beds available in the government and private sector, 70 per cent are occupied currently. Out of the 7,700 secondary hospital beds, just a little over 33 per cent are occupied, showed government data.
Renowned cardiologist Dr K.K. Talwar, who is an advisor to the Amarinder government on Covid management, said a politically motivated disinformation campaign alleging that government hospitals are harvesting organs of Covid patients has also kept people away.
“For many years, the government health sector was ignored and there is a tendency among people not to come to government hospitals. The disinformation campaign worsened the situation,” he said.
Since 1 September, as many 697 people have died in the state with the number of daily deaths averaging 70.
Talwar said a better way to calculate mortality among Covid patients should be deaths per million and not CFR. “If in the coming days, the number of people found positive goes up because of increased testing, the death rate will come down because the denominator will expand. In that one sense, the CFR is not the perfect criteria to compare fatality rates,” he said.
He also claimed that Punjab has at least 20 to 30 per cent more people suffering from comorbidities, like heart problems, hypertension and diabetes, than other states.
“In cases where the comorbid conditions were not being managed by the patient the fatalities have been very high,” said Lal.
“Out of the total 2,149 persons who died of Covid, only 125 did not have any comorbid condition. The number of deaths due to Covid and comorbidity is almost 95 per cent,” said Amit Kumar, who heads the Punjab Covid control room.
Dr Rajesh Bhaskar, the state’s nodal in-charge of Covid management, highlighted that Punjab also had a more aged population than other states.
Giving data about testing, Kumar said, “Punjab has carried out almost 13 lakh tests, out of which 10.5 lakh are RT-PCR. Another 2.3 lakh are rapid antigen tests. Our positivity rate is around 5.32 per cent.”
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‘Horror’ hospitals to blame, says oppn
The opposition, however, is not impressed with the government’s explanation about the high fatality rate.
Harpal Singh Cheema, leader of opposition and Aam Aadmi Party MLA, said the main reason for the sharp rise in CFR is “the complete lack of care” of Covid patients in government-run hospitals.
“The three hospitals attached to the medical colleges at Faridkot Patiala and Amritsar are horror hospitals. Everyday receive video and audio messages from Covid patients undergoing treatment in these facilities. No doctors are seeing them and there is no care. Patients have been left to the mercy of safai karamcharis and other sewaks,” he said.
“Not a single cabinet minister or Congress MLA who tested positive for Covid-19 has offered to undergo treatment in a government facility. One MLA who got admitted at the government medical college in Patiala ran away within a few hours and got himself admitted into a private hospital,” Cheema claimed.
“Even the vice-chancellor of the Baba Farid University of medical education (Health Sciences) that controls the three medical colleges was admitted in PGI Chandigarh for Covid treatment,” he added.
He further said CM Amarinder Singh, in whose constituency the government college falls, didn’t even bother to visit the hospital and see the condition of patients there.
Shiromani Akali Dal general secretary Dr Daljit Singh Cheema said Covid in Punjab is being handled politically and not professionally.
“The focus of the government is not to provide the best healthcare facilities in hospitals but to implement curfew and lockdown. The role of the police in Covid management is the highest while the role of the directorate of health services or medical education or principals of medical colleges is minimal… No patient in Punjab wants to go to a government facility if he can afford a private one,” said Daljit Singh.
‘Both govt and community at fault’
Independent experts have a different view of the situation. According to them, the government and community both are at fault.
“There is no point in indulging in a blame game when the responsibility of containing this epidemic lies both with the community as well as the government. People who are falling sick are not reporting until they are really unwell and need hospitalisation,” said Dr Subhash Verma, director, internal medicine and hematology, Fortis Hospital, Mohali.
“If the government is to be blamed, the community is to be blamed as well. Also it is true that Punjab has a larger share of people with comorbid conditions,” said Verma.
Prof Preethi John, dean, Chitkara School of Health Sciences, Chandigarh, said the Covid management has laid bare the need to strengthen primary healthcare in comparison to availability of tertiary hospitals.
“To protect population health and prevent catastrophic illness primary healthcare is of paramount importance which is lacking. Mortality of Covid patients relates to comorbidity. Punjab being a state of affluence lifestyle diseases are high. As a result immunity is compromised. Hence the death rate is more,” she said.
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