Why does Pune lead all-India cases? Top govt official breaks it down

Punekars, some without masks, out on a morning walk. Pic/Atul Kamble

Over 40 per cent of Punekars are now suspected to have COVID-19 antibodies. Considering the substantial number, senior advisor to Deputy Chief Minister and Pune's Guardian Minister Ajit Pawar, Dr Subhash Salunkhe, feels one can expect herd immunity to set in soon. Dr Salunkhe also heads the Maharashtra Communicable Diseases Prevention Control Technical Committee and is the chairman of the COVID-19 taskforce in Pune. Excerpts from an interview:

Why does Pune, with just 40 lakh people, account for the highest number of COVID cases in India?

Pune has a unique geographical and socio-economic background due to two interconnected municipal corporations (Pune and Pimpri-Chinchwad) and three rural talukas. There are congested localities, slum pockets where strict lockdown, initially played wonders but people failed to maintain social distancing and follow other rules when it was lifted.

Where did things go wrong for Pune? Was it lapses in the system?

I won't say lapses, but there were gaps because this disease is new. It has confused a lot of authorities, both medical, administrative and political so nobody can be blamed. Perceptions will change as it is a dynamic situation. Yes, you can do post-mortems and have a retrospective discussion, but that doesn't mean the earlier decisions were wrong. I feel instead of analysing lapses now, we should first ensure that people don't die and the outbreak is controlled.

As a communicable diseases expert, what is your role right now?

As the chief technical coordinator and advisor to the deputy CM, my role is to try and bridge the gap between the administration, people and the NGOs. The taskforce under my chairmanship has to ensure communication and public health strategies and take advantage of expertise in private healthcare. The primary task is qualitative enhancement on the technical side. Area-wise, I am focussing on Pune urban, Pune district and Pune division with five districts.

Dr Subhash Salunkhe, chairman of the COVID-19 taskforce in Pune

Is Pune heading towards herd immunity?

Yes, definitely.

Some people have doubts. What is your view?

I know there are doubts. This is why the definition we are looking at for herd immunity can be debated. But one thing is obvious - take areas like Rasta pet, Bhawani pet that had a huge number of cases for example, and the sero survey that indicated nearly 40 per cent people had antibodies. Putting these statistics together, we believe herd immunity plays a role as very few cases are coming up. Though nobody can say with guarantee that it is herd immunity.

When do you anticipate it will completely set in in Pune?

We are witnessing a drop in the number of cases from the otherwise affected areas of Pune. Though no one can be 100 per cent certain. May be by November-end, things will start moving in that direction, unless there is some change in the virus.

Is Pune witnessing community spread (Stage 3) of the pandemic?

Yes, Pune definitely has community spread.

Do you foresee a second wave of COVID-19?

I think in Pune, the situation will be minimal because, by that time, a large number of Puenkar's will have the antibodies. Unless the virus changes its antigenicity, I don't think Pune will have a second wave that might impact a large number of Puenkars again.

Are asymptomatic patients quarantined at home?

No, at this stage, we are not encouraging asymptomatic patients to home quarantine.

Pune is one of the worst-hit cities amid the COVID-19 pandemic. Pic/Atul Kamble

Do symptomatic patients have sufficient ICU and hospital beds with oxygen?

We are anticipating a shortage for both, oxygenated and ICU beds. Preparatory steps are being taken by the administration. By mid-October, we will have to add another 250 incubated beds with ventilators and around 400 beds with oxygen support, the administration is on the job. By October 15, this additional set-up will be functional.

But with a shortage of manpower, do you think you will be able to handle the additional setup?

It is a matter of concern. Manpower shortage is a major problem at both government and private hospitals. We are trying to find alternative strategies to recruit more healthcare providers, by roping in those who are not directly dealing with COVID-19 patients. We are also trying to get home nurses, who have just appeared for their examinations. Also, NEET exams just finished. So we are considering how to use those students.

Do you think you would have been in a better situation to handle the COVID-19 pandemic had you taken charge earlier, when the pandemic started, you were roped in later when the situation started going out of hand?

No, actually my involvement is there for last three to four months, but it was primarily in an advisory capacity, but now in addition to advisory capacity, I also have authority to not only recommend but ensure and monitor that feedbacks are given to me, which can be passed on deputy CM, there is a kind of administrative team and authority that has been given to me now. I agree had it been a little earlier, I would have done a better job, but I do not want to bother about it. Now that I am supposed to the job, I will put all my focus to help the administration and people at large.

What is the percentage of patients recovered with COVID-19? Have you started post-COVID OPD, for screening patients with post-COVID complications in civic and government hospitals?

The recovery of COVID-19 patients is around 78 to 80 per cent in Pune. The Post COVID OPD, concept, has already started, but we are encouraging government hospitals including Sassoon hospital, to widen the post-COVID OPD screening. Also, we are indulging private hospitals for screening post COVID complication cases, without calling it a post-COVID OPD, but they are screening follow up cases"

Presently out of all COVID-19 positive cases, how many are symptomatic and asymptomatic?

I do not have an exact figure, it is already on the public domain, on the Pune Municipal Corporation web site. Pune on September 24, registered 1572 new cases, taking the total tally to 1,47,634 cases, while 26 deaths took the death toll to 3,355.

Are you also intending to rope in retired government/civic doctors/General Practitioners to assist the administration to fight the pandemic?

We are encouraging them to work at their own setups and also trying to find out with their qualifications if they are available to render their service, we are looking at that front too.

Do you also have age barrier for front line health care service providers?

Yes, we do not want to recruit anyone beyond 55 years of age for COVID duties but they can be very well used for telemedicine services, for non-COVID duty purposes, so that is being attempted.

Are you making data bank of all COVID cases, symptomatic and asymptomatic and are you forwarding such data collected to the state and central government for future reference? And is the data referred by doctors for telemedicine?

Both the municipal corporation, Pimpri Chinchwad Municipal Commissioner, Pune Municipal Commissioner and the district administration have these data and the same is shared with the government. The doctors on telemedicine duty do make use of the data collected for such services.

Has Pune witnessed relapse of COVID-19, in patients who were treated for COVID-19, tested negative while discharged, but were again tested positive, a few weeks later?

Yes, there are such cases, but the number is quite limited. And these are quite natural, such relapse can happen, and this is because if the body produces antigens for a particular strand of virus they do not work as mutant against the same virus, which is seen in case of SARS-CoV2, and therefore, while patients recovered with COVID-19, may develop immunity for a particular virus, but it may not against a mutant version of the same virus and they can get infected again.

Have you seen any trend in cases of COVID-19 positive patients, in Pune impacting multi-organ, other than respiratory or lung involvement?

As a matter of fact, there are a lot of cases now coming, with cardiovascular involvement, nephrological impact is seen in kidneys and neurological impact in brains etc primarily lungs and respiratory tract were getting affected in COVID-19 patients but the extend of disease adversely affect either heart, kidney or even brain, making the case not only severe but also complicated with multi-organ involvement, and some cured patients, therefore, may need a long-term follow up medical care.

Is it people with co-morid issues, having such multi-organ risk due to COVID? What is the age group of patients with such an issue?

More than 50 per cent of the patients having multi-organ issues are those with comorbid conditions like diabetes, hypertension etc, but we are seeing a trend of youngsters having uncontrolled diabetes and hypertension, having similar issues.

To explain the steep surge in COVID cases in Pune, was there something specific that went wrong?

What went wrong is that people did not follow the social distancing norms, as soon the lockdown was lifted the mobility was absolutely intense and this was also added with Ganpati festival, and we are now worried about the coming festival season of Navratri and Diwali. Now the focus is how to make people aware about the danger, and we expect them to have an introspection of the situation, and we want them to take a call from within rather than enforcing social distancing and wearing masking compulsory than using legal recourse. We will soon be starting a campaign where there will be ownership from Punekar, wherein they will take responsibility for their own action, which will be in line with Maharashtra Government Campaign ‘Maze Kutumb, Maze Jababdari' (My family, My responsibility.), ‘Me Punekar Maji Jabadari' (I am Punekar, I am responsible) a campaign which will begin from October 2.

The Baramati pattern or say the Dharavi model are believed to be a success, and if that is so, why these patterns were not tried in Pune?

Baramati and Dharavi models are workable within the limited geographical areas, and with very intense public cooperation, Pune in comparison is much larger and we feel that the compliance of the public health norms is not workable in such largescale areas. But having said so, this has worked out in areas like Bhavani Pet, and Rasta Pet and the number of cases has come down drastically low from these pockets, after adopting the Dharav/Baramati model. Earlier we would get 150 plus cases a day from these places, which has now drastically come down to 7 to 8 cases. We are now trying to adopt these models (Dharavi/Baramati) in other congested areas of Pune, and in non-congested middle-class areas, the strategy will be different.

Is it true that PMC is not having manpower to run the Jumbo CCC, a setup constructed near Engineering College, Pune, spending a whopping Rs 200 crore? So why was it constructed without thinking on the manpower issue?

It was definitely a problem, now private players have been roped in and they are now taking care of the Jumbo CCC, we have outsourced the entire Jumbo hospital set up to private players. Just last week, the State Health Minister and I was also there, we have reviewed the situation and things are improving, as compared to what it was three weeks ago, the number of nurses required have been recruited for the 400 bed and now they will be escalating the beds to 800. Initially, the problems were there, but now it is being resolved.

Knowing the high mortality rates in Pune, whether arrangement for quick cremation or burial, have been put in place? The former mayor who died of COVID-19, his body was taken four cremation ground, but could not get space?

Yes, that point has been addressed, two days back when we had a discussion with the Pune Municipal Commissioner (Kunal Kumar) and this is a priority action task and minimum delay is to be expected.

In Pune, are COVID-19 bodies wrapped in polythene sheets laced with Sodium hypochlorite? Experts say it might be an environmental hazard?

I think it is being done. But the municipal authority will be a better agency to comment on this.

Involvement of Private Hospital in COVID management. Is it as aggressive as seen in Mumbai and MMR areas, wherein private hospitals, as well as private medical colleges, are shouldering a significant portion of the responsibility?

Yes, we are getting similar cooperation from private hospitals. Just a few days ago deputy CM Pawar, who is also the guardian minister for Pune, spoke to all private hospital representatives, appreciated their efforts, but also informed them to enhance the availability of beds in these hospitals also substantially.

Staggering of working days of the working population on alternate days, as seen in Bengaluru, are you intending to do something similar in Pune?

No, I think, it is an administrative and political decision.

Are you planning for a complete temporary lockdown in Pune to control spread?

On last Friday, this issue was discussed by the hon Deputy Chief Minister, who is also the guardian minister of the district, he has asked the administration, both municipal commissioner (PCMC and PMC), mayors, important leaders, MLA's and MP's from Pune and the matter is being still discussed at that level, which will depend mostly on the ground level situation in coming days.

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