Break the Inertia!
Tikender Singh Panwar
The Covid situation is worsening in India by the day due to mismanagement of the second wave. Thousands are dying and lakhs are getting infected every day. Gory stories and scary pictures are posted on social media, where relatives and friends of Covid patients are crying for oxygen or a bed at the gates of hospitals. It’s no more just about ‘life’s struggles’, even after death, bodies are waiting for space at the cremation and burial grounds.
This is definitely a war-like situation in India where nearly 300,000 people(officially) and five times to this number have died so far from the Covid pandemic.
Break the Inertia
The approach of the governments – central and states’, barring a few are ‘not to break the inertia’ in the system, rather allow the ‘work as usual’ practice. This will not help. Of course, for such an approach to have been imbibed, it is our ‘supreme leader’ and his fancy ideas; from “finishing Covid in 21 days”, to “we have attained victory over Covid,” etc., nevertheless, this approach must be checked and alternatives have to be developed; if not from the top, then from the bottom up.
Take for example two concrete instances of two cities- Delhi, a metropolis with a population of over 20 million, and Shimla, a small hilly town with nearly two hundred thousand people.
Delhi, which boasts of its massive health infrastructure, just crumbled badly as a regular supply of oxygen could not be maintained for the patients. SOS calls by individuals and hospitals for oxygen demand were and continues to be a regular feature even after a month of the second wave of Covid. Not just that, even beds were not available for patients and we have seen pictures of distressed people as mentioned above.
In Shimla, however, such a situation has not arisen, yet. But going by the rise in numbers, the day is not too far when similar stories may be witnessed in this hilly town as well. There is immense pressure on the medical fraternity, right from the sanitation staff to the doctors who have not taken any leaves since March 2020, and despite two shots of vaccine, are still getting infected by the virus.
But that is not the point. The point is that a complete revamp of the existing structure and operations must be done on a war footing. Just recently in a single ward of medicine unit in the Indira Gandhi Medical College and Hospital (IGMC) Shimla, 25 indoor patients tested positive for Covid. Likewise, in the intensive care unit of the Heart Centre, all the patients tested positive. All of them were tested negative in their RTPCR report while getting admitted to the hospital.
This is an alarming situation and is not limited to one hospital, but almost all the hospitals across the region are affected. The virus is spreading fast and as stated it is a war-like situation where radical steps must be undertaken. Vaccination, testing, treating, and isolation are the mainstay of managing this pandemic. It is very important to ensure that adequate testing, isolation, and treating facilities are created at the community level.
This cannot be achieved by building new hospitals because the time lag will be huge. The only way it can be achieved is by re-designating the already existing facilities in a time-bound manner at an appropriate time. They need to be converted into Covid facilities and then go back to their sub-specialist work like clockwork for any reasonable success. All hospitals and healthcare facilities need to respond to Covid and become treating facilities the moment the positivity rate crosses the threshold, which depends upon the disaster mitigation capabilities in a given situation. That is the only way out of the pandemic because multiple waves cannot be ruled out.
Mitigate Second Wave in Delhi
Let me cite two hospitals, Hindu Rao Hospital in Delhi and IGMC in Shimla. Hindu Rao Hospital is a large hospital run by the Delhi Municipal Corporation, with a capacity of 1,000 beds; however effectively; only 832 beds are shown on the website. Out of these 832 beds, just 250 are allotted for Covid patients(though in a recent notification it is augmented to 350, however at the moment only 250 are available). The rest i.e., 582 are kept aside for elective, routine work which has now become redundant due to lockdown and closure of outpatient department facilities.
Likewise, IGMC has a bed capacity of 850 beds and 150 were reserved for Covid patients. However, with some proactive interventions of the hospital administration and the need owing to the spontaneous situation, now this hospital has 350 beds for Covid patients.
This is a situation in almost all the large hospitals in the bigger cities, where a small percentage of beds have been kept for Covid patients and the rest of the hospital staff is working tirelessly treating other patients. As the virus is spreading super-fast, other departments are also getting infected, and then the response is more with spontaneity, rather than planning.
What needs to be done is this: Let us take the example of Hindu Rao Hospital once again. In any given hospital if the outdoor patients are stopped and the hospital is allowed only to deal with trauma patients, not more than five percent of the beds are required for medical and surgical emergencies. This in simple terms means that in Hindu Rao Hospital Delhi, out of 852 beds just 85 beds are required to deal with trauma cases.
The other 752 beds can be optimally utilized for Covid patients. This means that there will be a jump of more than 300 percent in the existing capacity of the hospital. Imagine the kind of difference it would bring in meeting the demands of the people of Delhi if such interventions are done in most of the hospitals. Likewise in Shimla, IGMC, the Covid bed capacity can jump to almost 200 percent totaling a figure of nearly 750 beds.
Now the point that can arise is where are the medical staff and other health infrastructure going to come from? The simple answer is that those departments that were dealing with their respective wards along with the paraphernalia should be allowed to manage their wards on a rotation basis.
Since for Covid management, the requirement of human resource intervention is far less than on any other surgery or medical indoor patients’ requirement, the situation can be easily managed. Even the supply of oxygen is available at most of these beds, and if at all additional augmentation is required, it can be done very promptly without any hassles.
In this way, the augmentation of the capacity in large towns can be increased by more than 300 to 400 percent, and this may be done just for a few weeks or months.
But a question may be raised, why so many beds are required when on paper there are surplus beds in Delhi. According to the Delhi government’s website, there are 21,561 Covid beds and out of these nearly 18,000 beds are óxygen’ beds(at least on paper). On any day if the total number of Covid patients is 100,000 then near 10 percent of them require hospitalization. This means only 10,000 Covid beds are required. Whereas the availability is nearly double the requirement.
Then why is there this mismatch? If the beds’ availability is almost double the requirement, then why are we witnessing patients dying on the streets, in front of hospitals unable to get oxygen beds. Some of them are migrating out of Delhi for treatment. Actually, the fallacy is both in numbers and practice.
In Delhi, it is not the numbers tested positive that should be taken as a consideration to measure, rather the positivity rate as the numbers of tests has been reduced over a period of time. Let us consider the population of Delhi to be 2.3 crore (considering the population of adjoining areas as well) and if the positivity rate is 30 percent then actually those who are infected is a startling number of nearly 69 lakhs.
In any given situation if 10 percent of this number of people require hospitalization then nearly 69,000 beds are required and we are nowhere near to that in Delhi(some will recover, while the others may fall ill). Hence a large number of people are dying at home and we find long queues at the cremation and burial grounds.
Now, what will happen if the formula suggested above is implemented and the bed strength is augmented in the available hospitals treating it to be a war-like situation.
It will definitely be easier for the existing medical staff to handle patients in the given infrastructure rather than to create new ones, which may be deemed fit, but requires time. RML Hospital Delhi is already doing it and converting a large section of the medical ward into Covid ward.
The second question that will arise is where will this extra oxygen come from? And that is where both the central and the state governments have to work together and ensure that a regular supply of oxygen is provided to these hospitals. Once done, the infrastructure is already available to cater to these patients as in most of these hospitals even for indoor patients(medicine, surgery, etc.) there is an existing oxygen line that supports these beds. The only bottom line is that the oxygen will have to be supplied regularly by the government. Even if there is no central line, oxygen cylinders can be provided at the bedside more promptly than relying on social networks.
This is the least that the governments must do to protect the lives of their people. The government must consider such proposals some of which are emanating from the medical fraternity itself, like the IGMC spontaneous intervention (though the OPD still functions) that could augment its capacity by almost 150 percent.
The OPD can also be managed through telemedicine and other forms of interaction with the patients. As it is a war-like situation, the hospitals cannot and should not shun the patients out just because they are exhausted.
About the Author
Tikender Singh Panwar, is a former deputy mayor of Shimla and an author who regularly contributes to urban matters. He is also a Visiting Senior Fellow at IMPRI Impact and Policy Research Institute, New Delhi.