There are only nine ventilators dedicated to government-run COVID-19 isolation wards across the Tricity which had reported 13 confirmed corona patients till Monday.
These nine ventilators are spread across the three isolation wards in Chandigarh. Panchkula has none of its own, it has managed to procure as many as 57 from its private sector.
The Mohali administration claims they are in talks with private hospitals.
With a total of 13 individuals already receiving treatment for COVID-19 in the Tricity, if the pandemic spreads at the rate it has in other affected countries in the world, about 20 per cent of confirmed COVID-19 patients will need intensive care with breathing support through some administration of concentrated oxygen or artificial ventilation.
Nine ventilators at isolation wards
In the Post-Graduate Institute of Medical Education and Research (PGIMER), there are two ventilators dedicated to the isolation ward which can be increased to a total of six if need be, an official source claims. In the isolation ward at the Government Medical College and Hospital (GMCH) in Sector 32, there are a total of three dedicated ventilators, and in the Government Multi-Specialty Hospital (GMSH) in Sector 16, ventilators are withdrawn from the general medical ICU ward if the need arises, according to a source from the emergency department of the hospital.
“Apart from the dedicated three, we will use all the remaining ventilators at our disposal in the hospital if need be,” said the Medical Superintendent of GMCH, Dr Ravi Gupta. The hospital has a total of 32 ventilators, most of which are already occupied by other patients admitted to ICU wards. At PGIMER, there are approximately a total of 50 ventilators, including the ones dedicated to the isolation ward, according to the director of the institute.
These ventilators are almost always completely occupied and patients enrol themselves at the bottom of waiting lists which have at least 20 patients enrolled already. “Most poor patients can’t even afford these ventilators and use manually pumped bag valve masks. So if we do get positive patients, I don’t know how we will handle the load,” a doctor from the institute said. “It is very expensive to manufacture ventilators and resources are already scarce in a country like India.”
The lack of ventilators is a cause for concern since most severe cases of coronavirus which lead to fatalities have symptoms of advanced and acute respiratory infection and require breathing support.
A joint report by the World Health Organization and Chinese authorities had noted that at least 20 per cent of the patients detected with the virus need ICU level care at hospitals. Five per cent of these patients require artificial ventilation and 15 per cent need to breathe concentrated oxygen in order to recover.
Each ventilator costs at least Rs 9 lakh in India. Apart from that, using the same ventilators for more than one patient exposes people to cross-infection. The pipes of these ventilators need to be replaced to disinfect and sanitise the machine, which will cost an extra Rs 10,000 per replacement.
At PGIMER, where the burden of the disease will probably be the most, institute director Jagat Ram claims that about 30 to 35 new isolation rooms, or up to 100 beds will be made available at the New OPD, ideally with about eight to 10 more ventilators. Apart from that, officials will be holding a meeting to procure more ventilators.
“We are trying to procure more ventilators as well in the meantime. Only the most severe cases require a ventilator so it shouldn’t be a problem. But I can reassure everyone that we will pool in our resources and do our best despite the onstraints,” the director said.
No ventilators at Panchkula Civil Hospital
The Civil Hospital of Panchkula, which recently got a makeover, has almost all but one facility, the ventilators. The authorities and local MLA put in everything, including ICUs and MRI facility.
This renders the Panchkula district on a whole, at the governmental front, without even a single ventilator.
But unlike the Mohali district, the Panchkula administration is taking measures and has tied up with several private hospitals of the city, including Paras, Ojas and Alchemist, which are not only building isolation wards to support the city in case of a disaster but have also provided them with almost 57 ventilators of their own, in case the need arises.
“Though we do not have any ventilators under us, the private sector has been very generous and has offered us their ventilators in case a need arises. But another issue remains that the number may go down because if a patient is already on it, we cannot really just take them off,” said CMO Jasjeet kaur.
The Panchkula administration has been referring patients that do need ventilators to either GMCH-32 or PGIMER in Chandigarh.
Meanwhile, following an advisory issued by the state, asking all dental departments and procedures to be brought to a minimum number, the Panchkula hospital which earlier used to see almost 300 patients a day, now takes in barely 10. All elective procedures have been postponed.
“We are only catering to just the emergency needs. It is our duty to relieve a patient from pain and are only taking cases that either present themselves with severe pain or are accidental and have fractured teeth et al,” said incharge of the department, Senior Dental Surgeon, Dr Shivani.
According to her, even in cases that are being treated, due precaution is being followed where they are asked to wash their mouth at least thrice with germ-killing mouthwashes and only then the procedure is performed.
Carbolisation (a method to disinfect) of the department is also done at least twice a day, including that of furniture, to prevent any infection from spreading. Fumigation is done twice a week.
Civil hospital ties up with other hospitals for ventilators
The civil hospital does not have a single ventilator which is inefficient to deal with any kind of emergency situation. The district administration, however, assured people that they had tied up with private hospitals in the city and there will be no problem in case the ventilators are needed.
Deputy Commissioner Girish Dayalan said that there was no availability of ventilator at the civil hospital but they had tied up with Max and Fortis hospitals in case they need the ventilators.
“The private hospitals are co-operating with us as we have made full arrangements. There is no need to get panicked. We have set up the isolation wards and the teams are ready to attend the affected people,” the DC added.
Asked in case of an emergency what would the district administration do, the DC said that the ventilator is needed at a very later stage so there was no need to get panicked.
The district has so far five positive cases of coronavirus and the administration has set up a state quarantine facility at Gian Sagar Hospital near Banur. An isolation ward too was set up at civil hospital in Phase VI.
The DC said that the PGI had asked the district administration to refer the patients who were in need of ventilators or are in serious condition.
“Our teams are ready. The PGI asked us to refer only serious patients. The affected persons shall be kept in the isolation wards,” the DC added.
The city has five big private hospitals: Max, Fortis, IVY, Indus and Mayo hospital. The state government has also directed the private hospitals to give access to their laboratories for tests.
Amid slew of complaints of mask shortage, PGI director assures of enough stock
Amid complaints made by the PGIMER healthcare staff that the institute does not have enough N95 and 3 ply surgical face masks, Director Jagat Ram has said that the hospital has enough masks for those who require them. “If they do have a complaint, they should approach the administration and the head of departments and in-charge to ask for more. From our side, we are following the WHO guidelines and equipping staff members who do require a mask,” said the director.
However, members of the healthcare staff have continuously complained about acute lack of safety provisions, such as masks and sanitisers, especially during the COVID-19 crisis. “Certainly, there is always a shortage of masks in the institute, which is even more severe during the pandemic, when awareness for precautionary measures has increased, and people have began hoarding masks and sanitisers as well,” said a member of the nursing staff, currently stationed at a private ward at the institute. According to the nurse, the panic created by the pandemic has led to patients and other staff members stealing the already lacking provisions that are present in the wards.
“There is surely a shortage of N95 masks but we have made attempts and now, at least those directly in contact with COVID-19 screening and patient care have been given N95 masks. All the others do not really need N95 masks, they can do with surgical or even cloth masks,” said Dr Uttam Thakur, President of Association of Resident Doctors at PGIMER. According to Thakur, in a meeting about a week ago, PGIMER authorities assured that they have a stock of 10,000 N95 masks and about 30,000 surgical masks. There is also local production of stitched cloth masks for employees working inside the hospital.
However, cloth masks do not have a filter, and cannot protect hospital staff from aerosol virus particles that might be produced by medical procedures and get suspended in the air. Hence, most staff working in and around COVID-19 isolation wards and screening facilities should be at least equipped with the 3 ply surgical masks. Many security guards and sanitation staff stationed at the hospital have been seen wearing cloth masks, some of them claim to have sown them at home, out of recycled clothes. “More than nurses and doctors, it is the sanitation staff and other contractual employees here who often do not have access to such provision on a regular basis. Even though they are as exposed to the virus as we are,” claimed the nurse, who works at the private ward.
“We do get the mask, but often it takes a lot of time to access it. Furthermore, they need to be changed in a few hours after one touches them or coughs or sneezes in the them. We certainly have far from enough to keep changing them as quickly as we are ideally supposed to,” said a doctor stationed at the emergency ward of PGIMER.
Another member of the nursing staff at the emergency department claimed that there is an acute shortage of masks even in the emergency ward. “There are so many people here around me without masks. The ward runs out of adequate number of masks quickly. Even if some of us are not directly exposed to the virus, soon we might not know which patient is stationed where. At least everyone in the building with the isolation wards should have masks,” said the nurse.
“We are still fine as of now. At least if we look around and persist we’ll get a mask. But if this pandemic spreads at the rate that is being predicted, we will surely be acutely ill-equipped soon,” said Thakur.
GMCH to procure 10 more ventilators with MPLADS fund
The Government Medical College and Hospital (GMCH) in Sector 32 is set to procure 10 more ventilators for its COVID-19 isolation ward after MP Kirron Kher released Rs 1 crore from her MPLADS (Member of Parliament Local Area Development Scheme) fund for the procurement of essential items such as ventilators to battle the coronavirus in Chandigarh. “We will procure a total of 10 ventilators using the funds,” said a spokesperson for the hospital.
The funds were released in response to a letter by Dr B S Chavan, Director Principal of Government Medical College and Hospital in Sector 32 (GMCH-32), seeking funds from the MP to curb the affect of the pandemic in the city, especially in GMCH-32, where six of the seven COVID-19 patients of the city have been admitted to the isolation wards.
In a letter addressed to Deputy Commissioner Mandeep Singh Brar, Kher said that the work of procuring essential equipment for treating COVID-19 patients and battling the spread of the virus is most urgent.
The work of procuring ventilators and other essential commodities should be “scrutinized, and technical, financial and administrative sanction issued as soon as possible on receipt of this letter”.
Furthermore, the letter stated that funds for all other recommended work under MPLAD may not be released and the procurement of essential equipment for fighting the epidemic should be done urgently.
“I had only written to the MP last night appealing for funds and was grateful that they came by so soon. We will be drawing up a detailed plan to procure ventilators and use the funds to pay for these,” Dr Chavan said. Each ventilator will cost an average of Rs 9 to 10 lakh.
SBI CGM LHO says ATM, essential services will remain operational
Chandigarh: Appealing to the SBI customers to carry out their banking transactions through ATMs and digital / internet banking and avoid visiting branch offices, CGM SBI LHO Chandigarh Rana Ashutosh Singh said, all the efforts will be made to keep ATMs and digital channels functional. He said, branches in Punjab, HP and Chandigarh will largely remain closed owing to the curfew, Haryana and J&K branches will operate with minimum staff to render essential services, including cash deposit,withdrawal, clearing, remittance, state transactions.