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Journalism of Courage
The third wave of the Covid-19 pandemic was different from the first two waves as most people were vaccinated, a large number of those who tested positive was asymptomatic and hospitalisation number was fewer, though the infection spread faster and the availability of self-testing kits obscured data about the actual number of infections.
Gujarat reported its first Omicron variant case on December 4 in a 72-year-old non-resident Indian (NRI) man who landed in Jamnagar city from Zimbabwe on November 28. In the surge that began after Christmas, cases went up to 24,485 on January 20 (from 1,069 on January 1), which the state health department considers the “peak” of the third wave. State health minister Rushikesh Patel also said that almost 80 per cent of these cases were assumed to be of the Omicron variant.
By the end of January, though the number of positive cases started declining, 355 persons died of Covid-19 that month, while only 2-3 per cent of the active patients needed hospitalisation compared to 30-40 per cent hospitalisation during the second wave.
Doctors, as well as health officers, agree that most patients succumbing to the infection in this wave have pre-existing comorbid conditions and are elderly. In the jurisdiction of the Ahmedabad Municipal Corporation (AMC), 60 per cent of the deaths were reported among unvaccinated patients.
AMC deputy municipal commissioner in charge of health Praveen Chaudhary said, “Of the 109 deaths reported from January 1 to February 1 in the AMC jurisdiction, those above 60 years accounted for 71 deaths, while 25 were among those aged 45-60 years, 11 died in the 19-44 years group, and two in the 0-18 age group. Among the two in the 0-18 age group, one was a two-month-old pre-term child and another 17-year-old with sickle cell anaemia.”
“Among the deaths, 39 were not vaccinated and seven others were not eligible for the vaccine (either due to age or due to exclusion criteria owing to medical reasons). We conducted surveys of family members of the 39 as we wanted to know why they did not get the jab despite being eligible. A common reply was that at such an old age (of the deceased) ‘we did not have the courage’,” added Chaudhary.
According to Dr Shital Mistry, adviser for Covid-19 to the Vadodara administration and former assistant professor of Gujarat Medical Education and Research Society (GMERS)-run Gotri hospital, the recovery rate of patients who have been put on a ventilator is extremely low.
“About 13 to 15 per cent of patients who arrived in a critical condition needed ventilator support — non-invasive or mechanical. Of these, about 40% recovered after being on BiPAP support while 60% deteriorated and needed the invasive ventilator. Most of those needing invasive ventilators are with severe comorbid conditions… the survival rate is only 5% on an invasive ventilator…,” he told The Indian Express.
According to Dr Mistry, SSG Hospital Vadodara had 45 on ventilatory support during the third wave, of which 20 needed invasive ventilators from which only one recovered. “The mortality is less than the previous two waves but are mostly those patients, who are on invasive ventilator support. The patients, however, are also giving doctors time to put them on to mechanical ventilators, unlike the last time where patients collapsed on BiPAP and NRBM without giving time for intubation.
A senior AMC official said, “We cannot claim success solely on the fact that our systems were not stressed this time. We had been augmenting resources but it is important to acknowledge that the (Omicron) strain was not leading to disease severity.”
President of Ahmedabad Hospitals and Nursing Homes Association (AHNA) Dr Bharat Gadhvi said the most common co-morbidities are diabetes and hypertension. “Seventy per cent of the critical patients have diabetes. Most of the critical patients (at private hospitals) are fully vaccinated and most are above 45 years of age. The few critical cases we got took around 12-14 days to be stable and most of them are recovering.”
In Rajkot, doctors say only elderly Covid patients are falling seriously ill, requiring intensive care. There were 80 patients admitted to the dedicated Covid-19 hospital as of January 30 in the Pandit Deendayal Upadhyay (PDU) Government Hospital, popularly known as Rajkot civil hospital. Of them, only one was on invasive ventilation support and 14 on oxygen support. The remaining 65 patients don’t require any breathing support.
Dr Radheshyam Trivedi, medical superintendent of PDU hospital, says, “Over the past 10 days, we have observed three categories of patients who have required ventilation — they are 75 years or older, partially vaccinated or non-vaccinated and have comorbidities. A fully vaccinated person has rarely become severely ill, requiring ventilator.”
Self-test kits
According to data from the Gujarat Food and Drug Control Administration (FDCA), sale of rapid antigen home kits went up by seven times in January, compared to that of December 2021. Mylab kits reported 25 times increase in sales from December 2021 — the highest jump — among the five key kits sold, from 21,403 kits in December 2021 to more than 1.70 lakh kits as of January.
At a press conference, Health Minister Patel admitted that persons testing positive through home testing kits are not tracked by the administration and are not considered in the official Covid-19 count. He advised that such patients should notify their case to a local doctor. Gujarat FDCA commissioner Hemant Koshia says Gujarat FDCA regulates the kits “in terms of production and sale of the kits”, including those being sold in the open market.
According to Alpesh Patel, president of the Gujarat Chemists and Druggists Association, nearly 20 lakh Covid-19 home test kits were sold in the state in 20 days in January. “Until the beginning of January, the demand for self-test kits was between 500 to 1,000 per day across the state. But between January 5 and 25, the sales went up to nearly 70,000-80,000 kits per day — the highest sale of home kits.”
Private testing laboratories, including Neuberg Supratech in Ahmedabad, say that number of queues has been fewer and demand for ancillary tests such as C-reactive protein, D-Dimer, etc., were negligible.
Patel added that 50% of the sale of home test kits was of CoviSelf by Mylab Discovery Solutions Ltd, which is the cheapest of the available brands priced at Rs 250. “The sale was the highest in four metro cities with highest demand in Ahmedabad, followed by Vadodara, Surat and Rajkot. The demand went up gradually as the cases increased and there was awareness among the public about the new variant of the virus. Until January, the sale of home kits had been at a constant number without any fluctuations,” Patel said.
Oxygen and drugs
The demand for medical oxygen went up to 1,200 to 1,500 metric tonnes per day during the second wave, while during the third wave, it has been near-negligible. Gujarat FDCA commissioner Koshia says that between January 25 and 27, the state saw a daily consumption of 98 MT, a marginal rise from January 18 when oxygen requirement across the state stood at 70 MT.
Koshia says that during non-Covid times, medical oxygen requirement is around 45 MT per day across the state and after the second wave, more than 500 PSA plants have been installed.
Other secondary indicators of Covid-19, such as sale of over-the-counter flu medicines have also seen a surge, with druggists in the state recording high demand of azithromycin, paracetamol, zinc and vitamins, and doxycycline.
However, the demand has gone down now with new treatment protocols issued by the Ministry of Health and Family Welfare doing away with several drugs, including favipiravir, that were used during the second wave, and restricting the usage of steroids such as Remdesivir and Tocilizumab to select conditions.
Alpesh Patel said, “The commonly needed drugs for flu cases have sold in high numbers but the demand for drugs such as Remdesivir is low. However, in this wave, there has been no shortage of any drug or pharmaceutical products.
The hospitals have not yet raised any high demand for critical drugs as compared to the previous two waves.”
Affected by 2 waves
The family of Dr Miloni Bhatt (28), faculty at Karnavati School of dentistry and consultant dentist, was affected in the second and third wave as well as in the early days of Covid-19 in April 2020. Dr Bhatt tested positive in January. Her father Mayank Bhatt (58) was infected first in April 2020 and now in January 2022.
“During the first wave (in April 2020), even officials and doctors were not sure on how to deal with cases. The course of treatment was undecided. Initially my father was at home for 11 days after being infected… on the 11th day, his health deteriorated and he had to be hospitalised. He was hospitalised for 14 or 15 days, while we were quarantined at home,” said Miloni.
“During the second wave, in the end of April 2021, my grandfather aged 85 years old and vaccinated, tested positive. Initially at home, AMC team would come for surveillance as he was a senior citizen. After two days they recommended him to be hospitalised and arranged for an ambulance and a bed at SVP Hospital…,” added Miloni.
“But he wanted to be with his family at home rather than hospital, but we refused and waited for him to test negative. He also had several existing medical conditions, including heart trouble and hearing issues, so it was difficult for him to communicate at the hospital. He was shifted to the ICU for around five days, following which he was shifted to the general ward. He recovered well and was later discharged. However, three days after being home, on May 7, 2021, he passed away due to cardiac arrest,” said Miloni.
“This time (in January 2022), four of us — my brother and parents and I —were infected and it was symptomically like the flu. We quarantined for seven days. My father (with a CT score of 32 indicating very low viral load) and brother were completely asymptomatic,” she added.
‘It almost took my life’
A 57-year-old man from Vadodara, who was on a non-invasive ventilator for over 10 days at a private hospital, after testing positive for Covid-19 in early January, continues to face respiratory issues.
The patient, who requested anonymity said, “I was borderline diabetic and this was my first Covid infection; I escaped in the first two waves… Though people say that this variant is mild, it almost took my life. I tested positive in the first week of January and had mild symptoms for three days and was in home isolation. But when my oxygen level dropped, I had to be hospitalised.”
At the private hospital, he was first put on oxygen with an NRBM mask but as his condition deteriorated, the doctors shifted him to a BiPAP machine.
“It was not an easy journey… Wearing the BiPAP facemask for several hours has its own set of challenges but then the longer one wears it the better the lung recovery can be. But it takes a toll physically and mentally — lying in a specific position for hours, suffering a dry throat, and keeping the mouth shut. Whenever they took off the mask, I would only ask them if I was going to live or die,” he says.
About a week later, the man was able to breathe without the BiPAP mask for a longer duration but continued to remain on BiPAP support for a few more days. “Doctors told me that I had moderate respiratory failure, but luckily, I did not need intubation… I tested negative for Covid-19 on the ninth day but continued to be on BiPAP and recovered a week later. I continue to experience difficulty in breathing and talking at length is almost impossible as I have a cough that refuses to go,” he says.
Doctors have advised him to monitor his oxygen levels and report any recurrence of symptoms. “The after-effects of the virus have left me wondering if I will need to be hospitalised again,” he said.
(With inputs from Gopal Kateshiya in Rajkot)
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