Why West Bengal's coronavirus mortality rate is high

Social stigma and low testing are the key reasons for the high mortality rate among COVID-19 patients in West Bengal, where the disease, like elsewhere in the country, is still an urban phenomenon, experts say. 

The state's Trinamool Congress government has been drawing consistent criticism from the Centre and opposition parties over the way it has tackled the pandemic, and has been accused of under-reporting data about the number of COVID-19 cases and deaths. 

As of May 7, the state has reported 1,548 COVID-19 cases and 151 deaths of people infected with the deadly virus. 

However, the state's public health authorities have attributed only 79 fatalities to the contagion and the rest to concurrent illnesses called comorbidities in medical jargon. 

The Centre recently rapped the state government over its COVID-19 management which, it said, was characterised by a very low rate of testing in proportion to the population, and a very high rate of mortality of 13.2 per cent, the highest in the country. 

West Bengal, which had tested just about 4,400 samples by April 18 at a rate of 400 samples per day, is now testing more than 2,500 samples a day. The aggregate now stands at more than 30,000, according to state officials. 

Experts in the field say given the fact that most cases were reported from Kolkata, Howrah, Hooghly, North 24 Parganas and South 24 Parganas, “the disease is still an urban phenomenon" but will spread to rural areas also sooner or later. 

According to public health experts and medical practitioners in the frontline of the fight against the disease, not just the low number of tests but the social stigma and ostracism faced by patients and their families are acting as a deterrent to effective tackling of the pandemic. 

Social stigma is a major issue in identifying a COVID patient. Since the spurt in the number of cases, people have stopped coming to hospital fearing social stigma and public shaming in their locality and instead prefer to stay home. And when they do turn up, it’s too late, professor and senior surgeon at SSKM hospital Diptendra Sarkar told PTI. 

"The stigma associated with this disease needs to be addressed so that more people come forward for tests, he said. 

Manas Gumta, a senior surgeon and general secretary of Association of Health Service Doctors, shared Sarkar's view and said it is the responsibility of the state government to chalk out a roadmap to remove the social slur associated with the disease. 

"The government needs to engage social groups and NGOs to address the problem of social stigma. It is indeed a reason behind fewer people coming forward for tests," he said. 

Gumta said the number of tests being performed now is still less than what has been recommended by ICMR. The numbers need to be increased substantially and also the testing facilities, he said. 

While decoding the arithmetic behind the higher mortality rate, he said the mortality rate of COVID-19 patients in most countries was 2-3 per cent, but in Bengal it was so high due to fewer tests being conducted since the onset of the disease. 

For example, if you test 20 people and 10 are found positive while two of those who test positive pass away then your mortality rate is 20 per cent. But, if you test 50 people and 40 are found positive and two of them die, your mortality rate is 5 per cent. 

"So the answer to decreasing the mortality rate lies in conducting more tests, random tests of asymptomatic patients and ramping up life support infrastructure at hospitals,” he said. 

West Bengal, despite the increase in the number of tests, lags far behind states like Maharashtra and Gujarat where the number of tests has crossed two lakh and one lakh respectively. 

“In most of the death cases, the patients arrived when it was too late. But if intensive and critical care facilities can be ramped up, many lives can be saved. We are a bit late but we are trying to catch up with other states in terms of testing and treatment,” said another senior doctor of a COVID hospital who did not wish to be named. 

West Bengal Home Secretary Alapan Bandopadhyay had recently attributed the low tests and high mortality rate to initial lack of testing laboratories. Only one COVID-19 testing laboratory was functioning in the initial days of the outbreak of the disease. 

“Today, we have 16 testing laboratories and a few others are in the pipeline. The more testing you do, the more people you treat and then the mortality rate will also be low. 

"The mortality rate appeared high not because Bengal was failing but because (adequate) infrastructural facilities were not present,” Bandopadhyay said. 

The West Bengal government had alleged last month that the COVID-19 testing kits supplied by the Centre were far less in number as compared to other states and many were defective. 

Meanwhile, some experts feel that though the disease has so far been limited to urban areas, it will spread to rural Bengal in the coming months. 

“It is true that the contagion is still an urban phenomenon but in months to come it will spread to other rural areas. In urban areas, the intensity of the spread is high because of high population density which is not the case in rural areas,” senior doctor and internal medicine specialist Rahul Jain said. 

Out of the 23 districts of the state seven predominantly rural districts have not reported a single COVID-19 case so far, according to state government data. 

At least 80 per cent of the cases have been reported from the four red zones districts of Howrah, North 24 Parganas, East Medinipur and Kolkata, with the state capital having the highest number of containment zones and cases. 

South 24 Parganas and Hooghly districts have also reported quite a few cases.