As per the revised estimate that the AAP government is citing now, Delhi will have 5.5 lakh coronavirus patients by July end, and will need 1.5 lakh beds. As of now, the Capital has 9,179 beds — 4,929 occupied and 4,250 vacant — and 582 ICU beds set aside for treatment of Covid patients.
The gap is a factor of many things, including faultlines between the Delhi government and private hospitals, pending procurement of oxygen concentrators and ventilators, insufficient clarity on facilities where additional beds can be set up, and resistance from hotels meant to be attached to hospitals.
The two-and-a-half months of lockdown were meant to help the Capital prepare for precisely such a scenario. During the same time, Mumbai (which is testing 17,956 per million population, as opposed to Delhi’s 13,180 per million), has set up 330 Covid care centres with 48,247 beds to quarantine high-risk people. Another 25,619 beds have been set up for asymptomatic and mildly ill patients. The city corporation created facilities in open grounds, horse-racing tracks, and exhibition centres, including some with oxygen-attached beds. Maharashtra has also issued a notification taking over 80% beds in all private hospitals to treat Covid-19 and non-Covid-19 patients.
Delhi, so far, has 344 beds in Covid health centres and 5,824 in Covid care centres (both are of mild/moderate cases).
Now, with the un-lockdown beginning, numbers surging and the peak still ahead, the Delhi government is trying measures such as reserving beds in the capital for Delhi residents and changing criteria for testing, seen as a bid to lessen hospital load — both struck down by the Lt-Governor. A look at what was, and wasn’t, done during the lockdown:
Delhi has 57,709 beds in all, including state, centre and private hospitals, according to the Economic Survey 2019-20. The Association of Healthcare Providers in India says these have around 1,600 ventilators, and over 2,800 ICU beds.
On March 3, 26 hospitals (19 government) with 230 beds were set aside for Covid patients. As the numbers grew, the government decided to cut down on hospitals but consolidate beds in a few facilities. On March 20, it told private hospitals to keep beds ready in case the need arises.
When the Capital entered lockdown on March 24, it had 30 Covid-19 cases and one death. Over the next few weeks, in several orders, the government added and removed hospitals from the Covid list.
At the same time, Chief Minister Kejriwal formed a five-member committee to assess Delhi’s infrastructure. The committee — now replaced by another — suggested converting state-run Lok Nayak and Rajiv Gandhi Super Speciality Hospitals into Covid-only facilities.
The first private hospitals to start admitting patients were Max Super Specialty, Indraprastha Apollo and Sir Ganga Ram Kolmet Hospital, in the first week of April.
Between April 30 and June 3, the government told 11 more private hospitals to reserve beds for Covid-19. On May 24, 117 hospitals and nursing homes were asked to earmark 20% beds. On May 29, three more Delhi government hospitals were made Covid-only. On Tuesday, 22 private hospitals were told to reserve 20% more beds, adding 3,456 beds to the existing capacity.
The Delhi government has talked about adding three new government hospitals — a 450-bed hospital in Burari, a 2,000-bed hospital in Dwarka and a 400-bed hospital in Ambedkar Nagar. While the first two are expected to start by month-end, the hospital in Ambedkar Nagar will take longer.
On why the Delhi government has converted only five of its 38 hospitals into Covid facilities, Dr Arun Gupta, a member of the new committee handling the crisis, said, “We have suggested that more government hospitals be converted. Plans are being altered depending on the number of cases.”
Beyond the government, any increase in bed capacity is hampered by the frayed relationship between the AAP administration and private hospitals. While private hospitals have faced criticism from the government for overcharging or denying beds to patients, the hospitals accuse the government of acting unilaterally.
Said a former health secretary: “During the lockdown, discussions should have been held between private and government hospitals to figure out the requirement… Learning from Mumbai, prices should have been capped for private hospitals.”
A former bureaucrat in the Union Health Ministry also underlined this lapse. “Sending a patient suddenly to a private hospital creates trouble for all. A public relations officer should have been deployed in every government hospital to oversee the process and referral should have been done by some network facility using technology.”
On the Delhi government’s projection for more beds, the former official said, “It has to be clear about the type of beds they need. Do they require beds with ventilators or oxygen concentrators?” Healthcare workers would have to be trained accordingly, she pointed out.
But, Delhi is also facing a shortage of healthcare workers — a problem set to worsen as more facilities are created. The state health official said, “A demand was put before the Central government and around 350 doctors added to Delhi’s strength.”
Health Minister Satyendar Jain argued Wednesday: “If we had arranged for beds equalling the number of Covid cases in Delhi, people requiring non-Covid health services could not have been treated… We are currently preparing for June 30. We will arrange 15,000 beds by June 20.”
The Delhi government, which has written to the Centre demanding Rs 5,000 crore, maintains it has not received anything so far from the disaster relief fund given to other states.
Since March 24, Delhi has increased its oxygen concentrator numbers from around 500 to 3,000; while a tender has been filed for getting 210 ventilators to add to the 308 now available in Delhi government hospitals. As per the current trends, of the total cases, 20-25% will require hospitalisation and 5% cases will need ICU/ventilators. A senior Delhi Health Department official claimed the delay was on account of lack of quality equipment. “Forty ventilators have been procured… There is shortage of quality products, which is why procurement takes time.” On Wednesday, the government said it has decided to make oxygen facility available in all hospital beds.
On April 7, the CM announced plans for 12,000 beds in hotels and 10,000 in banquets and dharamshalas, to handle up to 30,000 active cases. While some hotels were used as quarantine facilities for those returning from abroad, the first step towards creation of additional facilities was taken only nine days ago.
On June 1, the Delhi Disaster Management Authority (DDMA) wrote to all district magistrates to identify, “on priority”, facilities where additional beds can be put up. Till Wednesday, the West, North-West, South and New Delhi DMs had prepared a list.
The West district has identified 13 banquet halls, community halls and marriage halls, with provision for 2,350 beds. South DM B M Mishra said Siri Fort and Saket sports complexes can be made coronavirus facilities, apart from a nursing home and three hotels, for around 350 beds.
North-West District has identified 22 halls, for setting up 3,280 beds. “However, the toilets are too few… In some places, the ACs may take a few days to become functional. Some banquet (halls) are in malls where there are shops and restaurants on ground floors,” says a document by Rohini SDM. Divisional Commissioner Sanjeev Khirwar said they plan to use the Talkatora Stadium and Pragati Maidan, linking them to Covid hospitals.
While North and East DMs said they are yet to complete the process, officials in Shahdara, East and North-East districts said areas under their jurisdiction are too densely populated, with very few multipurpose halls. Those in Central District said they had initially identified IGI Stadium but the decision is not final.
While Delhi L-G Anil Baijal Tuesday listed a set of stadia, including Indira Gandhi, where coronavirus facilities could be set up, a senior official said convincing sports authorities is not easy. South-East District administration, for example, issued an order in March to convert JLN Stadium into a quarantine facility, which never materialised.
The Delhi government has blamed the Sports Authority of India for the delay, but the latter said it had given its approval.
Hotels as hospitals
In April, the Delhi government had said that as Covid cases increase, hotels would be equipped with medical facilities to house people who do not have serious symptoms. “There will be 12,000 hotel beds,” the CM had said.
However, the first requisition for hotel beds for Covid patients was made on May 29, with the number of cases up to 17,386.
For the five hotels, the order attaching them to five private hospitals, came as a bolt from the blue. A government official, on condition of anonymity, admitted that while hotels had been told their facilities might be needed, no one contacted them till late May. Delhi government sources said there was opposition from hotels. “They raised issues such as stigma, loss of business in the future and lack of staff,” said a senior official.
While Batra Hospital & Research Centre was assigned Crown Plaza Hotel, Sir Ganga Ram City Hospital got Hotel Jivitesh, Dr B L Kapur Memorial Hospital Hotel Jaypee Siddhartha, Max Smart Super Specialty Hospital at Saket, Hotel Sheraton, and Indraprastha Apollo Hospital, Surya Hotel. The order said hospitals would provide manpower, such as nurses and doctors, along with oxygen supply to their assigned hotels.
Batra Hospital Director Dr Sudhandhu Batra said the Crowne Plaza administration has not allowed them to assess their facilities so far. “We are ready to follow the government’s directives,” he said. The hotel did not respond to calls and emails seeking a comment.
A representative of the 100-room Hotel Jaypee Siddhartha said they were waiting for a hospital visit. “The hotel has been shut since March… No meetings about this have been held with the hotel staff yet.”
The 200-room Surya Hotel has gone to court, flagging among other issues the lack of consensus on fixing rates per room.
The only hotel which has started admitting patients is Sheraton. A Max Hospital spokesperson said patients who are not in a serious condition have been shifted to the hotel, refusing to give a number.
Ganga Ram Chairperson Dr D S Rana said preparations were on to start facilities at Hotel Jivitesh. “The conversion will take time but we will be able to create around 36 beds there,” he said.
A representative for one of the hotels, on condition of anonymity, asked why they were not consulted. “The hospital has told us that our entire ventilation system as well as floor plan needs to be altered. Our staff members are refusing to come to work. How will we manage?” he said.
At Tuesday’s DDMA meeting, Delhi Principal Secretary (Health) Vijay Dev Dutt told the L-G that more four- and five-star hotels will be linked to hospitals, with their price capped at Rs 10,000 per day per bed. “District Magistrates are carrying out the exercise of linking 19 more hospitals with hotels, which would tentatively increase the capacity by around 2,000 beds by June 15.”
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