New Delhi: An elderly resident of the Alaknanda area in New Delhi tested positive for Covid-19 on 4 November. Since her symptoms were mild, she was advised home isolation. However, by 12 November, her condition deteriorated. What ensued was a harrowing time for her family as they tried to get her hospitalised.
Speaking to ThePrint on the condition of anonymity, her daughter said the government app — Delhi Corona — showed beds available at numerous good hospitals. But they had to wait almost an entire day for hospitals to confirm vacancies. Even then, she said, they only managed to “get details of bed availability in Dwarka (around 25 km away) and Noida (over 40 km away)”.
“We finally got her admitted to a hospital in Noida on the evening of 12 November and shifted her to a renowned Delhi private hospital the next day after pulling some strings,” she said.
A similar ordeal awaited Somesh, 23, a shopkeeper in Lajpat Nagar, over the Diwali weekend. He needed to arrange a hospital bed for his mother-in-law when her oxygen level fell to 80 — 10 points below the level that demands immediate hospital admission.
“My wife called up so many hospitals since one of her friends is a nurse in a government hospital, but everyone kept claiming that there were no beds,” he said. According to Somesh, they finally had to use a contact to get her admitted to a prominent government hospital.
While 80 per cent of Covid-19 patients in India are believed to be asymptomatic, some of those facing a more severe form of the disease complain of trouble securing hospital admission. A common complaint is that the availability shown on the Delhi government app doesn’t always reflect the ground situation.
In situations where time is of the essence, any delay in medical attention can mean the difference between life and death.
But hospitals say they are helpless, and that they are forced to turn away patients in the absence of an alternative. According to them, many patients come to them at a stage where they require ICU beds, whose availability is much lower than that of regular beds to begin with, which means they run out sooner too. They say most of the patients turned away are those seeking ICU beds.
This isn’t the first time Delhi has struggled with such a situation. A shortage of ICU beds had emerged as a concern in September amid an earlier surge in Covid cases. The Delhi government had subsequently directed 33 big private hospitals to reserve 80 per cent of their ICU beds for Covid patients.
ThePrint reached Delhi Director General of Health Services Nutan Mundeja by calls, text messages and on email with queries about people struggling to get hospital beds, but received no response till the time of publishing this report.
Delhi Chief Minister Arvind Kejriwal, after a meeting with Home Minister Amit Shah Sunday, said the central government has promised 750 more ICU beds at the facility set up by the Defence Research and Development Organisation (DRDO) to treat coronavirus patients.
The Union Health and Family Welfare Ministry, meanwhile, said at its briefing Tuesday that Delhi’s ICU bed capacity will be raised by 80 per cent to 6,000 in the coming days as the city grapples with what is being described as the third Covid wave in the national capital.
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ICUs filling up
According to the AAP government’s Delhi Corona app, which officials say is updated in real time, Delhi had 16,689 Covid-19 beds as of Monday afternoon, of which 7,715 were vacant. Of these, 1,342 are ICU beds with ventilators (for patients who require respiratory support), 164 of them vacant. Of the 2,184 Covid-ICU beds without ventilators, 233 were vacant.
As of Tuesday, Delhi had recorded a total of 4,95,598 Covid-19 cases, of which 7,812 have died and 4,45,782 recovered, while just over 42,000 are active cases.
Speaking to ThePrint, several Delhi hospitals said there was an increase in admissions of severe or critically-ill coronavirus patients in the past fortnight.
“As cases have increased, we are seeing an increase in the number of patients who need ventilator beds. More and more severe patients are seeking admission, which is why ventilator beds are filling up faster than non-ventilator beds,” said Dr Suresh Kumar, medical director at the Lok Nayak Jaiprakash Narayan (LNJP) Hospital, Delhi’s nodal Covid facility.
Figures on the Delhi Corona App suggested that, as of Monday afternoon, only 8 of the 200 ventilator beds at LNJP were vacant. In comparison, 1,511 of the non-ICU beds were vacant.
Another major Covid facility of the Delhi government, Rajiv Gandhi Super Speciality Hospital, said over 30-49 patients have been admitted daily over the past two weeks, 70 per cent of them critical.
“The majority of the patients are coming in late, or the infection is so severe that it is fatal,” said medical director B.L. Sherwal, adding that this has resulted in a higher case fatality rate (CFR).
Delhi’s CFR, which is the percentage of Covid patients dying, currently stands at 1.58 per cent — higher than the national average of 1.47.
Similarly, at the central government-run Lady Hardinge Medical College and Hospital, all of the daily Covid admissions are patients categorised as “severe”. “About 20 new patients are coming in everyday and all of these are severe cases,” said Lady Hardinge Medical Superintendent Dr N.N. Mathur, adding that 90 per cent of their beds are occupied in general while almost all ICU beds are taken.
According to the Delhi Corona App, however, 11 of the 50 ICU beds at the hospital appeared to be vacant Monday.
Leading private hospitals in the city like Saroj Superspeciality Hospital, the two Max Hospital branches at Saket and Shalimar Bagh, Indraprastha Apollo, and Moolchand Khairati Hospital are already out of ventilator beds, according to the Delhi Corona app.
“The patients who are running around for beds are those who require ICU beds. Even the patients who are being referred from other hospitals are ones who require ICU beds,” said Dr S.P. Byotra, chairman of the department of medicine at Sir Gangaram Hospital.
“In addition, we have very sick patients coming in from other states, sometimes as far as Jammu and Kashmir, and even they need ICU beds. As a result, ICU beds are in high demand and not available,” he added.
Dr R.S. Rautella, medical director at the Delhi government’s GTB hospital, said “if there are no beds left, how does one let more patients come in?”
“It’s beyond our control too and even we get upset,” he told ThePrint. GTB currently has no vacancy as far as ICU Covid-19 beds are concerned, according to the government’s Corona app.
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‘Late admissions leading to deaths’
Doctors said the increased requirement for ICU beds can be attributed to the fact that patients in home isolation don’t always seek medical attention at the right time.
According to doctors, one key parameter to judge if a Covid patient requires hospital admission is their oxygen level, which they say should be tracked with pulse oximeters that are now widely available in the market.
Patients, they say, should not wait to seek admission once their oxygen level hits 90. However, many a time, they claim, patients arrive when oxygen levels have dropped as low as 50-60.
“Due to home isolation, people are coming late to hospitals. Patients often say that they had fever for 2-3 days, which then subsided. But the problem with Covid is that, often, we notice in the second week that oxygen levels drop suddenly. Or patients develop pneumonia,” said Dr Dhiraj Malik, medical superintendent at Saroj Superspeciality Hospital, a private facility that was turned into a Covid hospital in June.
“When they come to hospitals with such conditions, it becomes difficult to save them. About 20 per cent of ICU admissions have resulted in deaths due to this at our hospital in the last month,” he added.
Dr S. Chatterjee, internal medicine specialist at Indraprastha Apollo, said while “home isolation is fine, patients often don’t monitor their oxygen levels, don’t keep in touch with their doctors”. “So they can’t judge themselves when they become serious. Even the elderly are preferring to be in home isolation now instead of getting admitted. Around 15-20 per cent of deaths from ICU admissions at our hospital have been due to this,” he added.
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