Covid death rate drops across all ages in Mumbai, points to better management

MUMBAI: Amid the continued rise in Covid cases in the city, there is a bit of a positive trend emerging. The case fatality rate (CFR, or ratio of deaths to positive patients) across age-groups has seen a decline, with the only exception being the age bracket above 90. While some say an increase in testing could have pulled down the fatality rate, doctors concur that the disease is now managed better than during the peak of May and June.
Mumbai’s CFR, which had touched 7% initially, has dropped to less than 5% in September. Within age-groups, 60-69 years has seen a decline in CFR from 16% in April to 12% in July, 11.9% in August and 10% now. This age bracket has contributed to 28% of the city’s 8,227 deaths despite accounting for only 14% cases. For those aged between 50 and 59 too, the CFR has dropped from 10% in April to 6% currently. The age-group to have seen the second highest deaths after the 60s is the 50s, which account for 24% mortalities.

CFR is the ratio of coronavirus deaths to the number of patients who have tested positive. An analysis of 8,227 deaths by the corporation revealed the decline in death trend. However, deaths in the age-group of 90-99 seem to be rising consistently. From 17.6% in July, the CFR increased to 19.5% in August and is 19.9% now. In absolute numbers, 438 nonagenarians have tested positive for Covid-19, of which 87 have succumbed. Civic authorities said families with super-senior citizens need to be extra-cautious as most contract the infection from a relative.

Former KEM Hospital dean Dr Avinash Supe, who heads the death audit committee, concurred that Mumbai’s CFR has been on the decline despite a rise in cases, and the age-group analysis reflects that. “The weekly mortality numbers for the city have dropped below 2% (1.8%) and it’s a positive sign. It appears that the rise in critical cases is not proportional to the significant spurt in cases (an average of 2,000 daily in September),” he said, adding that physicians feel there is a shift in the virulence of the disease as well.
Testing and early care-seeking too have contributed to keeping the critical cases in control. Of the 31,000 active cases in Mumbai, nearly 1,270 are critical, 8,143 symptomatic and 21,475 asymptomatic. Dr Supe said the last analysis of 6,500 deaths had shown that 29% died with 24 hours of admission and 58% within four days. “These numbers have seemingly improved with antigen test now giving results within two hours. That way, the time wasted in waiting for an RT-PCR report is saved,” he added.
Dr Tanu Singhal, infectious disease expert with Kokilaben Ambani Hospital, believes that Remdesivir has made a big difference in terms of treatment options for patients. “There is a belief that the virus has become less virulent over time. The bed management has become better too, which ultimately leads to people landing up in the right setting,” she said, adding that doctors also know the disease better than in the early months.
A civic official said while the fatality rate has been declining, there are concerns about deaths among the young. In children below 10 years old, there have been 13 deaths, 27 in the 10-19 age-group and 113 among those in their twenties. Dr Supe said that in those under 40, undiagnosed hypothyroidism, diabetes and obesity have been found. “We will be looking at under-30 deaths more closely,” he said.