Infra overrun: Scramble for ventilators, oxygen, ICU beds
In urban centres with high caseloads shortage of beds, oxygen supply crunch make matters worse
A record daily spike in coronavirus infections pushed health infrastructure to the brink in several states on Friday as patients scrambled to secure hospital beds, governments struggled to provide oxygen needed to stabilise serious patients, and crematoriums in major cities reported huge rush and long delays.
The worst crisis was reported from major urban centres with high caseloads, bringing true fears, expressed by experts when the pandemic first hit India in March last year, of infections inundating hospitals, overwhelming civic infrastructure and taking medical staff to the breaking point.
In Delhi, which reported its highest daily case number of 19,486 on Friday, 88% of 3,976 intensive care unit beds were occupied, according to the government’s Delhi Corona app. Patients also reported acute difficulties in securing a bed.
In Bengaluru, which logged 9,917 cases, 99% beds in government hospitals were occupied, an increase of more than 20 percentage points in the past three days. In Mumbai, which saw 8,839 cases, the bed occupancy rate was close to 80%. The availability of beds in ICUs or with oxygen support was even harder to come by. What made matters worse for critical patients in several big cities was that the distribution of vacant beds was uneven and poorly publicised, and getting care in hospitals in the vicinity was difficult.
“We do not have beds, what can we do. We have to refuse patients. We do not even know where to refer them to; it is not like there are hospitals in the city that have beds available,” said a doctor from a top private hospital in Delhi. The situation was no better in smaller cities.
In Chhattisgarh’s Raipur, the occupancy rate of beds increased to 90% on Friday even as the state announced new Covid care centres for mild or asymptomatic patients. In Patna, all Covid beds in premier institutes such as All India Institute of Medical Sciences, Patna, and Indira Gandhi Institute of Medical Sciences were full, while those at Patna Medical College and Nalanda Medical College were up to 90% occupied, according to health department.
All major hospitals in Ranchi such as Rajendra Institute of Medical Sciences (RIMS) and Sadar hospital showed full occupancy of oxygen-supported and ICU beds, showed the city Covid dashboard on Friday evening.
In West Bengal, which is in the middle of eight-phase assembly elections, hospital occupancy rate zoomed from 25% on February 26, when the polls were announced, to 86% on April 16, according to the state health department. During the same period, daily infections rose from 190 to 5,334, in a spike of over 2700%. Out of the 56 private hospitals in and around state capital Kolkata, 21 had no beds vacant and 22 had less than 10 beds left, showed health department data on Friday evening.
“The occupancy rate in the government hospitals in Kolkata is much higher as the city and its adjoining district of North 24 Parganas have nearly 50% of the total cases,” said a top state health department official on condition of anonymity.
Several states such as Maharashtra, Bihar, Uttar Pradesh, Gujarat and New Delhi, have set up Covid care centres for mildly symptomatic patients, and officials hoped these would help tide over the crisis. “We have designated 50% of all hospital beds for Covid patients,” said Chhattisgarh health minister T S Singhdeo, after videos appeared of patients on stretchers waiting outside emergency wards of hospital for admission. Some states have also placed orders for additional ICU beds.
An associated problem was that of oxygen supply crunch. In many states, patients said hospitals and care centres reported a shortage of oxygen that is crucial to stabilise Covid patients whose blood oxygen levels can plunge suddenly and therefore need to be consistently monitored. States such as Jammu & Kashmir, Maharashtra, Gujarat and Madhya Pradesh issued orders mandating 50% of oxygen produced by factories be provided for medical purposes. In Maharashtra’s Aurangabad, the district collector took over a local steel plant to ensure oxygen supply to hospitals in the district. On Friday, the Union home ministry directed all the states and Union territories to ensure uninterrupted movement of medical oxygen carrying vehicles along their borders, and said they must not impose any curb on production and supply of the commodity anywhere. Union home secretary Ajay Kumar Bhalla said availability of adequate and uninterrupted supply of medical oxygen is an important prerequisite for managing moderate and severe cases of Covid-19.
In Maharashtra, chief secretary Sitaram Kunte said the state government arranged for transportation of oxygen from neighbouring states but feared a disruption due to lockdowns in many states.
Increasing Covid deaths in many of these states have also led to long delays at crematoriums. In Lucknow, workers at the city’s three biggest crematoriums said they were working round-the-clock, leading to a shortage of wood. In Ahmedabad, crematoriums reported a waiting time of anywhere between five to 12 hours.
In Raipur, the district administration created 14 makeshift cremation grounds while in Surat, the authorities reopened a crematorium after 15 years and created another makeshift one.