Some ‘more severe’ second wave cases fly under the radar

Nagpur: Nagpur is among the most adversely hit cities in the country with more than 7,000 COVID-19 positive cases and 110 deaths reported in the region on April 22 due to the ongoing second wave. While hospitals are running short of beds, oxygen cylinders and Remdesivir injections, experts suggest that the second wave is more severe and affecting people across all age groups. Cases of a ‘false negative’ in RT-PCR test, have also been reported.

“There may be a variant which is more contagious and severe and reaches out to the lungs very quickly. Originally the virus was identified to affect only people with comorbidities, whereas youngsters had mild effects, but the situation has changed drastically now. The virus is skipping the nose and throat and directly attacking the lungs, which maybe a major reason for it going undetected in RT-PCR and another reason could be late testing as RT-PCR detects the virus at early stages”, said president of Vidarbha Hospitals Association (VHA) and senior pulmonologist, Dr Ashok Arbat.

People are obtaining a high value in HRCT chest scan after complaining of COVID-19 like symptoms despite a negative RT-PCR report. Citing two observations about the second wave, convenor of VHA, Dr Anup Marar said, “Some RT-PCRs are testing negative despite the patient being clinically positive. Also, the deterioration rate is fast this time, so patients should get chest scan done at earliest as RT-PCR has only 65-70% accuracy.”

18 year old Simran Mitra who traveled from Dubai to Nagpur, tested negative at both airports during her journey. Within a day or two, she collapsed and was rushed to the Nucleus Hospital only to find out that she was COVID-19 positive and the virus had infected her organs. Simran was put on a mechanical ventilator and is recovering now, informed her mother Rashida Mitra, teacher at a Dubai school.

Addressing the ‘false negative’ patients, Dr Farah Aamir, who heads the Covid Laboratory at Crescent Hospital, Nagpur said, “Fortunately or unfortunately, pneumonia patients with a high HRCT value are been given the same line of treatment as COVID-19 due to the similarity in the lung patches. There may be a new mutated strain, but nothing can be attributed to it at present.” 

A positive RT-PCR is the minimum criteria to attain a bed in the COVID-19 ward. Turns out, swab positive patients have an edge over ‘false negatives’ in terms of getting a bed.

Dr Aziz Khan, senior cardiologist and director at Crescent Hospital, Nagpur said, “We are taking in people with a corads 5 level in HRCT as it indicates atypical COVID-19 infection, but some private hospitals have their own limitations and have to say no to swab negative patients.”

The other set back for patients who may come under the false negative category is that they cannot officially avail COVID-19 related drugs including Remdesivir.

Additional municipal commissioner at Nagpur Municipal Corporation, Jalaj Sharma said, “Vials of Remdesivir injections are sent to the hospitals on the basis of the number of covid patients. The swab negative patients cannot get admitted in covid ward because there is still a 30% chance that they are covid negative, so we avoid risk.”

“In fact, if these patients die, their bodies will be handed over to their families just like regular patients”, added Dr Marar.

However, irrespective of test result, the scenario for bed, oxygen and drugs availability is worsening at Nagpur. Resident doctor on COVID-19 duty, Dr Mariam Siddiqui said, “After experiencing major symptoms, a common man might take roughly 5 days to get a bed with proper facilities. The labs are dishing out results in 1 or 2 days and there is 4 days waiting time in many hospitals. Meanwhile the lung infection might keep on spreading at a fast pace during the delay.”

With hospitals collaborating with hotels, new beds are expected to be operational in a few days. The Nagpur Bench of Bombay High Court came down heavily on Maharashtra government for their ‘callous behaviour’ during a hearing on April 21 regarding non-compliance with its order to supply 10,000 vials of Remdesivir for Nagpur patients on April 19.