The reception area at the main in-patient building of St John’s Medical College Hospital in Bengaluru, a key private sector treatment facility for Covid-19, has been converted into an emergency room for patients arriving with acute breathlessness. A resident doctor in full Hazmat suit rotates between three patients on oxygen at the makeshift Covid-19 emergency room, and patients arriving in the room.
Outside, there is a long line of people waiting to get their swabs collected for Covid-19 test.
In a building adjacent to the emergency response facility is the ICU, where all 32 beds are occupied by coronavirus patients, 20 of them on ventilators and 12 with ventilators on standby, a senior professor at the hospital said.
On a day Karnataka Chief Minister B S Yediyurappa held a meeting with private hospitals, and asked them to provide 50 per cent of beds as promised by them “with effect from tomorrow” due to “an acute increase in Covid-19 cases reported in Bengaluru”, according to a press release, St John’s Medical College Hospital reported six Covid deaths, a staff member who returned after depositing a body in the hospital mortuary said.
Out of 4,537 fresh cases reported on Saturday, 2,125 were from Bengaluru urban alone.
The healthcare infrastructure in Bengaluru, which seemingly had the situation under control three weeks ago, is now wilting under the growing pressure, as cases have grown five-fold — from 4,555 on June 30 to 22,941 on July 17, including 20,863 active cases. As many as 485 of 582 Covid deaths in Bengaluru have occurred since July 1.
“The situation is pathetic. There is a severe shortage of ventilators. The government has the most resources — land, money and equipment. They should do something but they are passing the buck to private hospitals,” said the doctor in Hazmat suit, insisting that he not be named.
A few days ago, a resident doctor at emergency response unit at the hospital put out a message on social media posted on Facebook: “March and April were marked by an uneasy calm. June and July have been an absolute nightmare. A nightmare that has laid bare every little deficiency in this city’s healthcare infrastructure.”
A professor at medical college hospital, who works on rotation in the Covid-19 ICU, agreed: “There has been very poor planning for this crisis. There are not enough ICU ventilator beds with the government and they are pushing patients to the private sector. The main government hospitals – such as Victoria Hospital and Jayadeva Institute of Cardiology — have a lot of resources but they have not been fully utilised. The government got complacent with the low numbers of Covid-19 cases from March to June.”
Caught admittedly unawares by the surge in cases, the state government is engaged in a daily battle of attrition with private hospitals to get the latter to dedicate more beds — specifically ICU ventilator beds — for Covid-19 patients on account of a severe shortfall in the government sector.
An official government portal with real-time information on hospital beds in Bengaluru, which went live on Friday, shows a severe shortage of ICU ventilator beds. On Saturday, it showed there are 138 ICU ventilator beds in the government sector — across three medical colleges and 15 government hospitals — with 45 ICU ventilator beds available to the public. In reality, there are only seven ICU ventilator beds available (one in Victoria Hospital, the main Covid-19 hospital, and six in others) in government sector, as 38 beds shown as being available at Trauma and Emergency Care Centre are also part of 50 beds at Victoria Hospital, where 49 beds are occupied by patients.
Warnings have been issued on a daily basis by state ministers, the state chief secretary; and meetings have been convened under the leadership of the CM to get private hospitals to relinquish more beds for patients sent by government health facilities. There have also been threats of power supply cuts, say officials of private hospitals.
This week, the Bengaluru Urban District Health Officer visited Vikram Hospital and a unit of the Apollo Hospitals and issued notices warning of cancellation of their registration under the Karnataka Private Medical Establishment Act for not releasing 50 percent beds to the government, as mandated by a June 23 order under the Disaster Management Act, 2005.
“The need of the hour is for private establishments and the government to come together and contain the pandemic. The Mumbai corporation (BMC) has taken over 80 percent of private hospitals (in the city) to handle only Covid cases and the prices they have fixed is less than what Karnataka has fixed,” Medical Education Minister Dr K Sudhakar said this week.
Massive shortage of ICU ventilator beds
An official government portal with real-time information on hospital beds in Bengaluru, which went live on Friday, shows a severe shortage of ICU ventilator beds.
On Saturday, the portal showed there are 138 ICU ventilator beds in the government sector — across three medical colleges and 15 government hospitals — with 45 ICU ventilator beds available to the public. However, in reality there are only seven ICU ventilator beds available (one in Victoria Hospital, the main Covid-19 hospital, and six in others) in the government sector, as 38 beds shown as being available at Trauma and Emergency Care Centre are also part of 50 beds at Victoria Hospital, where 49 beds are occupied by patients.
”There are 36 ICU ventilator beds in the Trauma Care and Emergency Centre and there are 14 beds in the Master Plan building in Victoria Hospital complex,” said the director and dean of Bangalore Medical College, which runs Victoria Hospital.
“They seem to have counted Trauma Care and Emergency Centre beds in Victoria (hospital’s) quota and separately also,” a senior doctor at BMCRI said about the beds portal data.
Dr Taha Mateen, managing trustee of private HBS Hospital, now a Covid care hospital, said: “There are not enough oxygenated beds in Bengaluru city. ICU beds are almost non-existent when you compare it to the total requirement. Large hospitals having 10 ventilators for a city like this is pathetic…. The US has 36 ventilators per thousand people; we do not have even 0.36 ventilators for 1,000 (people). The demand far outstrips availability.”
Data on the portal shows that the majority of available ICU ventilator beds in Bengaluru are in the private sector — with 358 available across 316 private hospitals and medical colleges and only 69 of the ICU ventilator beds occupied by patients, leaving 297 available to the government.
On Saturday evening, the portal showed presence of 8,746 hospital beds across sectors (1,622 in government, 7,124 in the private sector) for Covid-19 patients, with 5,578 beds available to patients — 391 beds in government hospitals and 5,187 in the private sector).
The Karnataka government contends that the private sector has been unwilling to relinquish 50 percent of the total of 16,257 hospital beds in the sector for Covid-19 patients by claiming to have only around 10,000 beds across private hospitals.
“With majority of beds earmarked for treating Covid-19 patients, treatment of non-Covid patients is going to be a challenge, and the government should rethink the policy of allocation of 50 percent of private beds for Covid-19,” Dr R Ravindra, president of Private Hospitals and Nursing Homes Association, said this week.
“The basic mistake happening is that hospital beds are being classified into private and government (hospitals). The division does not help foster public-private partnership. We feel the respect we have for the government is not reciprocated,” he said.
Dr Ravindra has claimed that private hospitals have admitted over 1,000 coronavirus patients of their own.
“It is very unfortunate that organisations representing doctors and private establishments are manipulating figures like this,” Medical Education Minister Dr Sudhakar said in a response to the stand of the private hospitals. “The government has details of all hospitals – don’t let it get to the fighting scenario. Under epidemic diseases Act we can take over and ensure that all patients get their due share.”