Covid second wave: From miscalculated to now, possibly, over-optimistic

The first case of Covid-19 in Maharashtra was notified on March 9, 2020. The increase in numbers began gradually till July 2020, and then, there was a sharp upsurge from August.

By mid-September, new cases per day rose to 23,500, which was a peak point. Later, it gradually showed a downward trend and by end of January 2021, the figure became minuscule, at 1,800 new cases per day.

In December 2020, at Amravati, numbers began increasing. The presence of variant viruses was noted in the genome sequencing of the samples of a few positive cases. Of them, some were variants from UK and South Africa, but a new mutant was noted and ignored, which later proved to be a double mutant, named recently as “delta” and “kappa” by WHO.

In January and February of 2021, the Vidarbha region, including Amravati, Nagpur, Bhandara and Chandrapur districts,showed a rapid increase in Covid-19 cases. By February 20, 2021, Amravati ranked second in the list of districts with the highest number of active Covid-19 cases in Maharashtra, with 5,406 active cases daily. The positivity rate was at 50%. The rest of the districts were showing a positivity rate of around 40%.

Similarly in Mumbai, Pune, Nashik, Aurangabad, Thane, and Navi Mumbai, the number of new cases was growing at a faster pace.

In February and March, it was noticed that…

- Numbers are increasing rapidly

- Symptoms are changing. Low-grade fever, severe breathlessness, loose motions, vomiting, rashes over the body, Covid tongue, and anosmia were the new symptoms.

- The upper middle-class and elite in big housing societies and bungalows outnumbered the slum dwellers in getting infected

- The age group of 20 to 45 years was mainly affected

- A large number of children below 10 years of age were getting infected

This was the beginning of the Second Wave. Doctors and scientists informed the government of Maharashtra that this is the second wave and a new mutant of Maharashtra origin has surfaced. Government of Maharashtra clearly said that there is no second wave and no mutants.

It was Rajesh Bhushan, chief secretary of health, Central government who finally, on March 24, 2021, conveyed to the Maharashtra government the existence of the mutant of Maharashtra origin - B.1.617.1 and B.1.617.2, and also declared that it is the second wave.

Bhushan pointed out and the doctors in the state said that:

- Contact tracing of 30 testings per new patient is required.

- Considering the massive rise in the number of patients, the need to make necessary infrastructure arrangements was stressed, but these suggestions were not followed.

During this second wave, Maharashtra was India’s worst-affected state, just as it was in the first wave of Covid 19 last year.

As of April 27, Maharashtra had 676,647 active patients, almost a quarter of the national total of 2,882,204. The state has so far recorded more than 0.1 million deaths, 30 percent of the national total of 3,46,000.

Data with the Maharashtra health department shows that the growth of positive cases had been exponential since February 12, which the state marks as the start of the second wave.

Maharashtra recorded 2,052,905 cases in the 11 months between March 9, 2020, and February 11, 2021. Then in just the first 72 days of the second wave, between February 12 and April 25 — it recorded 2,174,654 cases. Almost 70 percent of these cases have been recorded in Tier II, Tier III cities, and the villages.

Until the middle of April 2021, the state’s positivity rate was 25.17 %, with figures from 16 rural districts coming in higher than that. These districts include Jalna, Beed, Nandurbar, Nashik, Latur, Gondiya, Parbhani, Hingoli, Osmanabad, Pune, Nagpur, Ahmednagar, Beed, Nandurbar, Palghar, and Ratnagiri.

With a 39.25 per cent positivity rate, Osmanabad topped the charts, followed by Parbhani (36.78 per cent) and Hingoli (36.7 per cent).

In April 2021, Mumbai recorded the lowest weekly growth rate at 1.09 per cent, and Parbhani recorded the highest, at 798 per cent, followed by Latur at 398 per cent, Beed at 347 per cent, and Jalna at 345 per cent.

Oxygen shortage

There was a shortage of medical oxygen even in the first wave in October 2020. But the government did not improve production and remained happy with 1,200 metric tonnes per day.

In April, during the peak period, the requirement escalated to 3,000 metric tonnes per day. Even with all the additional support, like the “Oxygen Express” train, the situation did not improve in time.

Around 40 per cent of the deaths that occurred in March and April 2021, were because of a lack of oxygen.

Large-scale use of the impure industrial oxygen is a probable cause of post-Covid complications, like the mucormycosis infection. This number has reached 11,000 cases.

Rural picture

In the rural areas of Maharashtra, the number of beds at Covid Care Centres was only 20 percent of the need and oxygen beds were fulfilling 70 percent of the requirement.

Due to an inadequate numbers of ICU beds and ventilators, 30 to 40 per cent of patients needed to be shifted to the nearest city. Of these, 50 per cent of patients died on the way and the rest were admitted, but half of them survived.

There was an inadequate number of RTPCR testing kits as well as rapid antigen tests.

A sufficient amount of medicines needed were not available in the government hospitals in rural areas throughout the period.

Lockdown

The CM of Maharashtra announced a lockdown in the second week of April. It should have been announced one month earlier. Mumbai and Pune districts were showing a downward trend in the patient numbers around 10-15 days before the official lockdown.

Vaccination

It has been proved historically and scientifically that vaccination is the only answer to curb the spread of a pandemic. The vaccination campaign never had a proper plan to vaccinate a population of 130 crore in one year.

The supply chain of vaccines needed to ensure speedy vaccinations was never thought of. Registration through CoWin and Aarogyasetu apps was a bad idea that decelerated the motion. Not allowing all the registered doctors to vaccinate officially, limited the number of vaccination centres to a handful of government and private hospitals.

Not making it available in the open market and keeping all the strings in the Central government’s hands, made the dream of “Vaccinating India through the Teeka Mahotsav” unapproachable. Covid vaccination is an utter failure; not only in Maharashtra, but all over India.

Unlock

As of June 7, 10 districts have been relieved from restrictions and life has again started. Criteria for unlocking a region has not been very convincing, scientifically. “Covid-appropriate behaviour” is forgotten again. Let us hope that a brand new variant does not evolve in the coming months to give birth to a still devastating Third Wave.

The writer is the immediate past president of the Indian Medical Association (IMA), Maharashtra