Bengaluru, Oct 23, 2020: Karnataka’s Covid-19 case fatality rate has declined in the past four months to 1% in October, thanks to progress on multiple fronts, right from testing to syndromic approach to patient management.
A performance review by the State War Room on October 22 found that the fatality rate declined from 1.9% in July, to 1.5% in August, 1.2% in September and 1% in October (October21).
One reason experts attribute to the decline is improved management of high risk patients who are being monitored through tele-ICU by the Critical Care Support Team (CCST).
As of Wednesday, 947 high risk patients were in ICU.
Earlier, treatment was decided based only on positive RT-PCR test results, clinical features such as co-morbidities, and oxygen saturation levels. It would be escalated only if a patient was symptomatic and had low oxygen saturation levels.
However, now, the CCST is following a four-pronged syndromic approach to decide the mode of treatment.
“Apart from looking at RT-PCR test and clinical features, we are looking at four biochemical inflammatory markers - Lactate Dehydrogenase Test (LDH), D-Dimer, Ferritin, IL6 - and conducting radiological tests such as HRCT (High-resolution computed tomography) and chest-X ray. Based on these results, treatment is escalated, with the patient being given remdesivir, dexamethasone and other drugs,” said Dr Anoop Amarnath, head of the Scientific Board at Manipal Hospital, and member of state CCST.
In the context of Covid, LDH is a sign of muscle inflammation, the D-Dimer test indicates the propensity of clotting of blood, Ferritin levels gauge acute inflammation, IL-6 is an indicator of cytokine storm and an inflammation marker, Dr Anoop explained.
The HRCT and chest-X ray reveal ‘ground glassing’, which refers to haziness of lungs, a mark of Covid infection. Recently, the state issued a circular recommending that CT-Thorax scan also be done, as it has greater sensitivity and lower false negativity rate than RT-PCR.
“HRCT and chest-X ray help pick up on even asymptomatic patients. Another reason for the decline is improved testing which leads to early capture of cases. We are crossing more than one lakh tests per day this month. Awareness campaigns, enforcement of masks and training of nurses and doctors in government hospitals has also played a role,” said Dr Trilok Chandra, head of Covid-19 Critical Care Support Committee.