Are Delhi and Mumbai running out of hospital beds for Covid-19 patients? The data shows they are not: Delhi has 4,606 beds available for Covid patients according to the Delhi government, and Mumbai, 3,289, according to the Brihanmumbai Municipal Corporation. And health care policy makers and administrators insist there is no lack of beds, or ICU bed/beds with ventilators (184 in Delhi and 64 in Mumbai).
Yet, over the past few days, several people who have been unable to find beds or get treated in Delhi and Mumbai have taken to social media to express their frustration -- this, when government data shows there is no shortage.
According to Delhi health minister Satyendra Jain, there is no shortage: “The truth is that there is absolutely no shortage of beds in Delhi at the moment. In the last three days, more than 1000 patients have been admitted to various hospitals in Delhi. If beds were not available, this would have not been possible. Even now we have close to 5000 vacant beds.”
Jain added that the issue lies with the hospitals not updating data on the Delhi Corona mobile application, where the official figures are made available. “So clearly the issue is that some hospitals are not updating the data on Delhi Corona app on time or misrepresenting actual data when patients call. Patients were not getting data on hospitals before, which the Delhi corona app is trying to fix. We are making hospital bed data live and real time soon.”
Still, on May 26, 47-year-old Jagdish Ujjainwala who was admitted to the hospital on May 21, died of the coronavirus disease (Covid-19) because his family was told that there was no free ICU bed available to treat his fast-worsening condition. And on May 27, the government-run Lok Nayak Hospital, one of the Covid-19 designated hospitals in Delhi had 1386 vacant isolation beds and 64 vacant ventilator supported beds, according to the data made available by the state government in its mobile application, Delhi Corona.
When asked about the number of available beds, the hospital’s acting medical director Dr PN Pandey said: “We have adequate ICU, ventilator, oxygen-supported beds available in the hospital. And, we do not refuse treatment to any patient in need of hospital care.” He added that he did not wish to comment on any particular person’s case.
Ujjainwala’s case is not an exception. In Delhi and Mumbai, the incidence of people being turned away from hospitals or kept waiting for hours on end, on account of non-availability of beds, is on the rise.
In Mumbai, the vacancies in the city’s 125 designated Covid-19 health centres and hospitals are even fewer. Of the total 1,097 ICU beds, 98% are occupied, according to data released by the municipal body on June 3; of the 442 ventilators, 85.5% are currently being used by the critically ill.
On May 26, a 51-year-old physician from Cheetah Camp in Trombay, Mumbai, died of Covid-19 related complications after being taken to two hospitals, and finally admitted in a third, where he was forced to share a bed with another suspected Covid-19 patient for two days due to non-availability of beds. His teenage son, who accompanied him, said that patients were lying on the floor between beds in the casualty ward of the government-run Lokmanya Tilak Municipal General Hospital. He died within a day of being shifted into the Covid ward.
In theory, everything is fine in Mumbai too.
“If anyone calls at the helpline number— 1916, it gets connected with a doctor who asked for symptoms of the suspected patient. Depending on the condition of the person, they will be allotted with centres or hospitals for treatment,” said Suresh Kakani, additional municipal commissioner.
Delhi has reported 1278 cases every day at an average in the last seven days; in the seven days before that the city reported 723 new cases at an average; Mumbai, meanwhile, has been consistently averaging over 1300 new cases a dayin the past two weeks. This indicates that the strain on resources will certainly not abate in the coming weeks. On Friday night, Mumbai had 25768 active cases (46080 total cases) and Delhi 15,311 active cases (26,334 total cases).
It is in this scenario that the Delhi government has tried to make resources available for those who are in actual need of them: on Friday, it directed five Covid-dedicated government hospitals to increase their bed capacity by 13,670, including 750 ventilators, in three weekly phases to be completed by June 25; earlier this week, deputy chief minister Manish Sisodia announced that three more private hospitals would be converted into Covid-19 treatment facilities, and warned that hospitals with mixed use beds (20% reserved for Covid-19 positive patients) will be converted into dedicated facilities if they are found to be non-compliant. It also issued fresh orders to hospitals on Thursday to discharge mild or asymptomatic Covid-19 patients and said that designated facilities should turn away such patients.
“In case the hospital refuses a bed to any patient in spite of beds being shown available, the government can and will take action. Some hospitals are refusing to take patients and the government will take strict action against them soon,” a media advisor to chief minister Arvind Kejriwal said.
Hospitalisation isn’t the only thing people are complaining about. There would appear to be a similar problem with testing.
On Wednesday, the Delhi government modified the national testing guideline set by the Indian Council of Medical Research, to rule out testing of asymptomatic direct contacts positive cases, including close family members, unless they were above 60 years, or had conditions such as diabetes, heart or kidney disease. The following day it banned eight labs from carrying out tests on individual samples and pulled them up for not following protocol, and — according to the state health minister — for taking too long to report the results.
“Some labs were giving reports very late. If someone has taken a test for the coronavirus, the reports should be ready in 24 hours. At times, some have not given results for 5-6 days. This leads to a delay in hospitalisation because the special corona facilities say they will accept only patients who have a positive test. Other hospitals refuse to admit unless someone is confirmed to be corona-free,” Jain told reporters on Thursday.
However, experts said that by revoking permissions from these testing labs — another, Dr Lal’s Path Lab has been disallowed since a month — the testing capacity has come down by at least 8,000 tests a day. Thus as cases rise, this clampdown will result in people getting wait-listed for testing, delay results, and cause a great deal of trouble to those who need hospital admission for life-saving procedures, as no hospital admits a patient without a Covid-19 test.
Kailash Chandra, a 43-year-old administrative worker in a private hospital, has been unable to get tested . He has had high fever for the past three days, along with a dry cough, body ache and chills and he fears they could well be symptoms of Covid-19, as he works in a hospital that treats Covid-19 patients.
“My hospital has been barred from testing and I have been really struggling to look for a laboratory that can do the testing. Many of the labs said they are not doing the tests currently. Even though my doctor has put me on medicines to ease symptoms but I can feel my condition getting worse. I used to feel relieved thinking I worked for a hospital and could get tested without much effort, but here I am struggling to get the test done like many others,” he said. Several government helpline users lamented that calling on the number never led to a satisfactory resolution either.
Experts said that a distinction needs to be made between those who test positive and those who wish to be admitted. Both the United States and the United Kingdom ask patients with mild symptoms to stay home, and only seek hospital admission if their conditions worsen, and the Delhi government too is hoping that residents here will exhibit similar restraint.
In Thursday’s press conference, Jain said asymptomatic patients with no or very mild symptoms such as slight fever and mild cough can be treated and recover in home quarantine. “Patients with moderate (respiratory rate of more than 15 per minute and oxygen level below 94%) and severe symptoms (respiratory rate of more than 30 per minute and oxygen level below 90%) require hospitalisation,” he added.
“Instead of limiting tests, we should widen testing to diagnose the asymptomatic and mild cases, so they can be self-isolate and not spread the disease to others. People will die of other diseases because of delayed testing. Limiting testing also leads to epidemics remaining undetected. If people are not tested, they may die of Covid-19 and we’ll never know. This is how pandemics begin,” said Dr Jacob John, former virology head, Christian Medical College, Vellore.
“At this stage, we need more people coming forward to get tested and unless you make the process easily accessible, they will stay away from testing. Testing should be made walk-in, you shouldn’t need a doctor’s prescription or symptoms for testing at a private lab at this stage of transmission,” added Dr Lalit Kant, former head of epidemiology, Indian Council of Medical Research.
“These eight labs were found to not be following the protocol prescribed by the ICMR. Therefore, action was initiated. As a temporary measure, these labs have been asked not to pick up individual samples. However, samples sent by various hospitals and other agencies will continue being processed in these labs. Every minute counts which is why Delhi government cannot compromise on any discrepancy which would consequently distort the facts in the daily health bulletin,” the Delhi CM’s media advisor said.
In Mumbai too, the situation is not much better for persons seeking a test. The city, which has a testing capacity of 7,000 a day, tests only 4,000 samples daily. Further, a significant portion of Mumbaikars have been left out of the testing net; until June 3, only 1.7% of the city’s population has been tested. The state follows the ICMR guidelines of testing: symptomatic patients with international travel history; frontline medical or support staff are allowed immediate tests; asymptomatic but high-risk contacts of infected patients can be tested only after five days of getting exposed, among others. However, these in itself, aren’t enough categories. Mumbai’s Sir JJ Hospital lab has an installed capacity of 2,000 tests per day, but it only tests half of that.