As coronavirus cases surge in India, 40,000 ventilators for 1.3bn people a worry
India has an estimated 40,000 working ventilators, a number experts said will be inadequate in case there is a surge in Covid-19 infections that, in approximately 5% of the cases, sends patients to intensive care units (ICU) with acute breathing problems.
The number of patients in India reported another sharp rise on Sunday, with 45 fresh infections taking the tally up to 360, raising the possibility that the outbreak is on a trajectory seen in other countries where the virus has become difficult to control. The number of fatalities in the country are now at 7.
A similar trend has led to a surge in patients in some of the worst-hit countries, such as Italy and Iran, where health facilities have been overwhelmed with high volume of patients who need intensive care.
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The coronavirus attacks people’s lungs, in some cases compromising their ability to breathe as they develop pneumonia. Ventilators, which deliver air to the lungs through a tube placed in the windpipe, are crucial to keep these patients alive.
According to Dr Dhruva Chaudhry, the president of Indian Society of Critical Care, a rough tally of medical devices deployed across the country suggests active ventilators may be around 40,000 and are mostly deployed in government medical colleges and private hospitals in metros, state capitals and semi-metro towns.
“If there is an unreasonable surge, we will definitely have huge problem. We have 20% the number of ICUs South Korea has as a result of chronic underfunding. We need to expand testing, identify the infected sooner, and treat them effectively to delay their getting into a critical stage. It’s the same strategy we followed for HIV and AIDS,” said Sujatha Rao, former health secretary and director general, National AIDS Control Organisation, ministry of health and family welfare.
South Korea has been widely held up as an example of a country that has successfully tackled the virus.
Data from China shows around 15 % Covid-19 patients get sick enough to need hospitalisation and 5% require ventilator support in ICU.
If these patients do not get the device, they are likely to die.
High fatality rates in Italy and Iran are partly blamed on lack of access to ICUs. “Nobody has enough ventilators, no one will be able to cope. We have 100 people on ventilators at any given time. Even cancelling elective surgeries in hospitals to free up ICU beds will not be enough because there is a huge shortfall,” said Dr Yatin Mehta, chairman of critical care at Medanta.
“Dealing with a surge will be a challenge, so the strategy is to delay spikes in numbers so that fewer people get infected, which will lower the number of people needing critical care all at once. That’s why measures like janta curfew and social isolation are very effective in preventing transmission,” said Dr Chaudhry, who is also the head of the department of pulmonary & critical care medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak.
India has banned exports of ventilators, cancelled elective surgeries to keep ICU beds on standby, and imposed a people’s curfew on Sunday to socially isolate people. It has also restricted travel in order to contain the outbreak. A top panel of scientists cleared on Saturday an industry proposal to ramp up production of ventilators in the country, according to government officials who asked not to be named.
In 2019, government-run hospitals were the biggest procurers of ventilators, with the public sector HLL Lifecare Ltd placing an order for 1,286 units, and Maharashtra, Hyderabad and Telangana placing separate orders, including for cheaper ambulatory ventilators. After the Covid-19 outbreak, they have ordered for the acquisition of 1,200 units, said Lav Aggarwal, joint secretary, ministry of health, on Sunday.
On average, a ventilator costs ₹8-10 lakh. Around 8,510 ventilators valued at ₹444.74 crore were bought by public and private hospitals in 2019, with imported equipment accounting for 64% by numbers and 75% by value of units, according to industry estimates.
Training medical staff to use ventilators and ensuing there are enough skilled operators to run them 24x7 is a bigger challenge than procuring machines, some other experts said.
“It’s a more complex issue than simply buying a machine. You need to train nurses and ensure continuum of care. If you factor in shifts, one unit of ventilators needs at least four nurses and five units need four resident doctors for round-the-clock care. Most government hospitals work at half the strength at any given time. A sudden increase will lead to Gorakhpur-like situation, where scores of children die because they can’t get adequate care,” said Dr Chaudhry, referring to the deaths of children in 2017 due to acute encephalitis syndrome.
ICU units vary in sizes, depending on the size of the hospital.
In India, there is one doctor for every 1,457 people -- lower than the World Health Organization recommended 1:1,000 ratio.
People living in rural areas are completely dependent on government hospitals and clinics, with the doctor-patient ratio at 1:10,926.