New Delhi: The Himalayan state of Sikkim, which had not registered a single case of Covid-19 till a couple of months ago, presently has the third-highest case fatality rate in the country.
Sikkim recorded its first coronavirus case in late May and since then, it has seen a total of 4,577 cases, which is a relatively low number compared to the rest of the country.
However, the state’s rising case fatality rate has become a matter of concern among health experts. Sikkim’s CFR, which was 1.79 per cent on 30 October, has surged to 2.07 per cent Thursday. This is considerably higher than India’s average CFR, which stands at 1.47 per cent.
Case fatality rate or CFR is the ratio of Covid deaths to the total number of cases recorded.
This surge in CFR is especially concerning since the active cases in the state with a population of just 6.11 lakh, according to census data, has remained low. As of Thursday, health ministry data indicated that there are 300 active cases in Sikkim and 95 people have died from the virus.
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Most deaths due to comorbidities plus Covid
According to state government officials, of the 95 people who died of the infection, at least 85 were above the age of 55 and suffered from comorbidities or underlying chronic diseases.
State health officials noted that earlier most Covid cases in Sikkim were asymptomatic but now, there has been a rise in symptomatic cases among people above the age of 55.
Sikkim Health Secretary Dr Pempa Tshering Bhutia told ThePrint Wednesday that 92.3 per cent deaths in the state were due to underlying conditions or comorbidities in the patients.
“Only seven deaths in the state are due to only Covid, rest are Covid plus comorbidities. We have observed the pattern in Sikkim and we have the infrastructure to attend to them. However, more research needs to be done and we are trying to plan out measures to reduce the CFR,” Dr Pempa said.
Dr C.S. Sharma, Medical Superintendent of Sikkim’s only Covid-dedicated hospital, Sir Thutob Namgyal Memorial (STNM) Hospital, echoed Pempa’s view.
He noted that most of the patients who died due to Covid after getting admitted had underlying conditions such as kidney and liver ailments, diabetes, hypertension and chronic obstructive pulmonary disease (COPD).
However, according to Dr Preeti Kumar, an epidemiologist with the Public Health Foundation of India, the high CFR of the state could also be “due to the denominator (the total caseload) being smaller, which results in a higher percentage when calculated”.
She added: “Having said that, it is extremely important to examine some of the potential reasons. Early and close follow up of positive cases, so they get treatment early in the disease cycle is imperative to reduce CFR. Sikkim also has a high burden of chronic diseases, and comorbidities, which account for some of the variation.”
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One Covid hospital and one RT-PCR testing centre
The STNM Hospital has 287 beds for Covid patients, along with 20 ICU beds and 57 ventilators. The hospital has around 150 doctors out of which about 25 don’t attend Covid patients. It also has the state’s only RT-PCR testing centre.
According to Dr Yudok Bhutia, the nodal officer for Covid in STNM Hospital, there are antigen testing centres in the state’s west and east districts but the hospital does not have an antigen testing facility.
“Earlier we were testing all primary contacts, but now according to government SOP, we are testing only the symptomatic primary contacts. Asymptomatic patients and contacts are in home isolation,” Dr Sharma said.
“After the lockdown, all the returnees were tested and mostly they were asymptomatic or mildly asymptomatic. Now due to community transmission, aged people are getting severely infected,” Sharma added.
According to state protocol, symptomatic primary contacts of Covid-positive patients are asked to visit the nearest antigen testing kiosks by the doctors and then go for the RT-PCR test, if they test positive.
Unlike the rest of the country, at-home sample collection is not available in Sikkim. The state is also not carrying out random testing.
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Late identification of infection and geographic barriers
Health officials in Sikkim also blame late identification of the virus for the increased death rate among aged patients.
“Out of the 85 who died, 12 patients tested positive for Covid after death. They were brought into the hospital after they died,” the state’s health secretary told ThePrint Wednesday.
Dr Sharma also noted that late detection is a major issue in Sikkim.
“People panic and don’t get admitted even if there are severe symptoms which increases the risk of death. Most of them die due to lack of timely treatment,” he said.
“Most of the time people don’t come for treatment or for getting tested over fear of catching the disease in a hospital. They are also scared that if they test positive, the area will be cordoned off,” Sharma added.
The medical superintendent also talked about how the hilly terrain of the state made it difficult for patients to access healthcare.
“The distance between the primary health care facility and the point where he or she got sick is very long, which is why by the time a serious patient is brought in, the chances of saving his or her life is meagre,” Sharma said.
He added that even though ambulances are provided, it cannot reach all places in the state. “It’s a hilltop, practically impossible to reach every case in here.”
People not following Covid norms
Authorities noted that another reason for the recent spike in deaths is people’s carelessness regarding distancing and masking norms.
Dr Yudok Bhutia said people of the state have stopped being afraid of the disease.
“People have stopped fearing the disease now. Even though masks are mostly worn due to strict guidelines, they aren’t always worn covering the nose and the mouth. Moreover social distancing is flouted in markets,” Yudok told ThePrint.
They only care for Covid when they get infected, not before that. All of this and community transmission has led to increased deaths in the state, she added.
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