Some thoughts from the Pune – the Covid Hotspot

By GauravL 17 Comments

As many of you might know i live in Pune, which is currently the Covid capital of the world. I am not very inclined to writing personal experiences on blogs read by strangers, but here i am making an exception as i have felt the urge to share this experience for over a month.

Like everyone in the world, Covid has had terrible impact on life in Pune (and Maharashtra on whole) especially these last 2-3 months. India went into a harsh lock-down around March end and the lock-down continued in some form into the month of May. Things started getting loosened up by May end when Mumbai and Ahmedabad were the Covid hotspots in the country shortly followed by Delhi and Thane. But since July, its Pune that had held the pole position. We are yet to see 3 digit new cases per day since start of July with the average daily increase of cases being around 3000.

Graph courtesy @DeoSahil on Twitter

As seen since July end the case load in Pune Municipal corporation (Pune city) has plateaued at saturation level with no signs of going down. A mega facility to treat the rising Covid patients was opened in the city, but it has gotten very bad reviews with many citing negligence and lack of medical staff at the facility.  Link

COEP Jumbo Hospital

A Pune based journalist died  a few weeks ago after not medical treatment on time. This incidence sent panics waves across the city as a well connected person (journalist and lot of noise of social media) couldn’t get treatment on time, the condition of normal patients is much worse (viz getting treatment). Out of habit i keep checking the CSS board of available beds daily and on most instances the picture is similar to seen below. A daily small time spike in ventilator means generally means there have been more fatalities than admissions into ICU with ventilators.

Even though the Oxygen-less beds are 3005, there is extremely acute shortage of staff, hence the number is largely immaterial. The vacant oxygen enabled bed is 133, but even they are not well staffed and getting admission is anything but easy.

The test positivity rate has been consistently over 20% since July and at times has also touched 30% inspite of testing being scaled up significantly. Pune district has a population of 7 million and 250000 positive cases. But no one believes these numbers to be accurate as there is massive under-counting as found in the sero surveys. Even if one assumes a moderate 5,6 times more cases, Pune has almost 15-20% population infected (with the number being higher in core city). Why the quieter non Metro city of Pune has overtaken busier Mumbai and Delhi hasn’t been properly explored yet.

Every-time i have gone out to buy something or just for a bike/car ride, i have atleast seen 2 or 3 ambulances (at times even more). As of now I personally know atleast 50-100 people who have contracted Covid – including many close relatives and friends. A reasonably healthy 50 year old woman family friend of ours, was in ICU for 2 weeks including on ventilator for 2-3 days before getting out of hospital. She also suffered a stroke and it might take her months to make a recovery. A close friend of mine aged 30 and in reasonable health had a high fever for 15 days before getting admitted for low oxygen. This friend got Remdesivir and apparently that worked well for him. His fever subsided the next day and oxygen level was back up in a couple of days. His experience in hospital was harrowing, as the hospitals are extremely overworked. Over 20 people from my old society (where ~40 people live) have been infected including one fatality. Currently 2,3 people i know well are in ICU with news of their health coming infrequently. Even in the people who have recovered (including my in-laws), the recovery isn’t 100% even 2 months after the negative test. There are many instances of people getting admitted for some other issue and getting infected in hospitals with Covid and finally succumbing to Covid (not the original ailment). My wife tested positive a day after she delivered in early August with CT value 37.5 (not infectious according to experts), I tested 2 days later and was negative. Thankfully my wife had no symptoms whatsoever, but still the experience was extremely stressful. Adding to the misery, the hospital was seriously understaffed, leading to lot of chaos and bad health care inversely proportional to current health care costs.

I had personally guessed that cases will start falling around end of August given the high % infection in Pune, but they haven’t fallen yet. The Ganesh festival wasn’t celebrated publicly for the first time in 100+ years – yet people did visit each others houses for the festival. The resultant infections , with entire extended families getting infected in a matter of days resulted in a tall spike around start of September. For last two weeks not a day has passed by when i haven’t heard of some new cases in people i know on first name basis. All this while i continue to lead a very safe life with working from home & incomes unaffected.

From my own anecdotes in my experience, I can say see reasonable correlation between quantity of exposure and severity as suggested by Siddhartha Mukherjee. The thirty year old friend of mine spent half an hour talking to a man who was coughing intermittently (without masks & indoors). Typically the person from the family who gets the disease first (who typically catches it outside home) has had milder symptoms versus his/her family members who must be exposed to more viral load in Indian homes. Most other younger folks who have had moderate/severe disease in my experience had more exposure to viral loads. Masks seem to work very well in so far as they atleast seem to reduce the severity of disease. Personally i have tried researching on evidences of fomite transmission (as a significant mode)of any respiratory disease but evidence i saw is extremely tenuous. I cannot overstate the harm the whole Fomite transmission theory as the primary spread of disease has done. People have been fixated on cleaning surfaces and items, yet removing masks while talking to strangers. My current apartment has had EXTREMELY STUPID rules – like cleaning the entire premises every time we get a new patient (we have had over 20) while people continue visiting each others homes without masks.

Take everything i wrote in this paragraph with a grains of salt – as these are conjectures of a non biology/ scientific background layman.

Experts and laymen have been saying the peak (or is it the plateau) is truly in Pune for two months, but there has been neither a drop in number of deaths, cases nor in the Test Positivity rate. There is no attention in the media to suicides and other economy induced tragedies, here is a small statistic – 7 barbers had committed suicide in the Pune district in the month of June (i cant find a newspaper link to corroborate but am pretty sure about its veracity). From where I stand, there is some light at the end of the tunnel, I am just unable to gauge how far it is. Eventually the cases will fall before the vaccine is out and most cities in India should attain some level of herd immunity by Diwali, but the cost – both lives lost, lives affected and incomes crushed will be very high. What lies ahead life wise and livelihood wise, is anyone’s guess, but i fear social life as we knew it will no longer exist (atleast for a few years). Personally I dont know when i can comfortably stand close to another unknown human being without wearing a mask 🙁 .

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17 Replies to “Some thoughts from the Pune – the Covid Hotspot”

  1. Do you think Fadnavis would have handled the situation better than Thackeray? Health being a state subject and all.

    “My wife tested positive a day after she delivered in early August”

    Congratulations on becoming a father.

    1. Thanks Ronen;
      “Do you think Fadnavis would have handled the situation better than Thackeray? Health being a state subject and all.”
      Marginally maybe- he couldve gotten more support from Center maybe – but not beyond a point – the issue is systemic lack of infra IMO –
      I guess what better admin can do is delay the peak/ cases – i dont think its practical for anyone to delay cases till vaccine arrives which seems atleast 3-6 months away (maybe even 12 for the masses)

  2. Very informative post Gaurav, congratulations on being blessed with a new born child. Glad to know your wife had only a mild case of Covid.

    It’s still puzzling, compared to other big Indian cities, why Pune has such a high rate of infection.

    This has been a brutal pandemic, and It will take at least a couple of years for most of the nations to recover from this.

  3. Was reading up on it over the weekend. Two things stood out

    India’s cases could be even higher because we are using some quick test method which gives more false negatives.

    Also Pakistan and India daily cases were similar till July with Pak’s lower testing. And now with Pak’s same rate of testing, daily cases have gone down. Something is amiss there.

    1. And now with Pak’s same rate of testing

      India tests far more than Pakistan.

      Still, it is possible that Pakistan was less adversely hit. Possible reasons:

      1. Average age in Pakistan is just 22, whereas it is 28 in India.

      2. Pakistan never had the kind of insane lockdown that India had, nor as abruptly announced as India. We all saw the streams of migrants criss-crossing India, often by foot, back to the villages. This had the effect of being a massive superspreader event.

      3. Pak’s medical infra is even worse than India’s, but they knew their limitations early on and didn’t try to ape the (in my view, misguided) lockdowns of the West.

      Still, until/unless we get solid excess fatality data from both countries to compare, we won’t know the real score. You’d also have to adjust by age. India has thus far refused to release its data. I don’t know about Pak’s excess fatality data, but I wouldn’t be surprised if they refused to release it also. It’s politically explosive stuff.

    2. With a close connection to and communication with the city of Pune, I can second everything in Gaurav’s post. I did some unscientific calculations. I have around 300 friends and relatives in Pune that I would consider in ‘my circle’. I tallied those and found 26 infections and 3 deaths. That puts the infection rate at 8.6% and fatality rate at 1%
      I think the sample size is good enough for a reasonable estimate of infection rate.. Fatality rate would be too sensitive to any variation.
      So rather than depending on hospital records etc, a psephologist may be able to design a survey and get us truer numbers.
      I have stopped believing any statistics they are putting out.

      1. PS:The survey of those 300 was done by using whatsApp. Took 1 hour or so to hear back from those 300. Amazing penetration and engagement that thing has!

        1. i did a similar thing myself; around ~100 people would attend some closed family function i might throw. (Friends,Family)
          Out of this inner group – i found ~20 infections.
          The group is middle class with more faculties at maintaining social distancing than average Indian so might be under representative or just randomly high;

          But i dont think this adds any scientific value but does bring the thing closer to home

    3. the point to focus IMO is the Test positivity rate for RT-PCR and not antigen.
      That seems the best parameter to judge the infection. In Pune it was 4 in April & above 20 since July

  4. Thanks for sharing. I know many, many cases of Covid infections in Mumbai among my relatives and relatives of relatives (also a few cases in Chennai, with one being quite serious).

    One of my close relatives passed away from it (they were in their mid 70s) and delay in taking them to a hospital was likely a factor (death was due to heart attack + stroke probably induced by Covid). Note that the delay was from the family and not because they couldn’t find a bed (they are well connected).

    Another close relative has/had a moderate case and were admitted to a hospital with the usual Remdesevir treatment course. This hospital was fantastic – amazing care, great communication, caring nurses etc..No complaints about the hospital at all. However, it was a struggle to find a bed (in Mumbai) and one was obtained only due to high profile connections / influence. Would have been impossible to find on time without that, and I hear that the waitlist for beds in decent hospitals in Mumbai is 100+.

    I do think that the # of cases going up is because of much more widespread testing (including of relatives of +ve patients). Many are asymptomatic / mild symptoms especially children and those in their 20s/early 30s. I haven’t followed the fatality numbers of Mumbai to say whether that metric has plateaued yet or not.

    1. “I do think that the # of cases going up is because of much more widespread testing (including of relatives of +ve patients). Many are asymptomatic / mild symptoms especially children and those in their 20s/early 30s. I haven’t followed the fatality numbers of Mumbai to say whether that metric has plateaued yet or not.”
      Yes i would not stress to much on the new number of cases – but the high Test positivity rate (20% +) is worrying – i guess there are statistical models to find how it could be related to actual cases.

  5. I do not think that any Indian city is the Covid capital of the world, let alone Pune. Positivity rates, fatality rates and incidence rates per million of population paint a different picture.

    There is the phenomenon and then the measurement of the phenomenon. Have you read Taleb’s analysis and also the black art of Swedish governance?

    Population density is a primary contributor in the Indian context. And the weather.

    1. “I do not think that any Indian city is the Covid capital of the world, let alone Pune. Positivity rates, fatality rates and incidence rates per million of population paint a different picture.”
      Yes but something which points to Pune being above Delhi/Mumbai would be that the saturation level of hospitals which has been constant for over two months- Unlike Delhi/Mumbai which had some reduction last month (though they may be back up again)

  6. principia (mathematica)**

    but they knew their limitations early on and didn’t try to ape the (in my view, misguided) lockdowns of the West.

    Hmm, I assume you have not seen Sri Lanka’s numbers.

    With the first local case, transmitted to a guide by Italian tourists the country went into complete lockdown on March 19th. On that day my deep well pump broke and I could not get it repaired for 3 months, so remember the date very well.

    Anyway, lock down was total from get go. No travel, basic foods stuff delivered to homes. It was three months before the lockdown eased up in May. There were cautious steps, restricted travel, limited passengers in public transport (unlike the normal sardine packed). Culminated with Elections on Aug 20. There was no spike in infections after the elections.

    The lock down paid off.
    Total Cases: 3,271 Total Deaths: 13
    Cases/1M: 153 Deaths/1M: 0.6

    For comparison UK (as bad as US when #/1M compared)
    Total Cases:378,219 Total Deaths:41,684
    Cases/1M: 5,565 Deaths/1M:613

    I think the crucial factor was lockdown immediately the first signs were seen*. The other was compliance by most of the population. None of the infringement on freedumb protests against wearing a mask. Plus 30 years of Civil war a Tsunami are fresh in SL minds and therefore very reactive to bunker down orders.

    There are report of new infections regularly. Every single one after elections has been from repatriated Sri Lankans from other countries. I kept tabs after elections (Aug 5) expecting a surge of local/community infections, none.

    Repatriations from mid east for housemaids and labor are free including quarantine. Those repatriated for the west have to pay airfare (almost double normal) and either free quarantine or paid at 2/3 star hotels.

    Much of the lockdown, quarantine worker have been the military and appreciated highly by most of the population.

    Things seem normal, back to crowded travel, half the population lax about masks and no enforcement. One very obvious difference, no International Tourists (20% of FX), as the airports are closed to incoming travel.

    That said even in the small rural village where I live, there is wariness expecting a second wave towards the end of year. Quite sure the first signs of community infection, a tight lockdown will be put in place.

    The thinking is that when you choose economy over human life, you will have neither.

    *The govt was in close touch with the Chinese, and I guess took their advice seriously. The first case was Chinese woman tourist, in early February. She did not infect anyone and recovered at the Infectious Disease Hospital (IDH) in Colombo. When the first local case was diagnosed in March, much of the thinking and logistics was in place.

    **I used to work for a place call Principia about 20 years ago (https://www.ppllc.com/)

    https://www.worldometers.info/coronavirus/

  7. Pune is in pretty bad shape. New york state has 450k cases in a population of 18 Million. So, 250k cases in 8 million is worse that New York.

    A have a question for the experts:
    I don’t understand the flatness of the daily-cases curves at high end (like in Pune city, stuck between 1500-2000 for 2 months) and low end (New York state 700/day.. or individual counties.. e.g. Nassau 60/day for months now). With exponential growth models, it should either ground to zero or keep growing exponentially. What is the nature of the “strange attractor” of R0 being close to 1.0? What disease transmission model accounts for it? Although.. for Pune, one hypothesis could be that it is “reflection” of the wave from surrounding areas, which appear to be growing based on curves Gaurav posted.

    Gaurav, I also have been hearing of wide-spread corruption in Pune (hospitals reporting positives falsely to get government money, exorbitant charges for hospital beds). What is your experience/perception?

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