Profiling of Home/On the way mortality found SARS-COV-2 positive in Rajasthan during the current season-Away mortality found SARS-COV-2 positive in Rajasthan during the current season-April to July 2020 For Strategic Interventions

Abstract

Background: First case reported from this empowered action group state  on 2.3.20 from international tourist after which state  saw an staggered spurt in COVID 19 cases along with rising mortality. Rajasthan was one of the foremost affected state bearing the frontal attack likewise geographicaly extensive states MP &Gujrat. Making indespensable for  converting information into evidence for timely identification of causal drivers &revising strategies in pandemic inferno. Objective:To sketch out the mortality profile with respect to demographic and clinical progression with an aim to identify the groups,this virus conspicuously pickedup with a perspective to control some of the avoidable factors.Methods:We analyzed the epidemiological data in 56 RT-PCR confirmed deaths of COVID 19 patients who were brought dead that occurred between 1stApril 2020 and 31^stJuly 2020 over a period of 120 days throughout Rajasthan by community surveys . A 3 member team of sector health workers(ASHA/ANM/Medical officer ) were constituted for verbal autopsy of deceased kith/kin after informed consent & 3 weeks after death . A written format for detail discussion with family members was pre hand given which later culminated into a single page dossier for identification of level of delays that lead to a death & actionable points from team itself. These delays were  classified into 6 broad categories i.e L1-Delay in seeking health care , L2-delay in availing transport facility, L3- Delay in getting optimum treatment , No Delay,Non COVID Death & cause unknown .Later inspired by the positive feedback impact government facility death review mechanism was also institutionalized steerheaded by medical education department to enrich the available knowledge of prevention & treatment. Results:Atotal of 650 patients died during four months period from 2 March to 5 July out of which 56 brought dead mortality cases presenting with COVID (+) post expiry were analyzed. 26 deaths occurred in the 30-60 years of age group. The mean age being 46.48 years. Males had a marginally increased mortality rate (F: M-1:1.43). The mean time of onset of symptoms to hospitalization was 7.8 days. Thirty Nine  (71%) patients were from urban areas, whereas 7(13%) belonged to rural areas.Only 23.52 % patients presented within 24 - 48 hours whereas 33% presented within aday of onset of symptoms& 25.49 % presented within 4-7 days wheras 17.64% had no symptoms .On economic status front 84% belonged to Non Below Poverty line (NBPL) & rest were BPL .Educational status was 34% were 5^th pass,23% uneducated ,20 % 8^th pass & rest 11  % were 10^th pass & graduate.77% deaths were without any associated cause of death. Based on initial rounds of facility level reviews 66.9% succumbed within 5 days of hospitalization, despite starting for hospital in advance .56.86% had predisposing risk factors. Conclusion: On the way/home  mortality of 8.06% was found out of total some 694 (April-July-20) which was low  as house to house survey conducted &community  awareness campaigns thru health worker helped in sensitization of general public . As  acorollary of this analysis the authors are of the opinion that a rejig of the existing guidelines to identify and treat influenza like illness be made available at the national level. What factors promote rapid progression especially in a group without any predisposing risk condition should form  the focus of  future studies. As  risk group individuals formed  a major chunk of deaths, the need to vaccinate this group should form a scaffold on which future directions and interventions have to be builtup to combat the morbidity and mortality