With Karnataka overtaking Maharashtra to report the highest number of cases as well as deaths on Tuesday, and Bengaluru reeling under 300-plus daily deaths, the state government plans to use the 14-day lockdown that began Monday to rationalise the use of hospital beds, set in place proper triaging of patients, and create ICU beds on a war footing.
Since the beginning of this month, Bengaluru has seen 2,153 deaths, compared to 1,907 in April. In the first wave, it had seen 971 deaths in the worst month of September 2020. The city has been reporting 20,000-plus cases daily.
Amid allegations of black-marketing of beds in Bengaluru, Chief Minister B S Yediyurappa on Tuesday assessed the situation himself, saying later, “One of the things I have said is that people must not occupy hospital beds for long periods of time. They are blocking access to beds for serious patients.”
Of the 9,242 Covid patients in 167 hospitals on Tuesday morning, nearly 303 had been admitted for more than 30 days, 503 for over 20 days, 1,900 for 11 to 20 days and 6,500 for one to 10 days, he said.
Home Minister Basavaraj Bommai said, “At many hospitals, even after a patient dies, these beds are not released for 15 days. Now we have a reporting system for patients after 10 days and this will be physically verified… We can get about 1,000 beds (freed) like this.”
The government estimates the demand for beds currently at 11,500. The gap between demand and supply is steepest in ventilator beds, with only 150 available in the public sector and 400 in private hospitals, and at least 200 new admissions requiring the same daily. The Indian Express had reported earlier that there had been very limited increase in ICU ventilator beds since the first wave despite Karnataka receiving over 2,000 ventilators under PM-CARES.
The state has directed all big hospitals in Bengaluru to tie up with hotels near their facilities to create facilities for less serious patients. Bommai said the government would help the hospitals, and that they plan to raise bed numbers by 5,000 thus.
In triaging, Karnataka is taking a cue from Mumbai’s success in ensuring that those who are seriously ill get timely medical help. The system was in place in the first wave in Bengaluru but has fallen apart in the intense second surge since late March. A May 9 Health Department circular said triaging could be done by telephonic mode or physical method.
IPS officer Dr P S Harsha has been made the nodal officer in-charge of a ‘Mission ICU’ for Bengaluru to augment critical care facilities. “We may require about 300 oxygenated beds, 150 HDU (high-dependency unit) beds, 15 ICU beds and 15 ICU beds with ventilators in each of the eight BBMP (Bengaluru municipal corporation) zones,” Harsha said.
Dr Sanjiv Lewin, the head of medical services at the 1,000-plus-bed St John’s Medical College, however, cautioned that creating facilities was not enough, with nurses, doctors and paramedics needed to run the same. “The government is waking up very late. If they can do it, it is wonderful. But there is a critical error.”
A senior doctor in charge of emergency care at a 750-bed government hospital for Covid-19 said a better route would be managing patients on the basis of risk categories. “If you increase the number of ventilators with the present staff strength, the new facilities will become ventilator graveyards… Managing a patient on a ventilator is very, very difficult. You need an intensivist, anaesthetist, pulmonologist, technician and ICU-trained staff… a six-member team. It is impossible in this crisis,” he said.