The Municipal Corporation of Greater Mumbai (MCGM/ BMC) has made recommendations to ‘strongly pursue’ people over 50 years suffering with the COVID-19 infection to get hospitalized. This has caused apprehension among the people of Mumbai. Directives during this pandemic, especially the lockdown, have not been well received and some with good reason. What then is driving the authorities to push these recommendations especially when it is clear as a bell that enforcing these recommendations would not be easy and comes with repercussions? This particular recommendation to hospitalize patients over 50 years has ‘preventing unwanted deaths’ at its roots.
We know that in India the death rate from the COVID-19 infection is lower than in several other countries. Yet, Mumbai is seeing many more deaths than should be ideal especially within a wealthy urban infrastructure. Death rate from COVID in Mumbai is over 5% while across India it is at about 2%1. This suggests that people who should ideally survive the infection are succumbing to it. These deaths are ‘preventable’. Preventable deaths occur often and are a mark of inefficiency rather than vulnerability.
The sero-surveys hint that with over 50% of the population of Mumbai infected, we are approaching herd immunity2. This, however, does not mean that we are ready to go about our lives as we did before the pandemic. The title, Home or Hospital, seems more like rhetoric than an actual question. The preferred choice is home. Initially, this was a choice for COVID positive but asymptomatic patients who had enough room to isolate at home. Increasingly, symptomatic patients have sought out-patient care and isolation at home. Over the past couple of months, many patients with suspected COVID symptoms are avoiding tests and hospitalization when advised by their doctors. Patients seek several opinions in the hope to hear that they need not get tested or hospitalized. This is a dangerous trend. Patients’ decisions are being driven by cost, responsibilities at home, fear, stigma, denial of contracting the virus, hope that symptoms will abate with home remedies or over the counter medication, opinions of family members and ‘web-searches’, to name a few. Even if some of these factors valid, they are no indications for testing and hospitalization. The decision for getting tested should primarily be based on symptoms and that of hospitalization on the doctor’s recommendation. This simple formula is not being followed. Some patients do not hesitate to get a COVID test and are prepared to be hospitalized. The challenge has been patients who are in absolute denial of their disease and go from doctor to doctor convincing each one that they feel fine, could not possibly have COVID and could recuperate at home. Some of these patients actually recover but some get sicker and the probability that those over 50 years will get sicker is high. When older patients delay hospital care, it is difficult to revive them. This happens classically with COVID-19 because of what is called ‘happy hypoxia’. The patient feels no breathlessness and is fine until it is too late, the lungs have deteriorated beyond repair and the patient succumbs. These are the preventable deaths. It is no secret that during this pandemic, finding a hospital bed has been difficult for many patients. In the time symptomatic patients ignore their doctors advise and wait to get tested and hospitalized, their lung health worsens and then they lose some more time before they actually get tested and hospitalized. A doctor’s decision is based on knowledge and experience. I am not exonerating anyone of medical malpractice here. It exists and must be addressed. That is a debate for another place. Patients have the right to choose to stay home or go to a hospital. The debate on the responsibilities that come with choices is missing. More often than not, patients feel they are better judges of their health and disease. It is one factor that contributes to preventable death. In case of COVID-19, these preventable deaths are more common among those over 50 years and the state is stepping in to persuade them to get healthcare.
We are more than six months into the pandemic and increasingly know more about the virus, the disease, its prevention and treatment. It is most unfortunate that prevention and treatment protocols are not being followed. Imperatives such as wearing a mask and maintaining distance are easily flouted. People are putting themselves and others at risk. Most patients can be treated fully, if the treatment protocol is followed in time.
It goes without saying that the state must work on other factors of stigma, planning quarantine time and the risk of death from disease. In fact, the state should step up further and insist on testing everyone over 50 years who presents with fever or cough. Costs of tests should be subsidized further to aid this. The ‘low death rate’ card has been over-played and may have misled people.
On this auspicious day of Ganesh Chaturthi, when we join our hands to him who overturns our obstacles, lets also be responsible with the opportunities he has blessed us with. God helps those who help themselves. Now, I know you are itching to throw an ‘atmanirbhar’ joke at me, but I am actually suggesting quite the opposite. Trust a doctor when s/he says you may have COVID. Get tested and do not delay hospitalization when it is recommended.
Dr. Hitakshi Sehgal
