New Delhi: As the number of Covid-19 cases in Delhi has risen, the time spent by patients in hospital has also increased. The shortage of beds in the national capital is a result of this, and it has now emerged that patients are also approaching hospitals only once their condition deteriorates, in turn leading to a longer stay in the ICU and also death.
Delhi Health Minister Satyendar Jain pointed out these facts last Friday, when he said most Covid-19 deaths were occurring more than 10 days after hospitalisation.
“There are some deaths that still happen within three days of hospital admission, but most deaths happen after 10 days,” Jain said.
Doctors at several hospitals told ThePrint that the shortage of beds is because the duration of patients’ stay has increased in the “third wave” of Covid, compared to the previous two. Five of the seven hospitals approached by ThePrint confirmed this trend, while only one each said the duration of hospitalisation had either decreased or remained the same.
Government data showed that Delhi has recorded over 100 deaths each day for three days in a row, starting Friday. The highest number of deaths reported in a day during the June-July surge was 101, but in the ‘third wave’, the highest daily toll has been 131 on 11 November. The number of cases also hit a record high of 8,593 in a single day on 11 November, while in the previous two waves — in June and September — the numbers recorded were 3,957 (23 June) and 4,432 (17 September) respectively.
According to the Delhi Corona app, just 136 ICU beds with ventilators were available as of Monday noon out of the city’s 1,411, while the corresponding figures for ICU beds without ventilators were 500 out of 2,749. Overall, 8,107 Covid beds are available out of 17,592 in Delhi.
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Patients arrive when oxygen levels have dropped to low level
At the Delhi government-run Guru Tegh Bahadur (GTB) Hospital, the average duration of stay for a Covid patient has increased from 10 days to three weeks. Dr Rajesh Kalra, additional medical superintendent, told ThePrint, “The condition in which patients arrive at the hospital also determines their stay. Since their oxygen saturation levels have already dropped to a low level, some of them have to be immediately moved to ICU. They take longer to recover.”
Doctors said patients’ condition in home isolation is becoming severe because they can’t judge their oxygen levels.
“Patients can’t really judge when they need hospitalisation. By the time they are coming, their oxygen levels have already dropped well below 90. In such a scenario, it becomes very difficult for hospital care to show effect,” said Dr Dhiraj Malik, medical superintendent, at the privately owned Saroj Super Speciality Hospital, which was converted into a 100 per cent Covid facility in June. “Patients are now staying for as long as 15 days to sometimes even a few weeks due to this.”
Doctors also said the long period of stay now is due to medical reasons, whereas during the first “peak” in June, it was due to treatment guidelines.
“Earlier, patients could only be discharged after 14 days — they were mandatorily required to test negative before discharge, even if they didn’t need hospital care. Now, we can discharge patients if they don’t need oxygen support for over 24 hours if symptoms are well-managed, but we are seeing patients stay severely ill for 7-10 days,” said Dr S. Chatterjee, internal medicine specialist at Indraprastha Apollo Hospital.
More severe cases
The only hospital out of the seven approached by ThePrint that said the duration of patients’ stay had remained the same over the three waves was Sir Gangaram Hospital. However, its chairman, Dr D.S. Rana, concurred with the other hospitals on the increased severity of cases.
“The average duration of stay was 11.04 days in both June and September, and data till 19 November says the average stay now has been 10.9 days. While the duration has remained the same, we have been getting patients who are more sick,” Rana said.
At Delhi’s largest Covid facility, the LNJP Hospital, authorities said more critical patients are coming in now, but the hospital hasn’t analysed data to see if the duration of stay has increased.
At the Delhi government-run Rajiv Gandhi Super Speciality Hospital (RGSSH), while patients’ average time spent at hospital hasn’t increased significantly, there has been a stressful situation over the past 10 days because of patients having to spend a long time in ICU, since the facility receives many referral cases from other hospitals in Delhi
“While a stay of 10-12 days has been the case even prior to this latest surge, since the number of ICU beds occupied is greater in number, those who require ventilator once they reach the hospital at times have to wait till an ICU bed is vacated. So, these things are leading to delays,” said Dr B.L. Sherwal, medical director of the RGSSH.
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‘Delayed admissions resulting in deaths within 72 hours’
Doctors added that with patients staying longer and more severely ill patients coming in, the number of deaths has climbed. Dr Sherwal said: “A majority of the deaths in the ‘third wave’ have occurred within 48-72 hours (of admission).”
GTB Hospital’s Dr Kalra further said given the multiple changes in government guidelines, “we would earlier admit even asymptomatic patients and even their contacts would quarantine in hospital, say during the Nizamuddin Markaz episode. But now since serious patients come in, 35-40 per cent deaths occur in the first 72 hours”.
At Max Super Speciality Hospital in Saket, where a large inflow of Covid-19 patients is seen round the clock, Dr Arun Dewan, senior director, critical care, said the majority of deaths were occurring within 24-48 hours of admission.
Pollution, cold weather, access to testing
Health experts pointed to numerous reasons for these worrying trends. Dr K. Srinath Reddy, president of the Public Health Foundation of India, said, “Severity of infection, more adverse outcomes and longer hospital stay could be the result of a combination of factors: Air pollution that reduces immunity, increases inflammation and aggravates damage to lungs; and cold weather, which depresses immunity.”
He also people stay in closed spaces for longer periods due to cold weather, and the reduced air flow increases survival time of the virus on surfaces, thereby adding to viral load inhaled.
“Longer hospital stay may be due to both severe illness and changes in treatment protocols involving new drugs, which require hospital-monitored administration,” Reddy cautioned.
Dr Anant Bhan, medical doctor and researcher in the fields of global health, health policy and bioethics, added that timely and increased testing can also help address the issue.
“Due to fear of getting tested or hospitalised, people also haven’t been as proactive as they ideally should be,” said Bhan.
Bhan pointed out that access to testing facilities is also crucial. “If someone has to travel a distance of 10 km to stand in a queue to get tested, and be surrounded by people who are coughing, then automatically there is reluctance,” he said.
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