Dying young

W hen she cried in agony indicating that her chest felt like exploding, the medical team that attended to her stood helpless. Though she was a Type I diabetes mellitus patient, doctors were optimistic that she would respond to the treatment. After all, she was in her teens. “But sadly, she collapsed and never recovered,” said a senior nurse who attended to the 17-year-old Chennai girl who became the 126th victim in Tamil Nadu government’s burgeoning COVID-19 list of the dead.

The girl died just under four hours of her admission to one of the leading government hospitals in Chennai on June 3. A note from the Health Department claimed that she died from “COVID-19 Pneumonia, Cardio Pulmonary Arrest, Acute Kidney Injury, Uncontrolled Hyperglycaemia, Left Pyelonephritis and Diabetic Ketoacidosis”. On the same day a 25-year-old woman from Krishnagiri district died of respiratory failure and asthma. Another person to die of COVID complication was a 33-year-old mother soon after childbirth. Another 27-year-old woman in Chennai died of the infection on April 27.

A large number of the people who died had co-morbidities such as diabetics, hypertension, heart and kidney ailments, lung diseases, cancer and, predominantly, respiratory failures and sepsis shock. Two senior private medical practitioners, two senior nurses and a laboratory technician, too, succumbed to the infection. J. Anbazhagan of the Dravida Munnetra Kazhagam became the first sitting MLA to die of COVID in the country. The list of the dead is growing long and the virus also seems to be breaking the barrier of age.

Front-line workers and health care personnel are worried about the increasing death rate, especially in the 30-60 age group, although the fact that a few over 90 years of age have recovered offers some solace. From April 29, the day the State Health Department started issuing daily bulletins on COVID deaths, to June 13, as many as 25 patients who lost their lives were in the 20-40 age group, 127 were in the 41-60 age group and 208 were above 61. On June 13 and 14 there were seven deaths each of people in the 40-60 age group who had no other illnesses.

The situation forced Health Minister C. Vijayabaskar to say that “the virus’ strain is intensely virulent today in the State”, suggesting that more patients were on emergency medicare and in need of oxygen. As the infection rate rose to nearly half a lakh in the third week of June, many people started thronging hospitals in what physicians call “clinically precarious condition” — most of them requiring nasal oxygen and ventilators. Correspondingly, the death rate also started going up, raising alarm.

“That many COVID patients need oxygenation bares the seriousness of the issue today,” said a senior infectious disease specialist. “Fortunately, all major government hospitals have integrated oxygen plants to meet the massive emergency requirements of today. The Madurai Rajaji Government Medical College Hospital in Madurai has one such plant, besides adequate number of ventilators. We are well-equipped to meet any emergency,” said Dr J. Sangumani, the hospital’s dean. A major referral centre for the southern districts of the State, it recently saved a 54-year-old COVID patient with plasma therapy. The hospital has so far recorded three deaths of over 450 patients there.

A study on COVID-related death in Tamil Nadu reveals many shocking details. The State recorded the first double-digit number in deaths, 12, on May 28. But June has seen an all-round spike in terms of infection and mortality. On June 5, 12 people died and the next day 19, among whom eight had no other serious illnesses. As on June 7, the death toll stood at 269; one of this was in the 10-19 age group, four in the 20-29 age group, 17 in the 30-39 age group, 31 in the 40-49 age group, 61 in the 50-59 age group, 71 in the 60-69 age group, 65 in the 70-79 age group, 17 in the 80-89 group and two above 90.

As on June 12 the State recorded 367 deaths, with a mortality rate of 0.90 per cent. Chennai city’s death toll that day was 294 with a 1.01 per cent death rate.

The death toll in the State touched a new peak, 38, on June 14. Of these, seven persons had no co-morbid conditions.

Chennai’s infection rate vis-a-vis the State as on June 12 was 64 per cent. The number of infections in Chennai constitues two-thirds of the State’s total, though according to Health Secretary J. Radhakrishnan, who is also the pandemic nodal officer for Chennai city, just 16 per cent of the city’s 37,000 streets, mainly in north Chennai, were infection-prone.

“Chennai remains a danger zone,” said a senior Corporation health officer. The sheer density of population in the city is the critical reason why containment has become difficult though the incompetence of the Greater Chennai Corporation cannot be overlooked.

Besides doctors and postgraduate medics, 155 staff nurses in all government hospitals have been infected in the last two months. Two of them, Joan Mary Pricilla, 58, Grade I Nursing Superintendent of Madras Medical College Hospital, who continued her service even after her retirement in May, and Thangalakshmi, 54, of Rajiv Gandhi Government General Hospital, lost their lives in the line of duty.

Meanwhile, the Supreme Court has asked the Tamil Nadu government to file a status report on how some 30 children of the government-run juvenile home in Chennai tested positive. The Chennai City police, following a complaint from the Chennai Corporation, are on the lookout for 199 persons of north Chennai who tested positive and jumped quarantine.

As many as 734 pregnant women were admitted for COVID treatment in various government hospitals; of these 547 had recovered until June 12. Two died. “Many of these women were denied treatment by private doctors and hospitals they had been going to before they tested positive. They were referred to our hospital and they recovered, many of them despite having co-morbidities,” said a senior physician of the Institute of Child Health and Hospital for Children at Egmore, Chennai. As on June 15, the hospital had 62 patients.

Keeping mortality rate low

“Since the virus is erratic and not confined to any set pattern that epidemiologists have perceived, we have decided to ‘indigenise’ our action plan, especially in Chennai,” said a city-based epidemiologist. As a result, the focus has shifted to hospitals, disease management and recovery so that the State-level mortality rate of around 1 to 1.5 per cent can be maintained.

Reports claim that hospitals in Chennai have started overflowing with patients. The State government claims that 70,000 beds, apart from corona care centres, have been augmented to meet the rising demand. It says it has also undertaken a massive exercise to recruit doctors and paramedical staff, besides laboratory technicians and health workers.

As the infection is on the rise in the State, especially in Chennai, pressure is mounting on the administration. A batch of 23 nurses staged a brief sit-in on the premises of the Omandurar Government Super Speciality Hospital, where over 400 patients are being treated, complaining that they were stressed out because of long working hours. It prompted the government to recruit, temporarily, 2,400 health care professionals and 1,000 postgraduate doctors. Doctors and paramedical staff in the districts are also being brought to Chennai to bolster the manpower, and additional ambulances have been added to the fleet.

Discrepancy in death toll

Allegations are rife that the government is not maintaining transparency while providing the statistics on COVID-19-related deaths. A visibly embarrassed Chief Minister, Edappadi K. Palaniswami, told the media in Salem that there was no need for the government to indulge in such activities. “How can one hide or cover up a death?” he asked. Media reports, however, claimed that in Chennai Corporation limits around 398 people could have died of virus infection until June 4 as against the Health Department’s number of 166.

On June 7, opposition leader and Dravida Munnetra Kazhagam president M.K. Stalin expressed his shock on Twitter over the discrepancies and contradictory claims of various departments on the death toll. One report claimed that the death of 20 persons in the Southern Railway Hospital at Perambur had not been included in the statistics provided by the Health Department. “Many deaths go unreported. While the intensity of infection is on the rise, the death rate remains surprisingly low. The media have to insist on the state maintaining transparency and providing correct statistics. From the beginning there has been a huge gap in the coordination of various agencies that are dealing with the pandemic,” said a social activist.

As the issue emerged to be a hot topic, Health Secretary, Dr Beela Rajesh, who was transferred from the post on June 12, said that a committee had been formed to “reconcile” the statistics on deaths and admissions received from Chennai Corporation and private hospitals with that of the Health Department.

“The task is clear and could hardly be more urgent. We have to save as many lives as possible,” said an influenza specialist. Meanwhile, with infection spreading, the government has declared a lockdown for 12 days from June 19 in Chennai and parts of Tiruvallur, Chengalpattu and Kancheepuram districts.