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Mumbai, Jun 27: The Bombay High Court observed that COVID-19 patients from poor and indigent sections cannot be expected to produce documentary proof to avail subsidised or free treatment while getting admitted to hospitals.

The court on Friday was hearing a plea filed by seven residents of a slum rehabilitation building in Bandra, who had been charged ₹ 12.5 lakh by K J Somaiya Hospital for COVID-19 treatment between April 11 and April 28.

The bench of Justices Ramesh Dhanuka and Madhav Jamdar directed the hospital to deposit ₹10 lakh in the court.

The petitioners had borrowed money and managed to pay ₹10 lakh out of ₹12.5 lakh that the hospital had demanded, after threatening to halt their discharge if they failed to clear the bill, counsel Vivek Shukla informed the court.

According to the plea, the petitioners were also overcharged for PPE kits and unused services.

On June 13, the court had directed the state charity commissioner to probe if the hospital had reserved 20% beds for poor and indigent patients and provided free or subsidised treatment to them.

Last week, the joint charity commissioner had informed the court that although the hospital had reserved such beds, it had treated only three poor or indigent persons since the lockdown.

It was unfathomable that the hospital that claimed to have reserved 90 beds for poor and indigent patients had treated only three such persons during the pandemic, advocate Shukla said.

He further argued that COVID-19 patients, who are in distress, cannot be expected to produce income certificate and such documents as proof.

However, senior advocate Janak Dwarkadas, who represented the hospital, said the petitioners did not belong to economically weak or indigent categories and had not produced documents to prove the same.

A person who is suffering from a disease like COVID-19 cannot be expected to produce certificates from a tehsildar or social welfare officer before seeking admission in the hospital, the bench noted and asked the hospital to deposit ₹10 lakh in court within two weeks.

Los Angeles, Apr 28: People who experience loss of smell as one of the COVID-19 symptoms are likely to have a mild to moderate clinical course of the disease, according to a study which may help health care providers determine which patients require hospitalisation.

The findings, published in the journal International Forum of Allergy & Rhinology, follows an earlier study that validated the loss of smell and taste as indicators of infection with the novel coronavirus, SARS-CoV-2.

According to the scientists from the University of California (UC) San Diego Health in the US, patients who reported loss of smell were 10 times less likely to be hospitalised for COVID-19 compared to those without the symptom.

"One of the immediate challenges for health care providers is to determine how to best treat persons infected by the novel coronavirus," said Carol Yan, first author of the current study and rhinologist from the UC San Diego Health.

"If they display no or mild symptoms, can they return home to self-quarantine or will they likely require hospitalisation? These are crucial questions for hospitals trying to efficiently and effectively allocate finite medical resources," Yan said.

The findings, according to the researchers, suggest that loss of smell may be predictive of a milder clinical course of COVID-19.

"What's notable in the new findings is that it appears that loss of smell may be a predictor that a SARS-CoV-2 infection will not be as severe, and less likely to require hospitalisation," Yan said.

"If an infected person loses that sense, it seems more likely they will experience milder symptoms, barring other underlying risk factors," she added.

Risk factors for COVID-19 previously reported by other studies include age, and underlying medical conditions, such as chronic lung disease, serious heart conditions, diabetes, and obesity.

In the current study, the scientists made a retrospective analysis between March 3 and April 8 including 169 patients who tested positive for COVID-19 at UC San Diego Health.

They assessed olfactory and gustatory data for 128 of the 169 patients, 26 of whom required hospitalisation.

According to the researchers, patients who were hospitalised for COVID-19 treatment were significantly less likely to report anosmia or loss of smell -- 26.9 per cent compared to 66.7 per cent for COVID-19-infected persons treated as outpatients.

Similar percentages were found for loss of taste, known as dysgeusia, they said.

"Patients who reported loss of smell were 10 times less likely to be admitted for COVID-19 compared to those without loss of smell," said study co-author Adam S. DeConde.

"Moreover, anosmia was not associated with any other measures typically related to the decision to admit, suggesting that it's truly an independent factor and may serve as a marker for milder manifestations of Covid-19," DeConde said.

The researchers suspect that the findings hint at some of the physiological characteristics of the infection.

"The site and dosage of the initial viral burden, along with the effectiveness of the host immune response, are all potentially important variables in determining the spread of the virus within a person and, ultimately, the clinical course of the infection," DeConde said.

If the SARS-CoV-2 virus initially concentrates in the nose and upper airway, where it impacts olfactory function, that may result in an infection that is less severe and sudden in onset, decreasing the risk of overwhelming the host immune response, respiratory failure, and hospitalisation, the scientists added.

"This is a hypothesis, but it's also similar to the concept underlying live vaccinations," DeConde explained.

"At low dosage and at a distant site of inoculation, the host can generate an immune response without severe infection," he added.

Loss of smell, according to the study, might also indicate a robust immune response which has been localised to the nasal passages, limiting effects elsewhere in the body.

Citing the limitations of the study, the scientists said they relied upon self-reporting of anosmia from participants, which posed a greater chance of recall bias among patients once they had been diagnosed with COVID-19.

They added that patients with more severe respiratory disease requiring hospitalisation may not be as likely to recognise or recall the loss of smell.

So the researchers said more expansive studies are needed for validating the results.

In an unprecedented crisis despite Prime Minister Narendra Modi assuring the continuation of essential services like food and groceries, online marketplaces like Flipkart and Amazon along with delivery platforms like Bigbasket, Grofers and FreshToHomes hit a major blockade on Wednesday as local authorities shut warehouses and sent delivery boys back, even harassed them.

Millions of people across cities were left helpless at homes as essential items like fruits and vegetables, dairy and milk, meat and fish etc did not reach their doors despite placing orders well in advance. Later, the orders went dry.

While Grofers' warehouse in Faridabad was closed by the local law enforcement agencies, Bigbasket complained that the police stopped its delivery partners and "some of them were even beaten up by for no fault of theirs".

"We are not operational due to restrictions imposed by local authorities on movement of goods in spite of clear guidelines provided by central authorities to enable essential services. We are working with the authorities to be back soon,' Bigbasket tweeted.

In a statement to IANS, Bigbasket said that it will help to have better coordination between the Centre and state, and between the state and local police to "ensure that our delivery vans and bikes don't get stopped by the police. Bigbasket and bb daily are not taking new orders".

Furious people stormed the social media platforms, writing their plight to NITI Aayog CEO Amitabh Kant on Twitter.

"Sir, all e-commerce are down. Believe me I tried everything (Grofers, Bigbasket, Flipkart, Amazon, Big Bazaar), no delivery till 31st March or Server Down or No Service. Need to think how we can enable them through digital India," tweeted one user.

Kant tweeted back to Bigbasket: "They should give me specifics - State & location. I will act on it by getting in touch with concerned authorities & sorting it out. Govt guidelines exempt them. We will ensure that citizens are not impacted".

Kant also responded to Grofers: "Cold storages & Warehouses as well as delivery of all essentials goods including food, pharma thru E-Commerce are exempted under MHA order. I have spoken to CS & DGP, Haryana . They have taken immediate action to ensure that supply chains efficiently function for the citizens".

The subscription-based hyperlocal delivery startup FreshToHome sent messages to its customers, saying that despite the government declaring food delivery as essential, "we are facing hardships in continuing our operations".

"Please bear with us as we are working hard to unblock local authority hurdles," said the FreshToHome team.

Reports later surfaced that the Department for Promotion of Industry and Internal Trade (DPIIT) has initiated talks with the state Chief Secretaries asking them not to restrict movement of people engaged in home delivery of essential items, mentioned in the list of exempted items circulated by the Home Ministry.

Meanwhile, Flipkart said it has temporarily suspended its operations and services - including grocery items. The marketplace has decided to halt all orders from March 25 for all three supply chains -- groceries, non-large goods and large items.

"Flipkart has temporarily suspended orders as we assess the possibilities of operating in the lockdown. We are prioritising the safety of our delivery executives and seeking the support of the local governments and police authorities to meet the needs of our customers as they stay home during this lockdown," Rajneesh Kumar, Chief Corporate Affairs Officer, Flipkart, said in a statement.

E-commerce giant Amazon said the company has to "temporarily stop taking orders and disable shipments for lower-priority products.

"For all pending customer orders on lower-priority products, we are reaching out to customers and giving them a choice to cancel their orders, and receive a refund for prepaid items," said the company.

Witnessing a surge in demand, supermarket chain Biz Bazaar entered the fray, with launching doorstep delivery services in major cities like Delhi, Mumbai, Bengaluru and Gurugram.

However, within no time, Big Bazaar was flooded with calls, forcing the company to issue a statement, saying that "In light of the recent announcement, we are receiving an unprecedented number of requests for doorstep delivery. There could be a delay due to the restrictions on movements".

Already battling massive surge in demand, the online delivery platforms faced other issues too, including zero access to several high-rises across the country which have gone under complete lockdown with all entry and exit gates locked.