Seeking COVID-19 care too late responsible for recent surge in deaths: Karnataka CCSU Head

As of Monday evening, the state had recorded a total of 89 COVID-19 fatalities (excluding two suicides), since the first Covid-19 death was reported in Kalaburagi on March 10. With the onset of June, the number of deaths have risen, with 33 fatalities reported in the month so far, compared to 32 for the entire month of May. While the mortality rate due to COVID-19 remains low, the disease does kill when people with a compromised immune system turn up for hospital care too late.

“The unifying factor among all the deaths so far is COVOD-positive people with pre-existing health problems turning up too late for treatment,” says Dr KV Thrilok Chandra, the head of Karnataka’s specially formed Critical Care Support Unit (CCSU), in an interview with DH’s Akhil Kadidal.

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Can you tell me a little about what the Critical Care Support Unit does?

We track all the high-risk COVID-19 cases in the state, including those above the age of 50, plus all paediatric cases (that is, under the age of 10), and we track every case which has reported a co-morbidity, including people with diabetes, hypertension, pregnant women and any other immunity-altering conditions.

How does the CCSU work?

We have a team of four doctors in the state COVID War Room. We also have several interns from KIMS and another hospital who help me carry out the daily e-rounds. We have also partnered with Columbia Asia and the Manipal Group for support. In the event of an emergency, our specialists hold multiple meetings and prescribe medicines to ensure that the patient recovers.

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Lately, we are seeing a rising number of deaths. What is causing this spike?

If you look at the data about the fatalities, a pattern can be seen. For instance, we have had nine cases where people were brought dead. We have had another 15 to 20 cases where the people expired within hours of arriving at a COVID-designated hospital. What we are seeing is that people are not coming forward to get care for Covid-19 in time. A lot of people are self-medicating or are going to private hospitals, where they get progressively worse. By the time they appear at the Covid-designated hospitals, it is usually too late.

How much time do people have to report to a COVID care centre after the onset of symptoms?

In terms of days, just one or two. Instead, we are seeing people showing up between three to five days. By this stage, oxygen desaturation is already taking place in their bodies. In many cases, people are literally breathless by the time they show up at our hospitals. By this stage, hypoxia or breathlessness has set in. That makes recovery very difficult.

What about pre-symptomatic individuals? If they develop a cough, for example, they might think that’ll pass. By ignoring the symptom, are they potentially risking their lives?

Absolutely. As far as we are concerned, it is better for people with even basic symptoms to come in for a medical check-up. We have had many cases with severe co-morbidities, and elderly people, who are highest at-risk, whom we were able to save because these people got to the hospitals before the disease entered its late stage. It is as simple as that.

The latest state COVID War Room data says that the death rate among ‘asymptomatic’ individuals is 0.3%. Please explain this.

This refers to the ‘brought dead’ cases. We don’t have medical histories for them, so we are not able to verify if they had symptoms or not.

Follow: Coronavirus India update: State-wise total number of confirmed cases, deaths on June 15

Over the last two to three weeks, we are suddenly seeing a spate of young people dying of the disease. What is causing this?

Again, I would have to say that delayed treatment is responsible in some cases. For instance, a 17-year-old girl died recently in Kalaburagi. She had a demyelinating brain disease which had weakened her immune system. She was taken to three different private hospitals where her status as a Covid-19 sufferer was not diagnosed. Swabs were not taken.

In some of the young COVID-19 deaths, could lifestyle choices also be responsible?

Yes. In the case of a 23-year-old man who died of the disease in Bengaluru on June 12, he had juvenile diabetes. But more than that, we see the same issue that we see in other fatalities. He sought treatment at a private hospital where his condition was not diagnosed. After being classified as a suspected Covid-19 patient, he was then admitted to Bowring Hospital.

But then, against all medical advice, he checked himself out. We had no option to hold him. It was his prerogative to check out if he wanted to. When his swab samples came back as positive, we had him admitted immediately to Victoria Hospital. But by then, it was too late.

The common thread within all this appears to be that private hospitals are not reporting suspected COVID-19 cases as they should? What needs to be done to ensure that they do?

There is a clear order to all private establishments registered under the KPME Act to report cases of Influenza-Like Illness (ILI) and Severe Acute Respiratory Infection (SARI), but a majority of the institutions are not doing it. We are cracking down on them. But it is not just medical institutions not reporting cases, it is also pharmacies flouting the order. This has posed a huge challenge that we are trying to rectify.