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Critical Covid cases reduced, but oxygen usage higher in Mumbai

Data accessed by The Indian Express shows that from last June to September to December the percentage of critical patients rose from 3.5 to 4.7 and to 6.4 per cent. But December onwards it was reduced to as low as 2.9 per cent.

A quarterly analysis of Covid-19 cases in Mumbai has shown that while the percentage of critical patients has reduced over the months, the count of those put on oxygen support has increased.

Experts attributed the rise in oxygen usage to easy availability and in some cases delayed hospitalisation.

Data accessed by The Indian Express shows that from last June to September to December the percentage of critical patients rose from 3.5 to 4.7 and to 6.4 per cent. But December onwards it was reduced to as low as 2.9 per cent.

Similarly, the cumulative positivity rate, an indicator of viral infectivity, stood at 21.5 per cent last June, reduced to 18.3 per cent in September, 14.01 in December and 9.62 per cent in March this year.

But the percentage of patients put on oxygen support has increased over last one year. Of 26,897 active cases last June, 14.5 per cent were on oxygen support, that rose to 18 per cent by September and to 19 per cent by December. This month, of 12,487 active cases one-fifth are on oxygen support– 21 per cent (2,668) patients — across Mumbai.

Dr Balkrishna Adsul, dean in Seven Hills hospital, which is a dedicated Covid facility, said they have to use prolonged oxygen therapy when there is delayed admission. “Perhaps it is lack of fear of the virus now. The delay in hospitalisation has increased recently. People with mild symptoms prefer home isolation and by sixth or seventh day they turn critical. We have to give more oxygen to such patients,” he said.

For senior citizens delay in hospitalisation can force them to rely on high flow oxygenation for longer duration. In September, during its first peak Mumbai had over 5,000 patients on oxygen support.

Apart from delayed admissions, doctors are also using oxygen for moderate patients based on demand and availability. “Oxygenation can be by choice rather than need. In a lot of cases even moderately or mildly ill patients are put on oxygen support as a precaution because its availability is easy,” said Dr Avinash Supe, head of death audit committee in state.

Supe said while the declining rate of critical patients is a good sign, there is still scope for further reduction in death rate. “Private hospitals have learnt ICU management, but smaller nursing homes still need training. In some districts where there are no medical colleges, we noticed there is need to improve suboptimal ICU care in civil hospitals. In Kalyan Dombivali the death rate is high. We held a meeting with Bhandara and Jalgaon to understand why their deaths are high. Referral to higher centre needs to be faster, even now several physicians resist Covid-19 tests leading to fatality,” he said.

Experts from the Task Force and death audit committee said they believe Mumbai’s active case load will keep rising and by April reach figures similar to last September, when city recorded its first peak. Deaths are expected to be much lower— from 4.9 per cent cumulative death rate in September it has dipped to 3.3 per cent by March. Supe said the daily death rate of the state and Mumbai are both below 1 per cent of total cases.

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