MUMBAI: Age combined with underlying comorbid conditions—diabetes, kidney disease, obesity and hypertension — have emerged as the biggest contributors to Covid-19 deaths in the metropolis. Over 85% of the deaths in Mumbai have occurred in age groups above 50 though they account for only 44% of positive cases.
A BMC analysis of 9,869 deaths in Mumbai shows the highest case fatality rate (CFR)—deaths as a proportion of cases—is among nonagenarians at 18.3%, followed by those 80-89 years old at 17.5%. This is almost four to five times the city’s average death rate of 4%.
The CFR drops as average age decreases. CFR in the 70-79 bracket is nearly 13%; it drops to 8.6% for those in their 60’s. But in absolute numbers, the 60-69 group has the highest number of deaths (2,829).
Children and teens, despite being affected in thousands, have a CFR of barely 0.5%. Even among 20-year-olds, fatality rate is below 0.5%.
So what are the lessons for Mumbai from the 10,000 lives lost? Dr Avinash Supe, former KEM dean and head of state’s Covid death committee, said that it is now beyond doubt that old-age and co-morbidities are the worst combination.
“And some amount of deaths will always remain in these age groups. But bigger worry is even after seven months, we see patients coming late and dying in 24-48 hours of admission,” he said, adding that late admission and detections remain a challenge. But, he said, the city has met with success in its effort to reduce CFR from 7% at the outset of the pandemic to 2% at present.
Doctors say a higher share of co-morbidities combined with stress endemic to Mumbai’s population could be blamed for its higher death toll. Compared to Mumbai which has 2.48 lakh cases in all, Bengaluru urban has nearly 3.2 lakh cases. However, it has about a third of Mumbai’s deaths and a fatality rate of 1.15%. Similarly, Delhi with 3.48 lakh cases has a little over 6,000 deaths.
Dr H Sudarshan Ballal, member of a Covid expert committee formed in Karnataka, said, “We don’t know what contributed to deaths in Mumbai but our experience shows that where the detection has been late and patient has come after 7-10 days, saving them has been a challenge”.
Dr Nitin Karnik, head of medicine at Sion Hospital, said Mumbai was among the first cities to be hit by the pandemic. “Till drugs like Remdesivir, Tocilizumab arrived in July, we were losing a lot of lives. Higher incidence of diabetes, hypertension and obesity combined with delayed treatment seeking behaviour has cost us lives,” he said. Many slim and fit 80-year-olds have walked out of the hospital, but survival chances dropped by 50% in. say, 55-year-olds with obesity, lung involvement and sugar levels above 700, he said.
Infectious disease consultant Dr Tanu Singhal from Kokilaben Hospital too said after they started using Remdesivir on June 17, the ICU mortality fell from 30-50% to 10-20%.