Second Covid-19 wave: Hospitals running out of beds, staff overstretched

A year later, non-Covid treatments fall off priority list again

The surge in Covid-19 cases across major cities, especially metros like Delhi and Mumbai, has left hospital infrastructure overburdened and impacted non-Covid treatment.

Occupancy levels for intensive care unit (ICU) beds with and without ventilators are now touching nearly 100 per cent, forcing local and state governments to either increase the number of beds or turn complete hospitals into Covid-care centres.

As on April 14, Mumbai had only 41 ICU beds left. Of the 2,664 ICU beds, 2,623 were occupied, Municipal Corporation of Greater Mumbai (MCGM) data showed. The city, which is adding close to 8,000 cases daily, has only 3,790 beds available combining private hospitals and public Covid-19 establishments. These include dedicated Covid hospital beds and Covid healthcare centres (these are jumbo facilities with oxygen support beds and doctors present 24x7).

The situation is similar across other cities in Maharashtra. Pune, for example, has only 15-17 per cent of its total beds available, and Nagpur some 4 per cent.

Civic bodies across the state are trying to increase the number of beds and MCGM has set up 24 ward war rooms to assist in their allotment.

Three more jumbo field hospitals are coming up in Mumbai over the next five or six weeks. Each of these will have a capacity of 2,000 beds, including 200 ICU beds and 70 per cent with oxygen support. The Mumbai administration is trying to add another 1,100 beds in dedicated Covid hospitals for which "around 70 new smaller private hospitals and nursing homes have been brought on board,” said a senior MCGM official. Some of these were treating Covid cases last year.

In Delhi, 593 additional Covid beds have been made available in government hospitals, and 14 private hospitals have been declared Covid centres with a total of 2,060 beds.

In Ahmedabad, Gujarat, all major government-run hospitals including VS Hospital, LG and Civil Hospital have been converted into fully designated Covid-19 hospitals. Bed occupancy at private hospitals has touched 92 per cent. While 5,327 of the 5,794 beds in over 140 private hospitals are full, occupancy for ICU and ventilator beds is at a 98 per cent high. Ahmedabad Municipal Corporation (AMC) has reserved 20 per cent of beds in all private hospitals for treating Covid-19 patients.

On Tuesday, Uttar Pradesh reported 85 deaths and 18,021 fresh cases. With this, the number of active coronavirus cases reached 95,980. The state is also facing an acute shortage of doctors and other medical staff, with many of them having tested positive.

In Delhi, the rampaging crisis has forced some doctors to turn away non-Covid patients. At Indraprastha Apollo, one of the 14 designated Covid hospitals, S Chatterjee, an internal medicine specialist, had no choice but to refer a patient he had long treated to another hospital on Wednesday.

“He was really sick, complaining of chest pain and breathlessness and not being able to maintain oxygen saturation. I couldn’t get him to hospital because he was not a proven Covid patient,” he said.

After being converted to Covid-only centres, the hospitals have had to stop admitting non-Covid patients. The only exceptions at Apollo, Chatterjee said, are treatments like chemotherapy/dialysis where daycare is allowed.

At Apollo, a 718-bed hospital, elective and scheduled surgeries had to be cancelled after Tuesday. Non-Covid patients outnumber coronavirus ones manifolds. This week, 40-50 non-Covid beds are being vacated every day. “They have to be converted into a type of ventilation that can accommodate Covid patients, and changes have to be made in every ward,” said Chatterjee, adding that non-Covid patients have to be stabilised before they are discharged gradually.

Converting the hospital into a Covid hospital is a big ask. “We have a limited number of physicians and chest specialists, so if you have 600 Covid patients, it will add a lot of mental and physical stress,” said Chatterjee.

Mumbai civic body is also clamping down on hospital admissions. An MCGM order said that no asymptomatic Covid-19 patients without co-morbidity would be allotted a hospital bed in any public or private hospital.

Joy Chakraborty, COO of Mumbai’s Hinduja Hospital, said the Covid-19 beds were 100 per cent occupied in the city, while non-Covid beds had 50 per cent availability.

There is also a crisis of trained manpower now, said another Mumbai-based private hospital administrator. "Some clinicians are ill, although the vaccinated ones are not severe so. There is a shortage of nursing staff too."

Global Hospitals, however, said it was balancing both Covid and non-Covid patients at its Mumbai premises.

"We have ramped up our Covid beds to last year’s numbers, and unlike last year, we have continuous non-Covid admissions, too,” said Jessica D’Souza, chief nursing officer, Global Hospitals, Mumbai. “We have demarcated the hospital into three zones: Covid, non-Covid and transplant dedicated floors for Covid. Accordingly, we have separate pathways to avoid crossover of staff, equipment and instruments.”

Ahmedabad Hospitals and Nursing Homes Association (AHNA) President Bharat Gadhvi said the association was in talks with hospitals to increase the number of beds for Covid patients to meet the rush. "Almost 6,000 beds have been made available”

AMA has asked Gujarat Chief Minister Vijay Rupani to direct oxygen manufacturers to supply 100 per cent of their production to the health sector. Currently, Gujarat has mandated 70 per cent of oxygen produced in the state to be used for health care.

The Gujarat government is, along with the Centre and the Defence Research and Development Organisation (DRDO), setting up a 900-bed Covid care hospital at a convention centre in Ahmedabad. Comprising a 150-bed ICU facility, the hospital is likely to be commissioned in the next couple of weeks.

UP Chief Minister Yogi Adityanath has instructed officials to arrange for bringing 25,000 injections of anti-viral drug Remdesivir from Ahmedabad, Gujarat.

The state, meanwhile, has ordered the shutting of out-patient department services in government hospitals in major cities including Lucknow, Kanpur, Prayagraj, Gorakhpur and Agra. All surgeries, barring emergencies, have also been postponed.