The ministry said that sudden deaths have been reported both at presentation to emergency department as well as in hospital.
India has been reporting one of the lowest COVID-19 fatality rates in the world with the figure further declining to 1.76 per cent as on date against a global average of 3.3 per cent, the Union Health Ministry said on Wednesday.
It also said that COVID-19 deaths per million population in India is one of the lowest in the world.
“While the global average is 110 deaths per million population, India is reporting 48 deaths per million population. The comparative figure for Brazil and the UK is 12 and 13 times higher, respectively,” the ministry highlighted.
India’s COVID-19 tally of cases galloped past 37 lakh on Wednesday with 78,357 new instances of the disease reported in a day, while the number of recoveries crossed 29 lakh pushing the recovery rate to 76.98 per cent, the Union health ministry data showed.
The death toll climbed to 66,333 with 1,045 more fatalities reported in 24 hours. India has so far reported 37,69,523 cases of the viral disease, according to the data updated at 8 am. As part of the COVID-19 management and response policy, the Centre’s sharp focus has been not only on containing the coronavirus-related fatality, but also to reduce deaths by providing quality clinical care to the critical and severe patients, it said. Collaborative efforts of the Centre, states and union territories have resulted in strengthening of the health facilities across the country, the ministry said.
As many as 1,578 dedicated COVID hospitals are providing quality medical care. The Central government has also issued the standard of care guidelines incorporated in the Clinical Treatment Protocol. The AIIMS, New Delhi, has been conducting e-ICU sessions to build the capacities of the ICU doctors in clinical management of critical patients towards reducing the fatality. Knowledge and domain experts have been holding tele- or video-consultation sessions twice every week from July 8 for the doctors manning ICUs in state hospitals.
Till date, 17 tele-sessions have been held and 204 institutions have participated in them, the ministry said.
To further build the ICU, clinical management capacities of doctors for treatment of critical patients, AIIMS, New Delhi, in collaboration with the Health Ministry, has developed frequently answered questions (FAQs).
One of these clarifies that Remdesivir and tocilizumab are experimental therapies and should not be used as empirical therapy for suspected cases. They should be used only in proven COVID-19 patients, where clinically indicated, the ministry said, underlining that there is no evidence to support the use of these two drugs in asymptomatic patients with comorbidities.
In one of the answers, the ministry said, Tocilizumab is an experimental therapy, has a limited role, and should be used only in patients with cytokine syndrome after ruling out active infections. As for the role of Favipiravir, the ministry said studies have used this drug mainly in mild or asymptomatic COVID-19 cases, claiming to prevent progression, whereas the majority of this cohort recover with just supportive care and monitoring and usually require no specific therapy.
Evidence is weak for the use of Favipiravir and is currently not recommended in national guidelines, it said. According to the FAQs, depression is a common finding in patients with COVID which may be because of a number of reasons including staying in isolation, anxiety related to disease, social stigma, among others. Such patients need empathy and psychological counselling preferably by a trained healthcare worker like a psychologist / psychiatrist, it said.
The ministry said that sudden deaths have been reported both at presentation to emergency department as well as in hospital. Reasons that have been proposed include a sudden cardiac event/ACS, preceding silent hypoxia that went unnoticed or due to a thrombotic complication such as pulmonary thromboembolism.
“Patients with risk factors to develop severe COVID-19 or with prior comorbid conditions such as CAD or chronic lung disease should be strictly monitored for their saturation. They should not be allowed to move unattended. Anticoagulant should be used on all at-risk patients who do not have any risk factors of bleeding,” the ministry elaborated.
As far as the role of plasma therapy is concerned, the FAQs said that convalescent plasma collected from ABO matched donors with high neutralizing titers can be given to patients at risk of developing severe COVID in early stages of the disease. However, it should also be considered an experimental therapy and should be used with caution, it stated.