These days, Gagan Bharti says his day doesn’t end until well past midnight. Phone calls—to government and private hospitals for availability of beds for COVID-19 patients, and circling the information back to the patients who need admission—start at 8am in the morning. “I know the system. I know who is the right person at each hospital for this information. But ordinary citizens don’t," says Bharti. Bharti is manager, charitybeds.com, a volunteer group that works to help poor patients get access to private hospitals in Delhi.
Ordinary folks, says Bharti, are simply at sea in this situation: Trying to get through helplines that don’t work, government apps that don’t show updated data on bed availability, hospital staff that pass the buck and security guards who shoo them away.
As Bharti continues his frantic calls to help COVID-19 patients in Delhi, in the past week, matters have only worsened. Active cases have continued to rise since the capital opened up—on June 16, Delhi recorded 1,859 new cases and 437 deaths (includes backlog of death data)—and doctors fear the health systems are on the verge of being overwhelmed.
The Central government, too, has swung into action. On June 14, Union Home Minister Amit Shah held a meeting involving all stakeholders in Delhi, the first such high-level meeting on COVID-19 in the capital. The meeting was followed by Shah's 'surprise visit' to the Delhi government-run LNJP hospital, a day later. Instructions were issued to the Delhi chief secretary to install CCTV cameras in COVID-19 wards for monitoring and provide back-up canteens for food supply and counselling for health care workers.
With Shah taking charge, a slew of other measures has been announced: In the coming days, testing would be first doubled, then tripled; 11 districts in the capital have got designated laboratories to avoid backlogs in testing; 500 railway coaches have been allotted to Delhi (adding 8,000 beds); contact tracing has been emphasised and reasonable charges for treatment are being worked out by top experts.
From June 20, around 18,000 samples will be tested daily; as of now, the 42 laboratories authorised to test for COVID-19 in the capital have a capacity of conducting 17,000 tests every day. The ICMR has advised states to use rapid antigen tests (that give results in 15 minutes) in containment zones and Delhi government has plans to begin these tests in the coming week.
Three committees, with four members each, have also been constituted for “rapid assessment” of healthcare infrastructure. The members include doctors from both the state and Central government hospitals and municipalities.
“We have to work on a war-footing now. Teams have already visited a few hospitals, and over the next few days, we will be making the rounds of several others in the city, including bigger corporate hospitals. The idea is to handhold them to ensure that the situation can be managed better. During our visits, we have found that there were issues of not enough capacity in mortuaries, shortage of manpower and supplies such as oxygen support, ventilators and beds. The fact that 160 HCWs (health care workers) had contracted the infection in LNJP and another 70-80 in Safdarjung has led to a shortage of staff,” said Dr Mahesh Verma, professor emeritus, MAMC. He is a member of the expert committees formed by the Central government to suggest ways to manage the situation in the national capital.
Verma insists that things have already started to change: At LNJP, split air conditioners have been installed in wards and central air-conditioning is being restored for patient comfort. “We have suggested that to manage manpower shortages, doctors and staff from other specialities need to be roped in, too, and government hospitals should be allowed to procure supplies at market rate. The MS of a government hospital should also be allowed to hire extra staff as per need. Portable containers that are used to transport flowers can be used for dead bodies,” said Verma, who is also vice-chancellor, Guru Gobind Singh Indraprastha University.
“I simply don't understand what governments are doing,” says Bharti. The problem, he says, is that many patients don’t want to go to government hospitals because of the patient narratives emerging out of these facilities.
"So even as the government adds private hospitals, they get full immediately, leading to a shortage, yet again. Also, when patients run out of money at private hospitals, they head to government hospitals, and by that time, it’s just too late,” he says.
The Delhi government added 22 private hospitals to the list last week, and while some are still preparing their facilities, most have run out already, Bharti says. “ICU beds are in short supply. Manpower is stretched. At times, government hospital staff are only too busy trying to procure supplies such as oxygen cylinders. Many government hospitals have ventilators but don’t have beds. In the coming days, if cases keep increasing as they are, general wards will also be full,” Bharti adds.
Health systems in city are about to get overwhelmed, critical care specialists warn. “Few hospitals in the city can offer critical care services anyway. Though the percentage of those with severe disease is less, absolute numbers are still high enough to overwhelm the system. If we go by the Delhi government’s estimate of 5 lakh cases, of which 5 per cent will need hospitalisation, we still have 25,000 cases. Delhi government hospitals have 12,000 beds, which is an inadequate number,” says Dr Sumit Ray, critical care specialist, Holy Family Hospital.
While additional beds are being added at alternative sites such as hotels (adding another 4,000 beds) and stadiums, both Ray and Bharti concur that while the focus was on infrastructure, trained staff such as doctors and nurses continue to be an issue.
“Managing a critically ill patient on a ventilator requires years of training. Already, without support from seniors, many young residents are just unable to manage and hence refusing to treat the really sick,” says Ray. Besides, Ray said that the modalities of how a patient would be shifted to a hospital in case they turned really sick at these sites needed to be worked out, too. “Until now, we have managed well because we have been pre-warned by the doctors in other countries on how to manage those in the ICU. But in the coming days, I fear a surge will come, and unless public health experts are roped in to decide on the feasibility of a lockdown in Delhi, our systems will be overwhelmed. Decisions will have to be made on who gets a ventilator, and who does not,” Ray said.
Experts say that lockdowns, now a subject of national debate, buy time for governments to prepare and help spread out cases in a manner that helps health systems cope. Given that a bulk of cases in India are concentrated in crowded urban spaces, state governments are considering deploying lockdowns, once again.
Even as Chennai has locked down till June 30, Delhi Chief Minister Arvind Kejriwal has refuted any such plans for the capital. But many, such as Bharti, are asking a different question: With a bulk of measures being announced in the last few days, what had governments been doing in the lockdown that just ended?
(With inputs from Soni Mishra)
