Central team finds lapses in Bengal’s Covid-19 response

One of the two Inter-Ministerial Central Teams (IMCTs) sent to West Bengal to assess the on-ground situation there in terms of dealing with Covid-19 has highlighted several anomalies in its letter to West Bengal chief secretary Rajiva Sinha: a waiting period of at least five days for test results of patients in isolation wards; the possibility of dead bodies lying on beds in wards for four hours; and the lack of social distancing at hospitals.

In a separate letter to the chief secretary, the IMCT has also asked for details on a committee of doctors set up to declare cause of death for Covid-19 patients and time taken by the committee in coming to its conclusion. West Bengal has asked the panel to consider co-morbidities (associated health conditions) while deciding the cause of death, unlike most other states which ascribe Covid-19 as the cause of death in the case of patients sufferIng any co-morbidity (such as diabetes or heart disease).

Hindustan Times has seen a copy of the letters dated April 23, 2020; the observations by the IMCT are based on an inspection of two hospitals in Kolkata. The IMCT has also sent its observations to the ministry of home affairs. The IMCT letters were written by Apurva Chandra , the team leader. The first letter also sought details of the testing capability of the state , and of people who returned to Kolkata from overseas destinations till March 8.

The West Bengal government, in its response, said it is looking into the observations made by the central team. “As some issues were related directly to health department, I have forwarded those queries to the state health secretary. He will respond. We are always ready to answer. They (the Central teams) have not come here as inspector or auditors. We do not have to pass any exam,” Sinha said. 

He also claimed that the expert committee to audit Covid-19 related death cases was set up as per the protocol of the Indian Council of Medical Research. “Till date the committee, which was formed on April 3, has audited 57 cases. Out of this, 18 have died directly because of Covid-19. In 39 cases, severe comorbid conditions were found to be immediate cause of death, while Covid-19 was incidental finding,” Sinha said.

The exchange is the latest in the ongoing war of words between West Bengal, whose Trinamool Congress government is headed by Mamata Banerjee, and the Centre.

Banerjee has previously accused the Centre of providing it with inadequate and defective kits; the state also initially objected to the creation of the IMCTs by the home ministry pointing out that fiveof the original six IMCTS created were for regions in states ruled by the Bharatiya Janata Party’s rivals. “The teams have been created with ulterior motive of doing politics with the opposition ruled states,” the West Bengal chief minister said, in a letter to Prime Minister Narendra Modi on April 22, claiming that sending the teams was ‘undesirable’ and a ‘breach of established protocol’.

Till Friday, Bengal reported 514 positive cases and 18 deaths. The state has carried out about 7,990tests. In the past one week, Bengal has tested 800 people per day. Sinha said the testing capacity is being increased to 1,000 tests every day. Till Thursday evening, the state has tested 199people per million, lagging behind most large states. The India average is370 per million.

The IMCT visited Chitranjan National Cancer Institute (CNCI) and MR Bangur hospitals in Kolkata, dedicated for Covid-19 patients, on Thursday.

In his first letter, Chandra wrote: “There were a large number of patients in isolation wards of CNCI as well as Bangur hospital awaiting Covid test results for five days or longer. Specifically at CNCI, there were four patients, since April 16 awaiting test result, two since April 17 and 3 since April 18. Some of the patients have tested negative. It is not clear why the test results should take such a long time and there is a danger of Covid negative patient acquiring the infection in the hospital while awaiting his test result.”

The team further observed: “The patient admission at Bangur hospital appears to be chaotic. There was no social distancing in the waiting area. Two patients appear to be in very poor health but there was no medical support available.” It also said that patients at Bangur are sometimes referred from other medical facilities. “However, it seems the patients are left on their own to report to the hospital and are not escorted. This would always leave the scope for some patients not turning up or delaying reporting to the hospital.”

It noted that there were only 12 ventilators at Bangur hospital which caters to 354 serious Covid-19 patients. The team said it was informed by hospital authorities that in case a ventilator is not available and ventilator support is required for a patient, the patient is transferred to some other facility.

Sinha said the response of the health department has been sought on all these issues.

After social media posts claimed dead bodies were lying on beds in a ward, IMCT asked about the matter on the spot and said in its letter that “it is possible that dead bodies were lying on bed in a ward as it takes at least four hours to issue a death certificate, after which the body is shifted to mortuary”. It has asked the state government for details. Sinha refuted the claims of the dead bodies not being removed from the hospital beds and said the test reports were coming without the time frame mandated by ICMR.

Based on a presentation given to the IMCT by the state’s principal secretary (health), Vivek Kumar on Thursday, Chandra asked for the details of people who came to Kolkata from overseas destinations till March 8 and whether all those required to be tested have been tested. Sinha said all suspects with symptoms from airports were sent to government quarantine. “Asymptomatic cases were sent to home quarantine. Later the protocol changed and we followed the protocol without any lapse.”

The state government has told IMCT that the number of tests has gone up by around 400 to 900 a day in the past four days; the team has asked the chief secretary for details on how many these are repeat tests. Sinha reiterated that the state’s effort to ramp up testing was hampered by not availability of enough testing kits from the Central government. The state has also informed IMCT that surveillance teams are screening 1.25 lakh to 2 lakh people every day in each district. The central team has sought details of number of screened persons actually tested for Covid-19 and found positive. 

IMCT also observed that from state government’s presentation before it, “it appeared that the state is reaching its peak capacity for testing”. IMCT has suggested that West Bengal consider conducting 2,500 to 5,000 tests a day.

The chief secretary refuted the IMCT’s claim that there was any relaxation in enforcing lockdown saying in all 33,997 people have been arrested and 3749 FIR have been lodged till date during lock down period. “We have extended all cooperation to the IMCT. After we have cleared the position of the state government we have told them that they can visit any pocket,” Sinha said, claiming that he will not accept that the state government did not cooperate with the IMCT.

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