Beds hold up, lens on other gear Specialists want focus on personnel and ventilators

Medics inside a hospital which is being converted into a 30-bed quarantine centre to treat Covid-19 patients at Wadala in Mumbai on Sunday. (PTI)

G.S. Mudur, TT, New Delhi, 13.04.20: India’s dedicated hospital beds for patients with moderate or severe coronavirus disease (Covid-19) have thus far exceeded demand, but critical care specialists caution that personnel and ventilator shortages could hobble the country’s response to the pandemic.

More than 600 hospitals with around 105,000 isolation beds across the country are now prepared to accept Covid-19 patients, the health ministry said on Sunday, releasing data on bed availability and the corresponding demand for the beds.

Health authorities had until 5pm on Sunday recorded 8,447 confirmed Covid-19 cases, including 765 recoveries and 273 deaths.

Among the 7,409 patients still in hospital, a health official said, 1,671 had moderate or severe disease requiring oxygen support or critical care facilities.

“We’re being extra cautious,” said Lav Agarwal, joint secretary in the health ministry. “As the cases have grown day by day, we’ve increased the numbers of dedicated Covid hospitals and isolation beds. This is important as in this pandemic, an exponential rise can happen. We need to be extra prepared.”

But health officials and doctors are concerned that any runaway exponential growth could overwhelm the hospitals — despite the isolation beds — because of shortages of specialist doctors, nurses and ventilators and the skewed distribution of human resources.

A senior doctor who requested anonymity said the severe Covid-19 patients who require ventilator support — although only a small proportion of infected patients — are “seriously ill” and require the best clinical care possible.

  

“If the numbers rise quickly, it might become a challenge to ensure that all such patients receive optimal care.”

Members of the Indian Society for Critical Care Medicine (ISCCM) estimate that India has between 40,000 and 60,000 ventilators, the majority concentrated in private tertiary-care hospitals. And the Centre has ordered 49,000 new ventilators.

“Not all of the available ventilators are free for the management of Covid -– some proportion is in use for patients with other illnesses,” said Yatin Mehta, a senior specialist in Gurgaon and former president of the ISCCM.

Doctors say the country has around 12,500 critical care specialists, most of them in private hospitals. ISCCM members had two years ago estimated that only around 10 per cent of government intensive care units were “properly equipped and staffed”.

“The ideal bed-to-nurse ratio is one-to-one and for five beds, we need one resident doctor and a senior intensive care consultant,” said Subhal Dixit, a critical care specialist in Pune. “A lot will depend on how our numbers go up, but we expect there will be a huge strain on human resources.”

The health ministry, aware of the potential shortage of critical care experts, has released guidelines to deploy specialists and resident doctors from branches of medicine other than critical care in the clinical management of moderately ill Covid-19 patients.

“If the patients’ numbers continue to rise at an exponential rate, there will be a need to pool public and private resources,” Mehta said.

Already, several private hospital chains have announced plans to establish dedicated Covid-19 management facilities.

Around 80 per cent of Covid-19 patients develop mild symptoms and do require hospital care, but the Indian policy is to isolate all patients in hospitals or Covid care centres.

“The isolation of every patient is absolutely required. The countries that sent patients with mild symptoms home are now facing the consequences – their numbers have exploded,” said Dhruva Chaudhry, ISCCM president and a critical care medicine specialist in Rohtak, Haryana.

Citing examples of hospitals with dedicated Covid-19 beds, the health official said AIIMS, New Delhi, had set up 242 beds with 50 critical care beds and 70 ventilators; Safdarjung Hospital in Delhi had 400 beds with 100 critical care beds, while the MCH Government Medical College, Kozhikode, had 950 beds.