New Delhi: Outside the entrance at Lok Nayak Jai Prakash Narayan (LNJP) Hospital — which has the 2,000 beds for Covid-19 cases, the most in the national capital — Tajinder Singh paced up and down as he waited to get his brother-in-law admitted, after having been turned away by four different hospitals.
“My brother-in-law has had a fever and breathing problems for around seven days,” Singh said last week. “We are trying to get a bed here through a source. But it’s been two hours and we still haven’t got a bed.”
But this anxious search for beds has culminated into death for many. Outside the mortuary, Bhupesh Gupta recounted taking his 40-year-old brother, Kamal, to five hospitals before he was admitted to LNJP. But Kamal’s condition deteriorated and he passed away suddenly.
“I got a call from him last evening and he said to please take him away, because he wasn’t getting adequate treatment and oxygen. Today morning we were told he was dead,” said Bhupesh. “We had taken him to five hospitals before coming here — no one did a Covid-19 test.”
This problem of beds or treatment, however, isn’t limited to just LNJP. Tales of panic and despair from residents desperate for admission and testing seem to be ubiquitous across the national capital.
Mounting cases, which hit 31,309 Wednesday, and varying government policies on the treatment of Covid-19 patients has left Delhi’s health infrastructure hard-pressed and its residents helpless.
Over the last week itself, the Arvind Kejriwal government barred six private and two public labs, with a combined testing capacity of 4,000 tests per day, from testing further because they allegedly flouted Indian Council of Medical Research (ICMR) guidelines.
On Saturday, 6 June, it announced hospitals turning away patients suspected to have Covid-19 would be punished. Then on 8 June, the Lieutenant Governor overturned a government order that stated only Delhi residents would be able to avail the services of private and government hospitals in the city.
The spate of orders comes at a time when the nationwide lockdown is being eased, and the Centre-state divide is widening. Health Minister Satyendar Jain said Tuesday that 50 per cent of cases were of unknown origin — but after a meeting with the L-G, Deputy Chief Minister Manish Sisodia said, “Officials from the Centre say there’s no community transmission in Delhi.”
Delhi’s Covid-19 casualties stand at 905, and its infections are rising by nearly 1,200 on an average daily. Sisodia has said the cases in the city are projected to spike by 5.5 lakh by the end of July, with 80,000 beds needed. Currently, Delhi has 8,975 beds across state-run, Centre-run and private hospitals.
On Tuesday, the Delhi government ordered hospitals and private facilities to prominently display information about the availability of beds on a flex board at their main gates.
Dr Sanjiv Kumar, former director of the national health systems resource centre and chairman of the Indian Public Health Association, said doctors and patients would ultimately bear the brunt of the government’s ad-hoc decisions.
“With all of these guidelines and orders that change within a day, a lot of misinformation is created. And that in turn creates stigma and fear. You already have people running from pillar to post trying to get admitted or tested. The government needs to be sensitive and plan ahead for this upsurge,” he said.
ThePrint reached Delhi’s health secretary and health minister for a comment, but calls and messages went unanswered until the time of publishing this report.
Endless referrals between hospitals
As an initial step to meet the demand for beds and ease the burden on public hospitals, the Delhi government had, on 25 May, ordered that all private hospitals reserve 20 per cent of their beds for Covid-19 patients.
Last week, it ordered three private hospitals — Sir Ganga Ram Hospital, Saroj Super Specialty Hospital, and Moolchand Hospital — give up most or all of their beds to ailing Covid-19 patients. But sources in these hospitals say they were taken aback by the order and weren’t given a warning or consulted before the policy came into place.
“We still have non-Covid patients in our hospital and we don’t know what to do with them. We were caught completely unaware with this announcement. We have dialysis patients, patients booked for due deliveries. We have to figure out what to do with them,” said an administrative source at Moolchand, which is now considered a 100 per cent Covid-19 facility.
At Sir Ganga Ram, where 80 per cent of its 675 beds will cater to Covid patients, a source said that till the facilities were ready, they would have to continue referring patients to government hospitals.
“We suddenly have to reserve a total of 505 beds for Covid-19 patients. It requires changing floor plans and exists, fixing the central air conditioning, deputing enough staff. It won’t happen in 24 hours,” said the hospital source. “It may take up to a week or 10 days till we are ready to admit more patients. Until then, we have to refer them elsewhere.”
The Delhi government last week slapped an FIR on Ganga Ram for allegedly violating testing protocols. Its testing lab, which has the capacity of doing 300 tests per day, has ceased all testing since Saturday. As it cannot test, it cannot admit Covid-19 patients or operate on non-Covid patients either, according to government rules.
“Most of the calls we get are for testing. We’re turning away hundreds of people because of the government order, and we can’t admit them or operate on them,” said the source.
At Saroj Super Specialty Hospital, the third facility to be converted, medical superintendent Dr Dhiraj Malik told ThePrint that shortage of staff was among the biggest concerns for private hospitals.
“Private hospitals don’t have as much staff as government hospitals like residents, senior residents etc. Most of the doctors we have are above 60 with comorbidities like diabetes or heart problems,” he said. “Staff is also scared to work on Covid patients. This is also one of the reasons why private hospitals were sending patients to government facilities.”
The lag in readying Covid beds as infections rise has put more pressure on the public hospitals. LNJP Chief Medical Officer Dr Ritu Saxena expressed disgruntlement at the rate at which private hospitals were making referrals.
“The moment we turn away a patient, it becomes a big deal. But why are private hospitals not treating Covid patients? The moment a patient tests positive, they send them all here to LNJP and leave. Is LNJP the only hospital in Delhi?” she said.
Ram Manohar Lohia (RML) Hospital, the city’s nodal facility, is already full up with all of its 200 beds occupied. According to the Delhi Corona app — which was launched on 2 June to ease the search for beds — 12 of RML’s beds appear to be vacant, but it hasn’t been updated since 6 June. RML Public Relations Officer Smriti Tiwari told ThePrint the hospital was forced to turn patients away.
“The app is not updated in real-time, but all our beds are full. We feel bad about turning patients away, but what else can we do? We can’t make statements about other hospitals, but RML cannot take excess patients that are being referred to us by private hospitals,” she said.
‘Not building capacity’
Dr Kumar of the Indian Academy of Public Health told ThePrint that the Delhi government’s plan to tackle Covid-19 was growing more unclear by the day. The government had ordered that testing be narrowed to mainly symptomatic cases, until the L-G stepped in Monday and overruled this decision.
“Instead of increasing capacity, they appear to be decreasing capacity. At every phase of the illness, a plan of how to increase state capacity and testing needs to be drawn up. They took a retrograde step,” he said.
Diagnostic chain Dr Lal Path Labs told ThePrint that securing permission to test was a time consuming process.
“We were ready to ramp up testing 15 days ago, but didn’t have permission except in two districts. We had written to the government to activate our RT-PCR app for other districts but it hadn’t come through,” said Dr Shray Malhotra, senior manager at Dr Lal Path Labs. With permissions in place, Dr Path Labs began testing in all Delhi districts Monday.
Without government regulation, some private labs and hospitals are also providing tests and treatment at their discretion. Saroj Super Specialty Hospital is charging a minimum of Rs 3 lakh for admissions, and an advance of Rs 40,000 or Rs 50,000. Asked about this, Dr Malik said it was “nothing wrong”, adding that the hospital was providing 15 to 20 free beds for economically weaker section patients.
According to Kumar, the best way to tackle the situation is through surveillance and communication.
“All interests need to be represented before the state’s Covid-19 task force. Central, state, and private agencies need to be part of all decision-making. Clearly that is not happening,” he said. “If these interests were put forth in a systematic manner, perhaps Delhi’s health infrastructure would not be under so much pressure,” he said.