At 10 am on June 10th, Delhi government’s Corona Dashboard showed a total of 9021 COVID-19 beds, of which 4873 were occupied and 4148 were vacant. The availability of ventilators was 494 with 262 being used and 232 lying idle. These are figures as updated by the Central and Delhi state government and private COVID treatment facilities. And this Dashboard pattern showing about half the beds lying unoccupied has been there for the past many weeks.
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Yet, recent days have seen social media bursting with stories of patients going from hospital to hospital in search of a bed and being turned away on grounds of non-availability. Many social media posts alleged that some hospitals were willing to give a bed only on payment of a hefty amount.
In a country notorious for hoarding and black marketing of everything consumable, activist-turned-politician, Chief Minister Arvind Kejriwal did not mince words as he openly accused a few private hospitals, without naming them, of black marketing COVID beds. The chief minister also appealed to people not to go to hospitals unless absolutely necessary.
There is clearly a massive mismatch between the government’s corona app, which claims to provide real time information on hospital-wise bed availability, and patients’ experience. The hospitals — government and private — are required to update the availability status as and when beds become available.
The surge in COVID cases, however, has stunned the Delhi government that was, till a few weeks back, confident about its ability to manage the virus. In end May, it had even supported the idea of relaxing lockdown restrictions.
The rising numbers of positive tests on a daily basis led to altering of the testing protocol to leave out asymptomatic cases in order to manage scarce resources. Kejriwal also tried reserving its beds for Delhi residents only, but that was overruled by the Lt Governor Anil Baijal.
Delhi needs 1.5 lakh beds by July end
The reality is that the Delhi government’s efforts in managing healthcare in the face of the pandemic is proving a tough one. It may not yet have lost the COVID battle, but could well be close to doing so. With a total of about 18,000 active cases as of now, things are not looking good
Deputy chief minister Manish Sisodia has projected 5.5 lakh cases by end July, when the bed requirement will stand at around 80,000. This projection was presented at a meeting on June 9th of the Delhi Disaster Management Authority, of which the Lt Governor is chairman. But just a couple of days later, Kejriwal said that the requirement is likely to be over 1.5 lakh beds by July end.
Baijal had on June 7th scrapped the Kejriwal government’s order reserving all beds in hospitals under the Delhi government exclusively for the residents of Delhi.
The reservation order was based on the felt need and fears that people from the National Capital Region (comprising 23 districts of UP, Haryana and Rajasthan) in addition to Delhi would rush for the free treatment that government hospitals provide. Baijal cited “the Constitutional right to equality and right to life, which includes the right to health” as he trashed the reservation.
A maze of numbers
Dr Randeep Guleria, Director of the premier All India Institute of Medical Sciences (AIIMS), described Sisodia’s projection of 5.5 lakh cases by end July as “one of many mathematical models throwing up different numbers.”
“Whatever the numbers may be, there is a shortage,” a senior AIIMS doctor said. “More so when people suspect they have symptoms and want to go for tests. And when asymptomatic people go for tests just to be doubly sure”.
Dr Arvind Kumar,Chairman of the Center for Chest Surgery, Sir Ganga Ram Hospital, denied allegations of patients being turned away when beds are available. “At this moment, we have 300 COVID positive patients” he said.
The Delhi government has directed 61 private hospitals to free up 20% of their beds for the use of COVID-positive patients. Health Minister Satyendar Jain has taken a stern stance on hospitals that doubt their ability to manage both COVID and non-COVID patients, saying that the government would declare them dedicated COVID hospitals in that case!
Yet, the harsh truth is, beds are simply not available!
Dr Naresh Dang, senior consultant at Max Super Specialty Hospital, Patparganj confirms there is an acute shortage of hospital beds in the capital, as he paints a grim picture of the future. “The number of patients is increasing so rapidly, Delhi is full of corona now and there are not enough beds,” said Dr. Dang. “It is not about the money, patients are running from pillar to post for beds. Even doctors testing positive are finding it difficult to get a bed. My own patients are running from one hospital to the other for a bed, and it is not as if they are free patients, they are fully paying patients, but if all the 400 beds in a hospital are occupied, where will they go?”
High treatment costs
A doctor at a private hospital who did not want to be identified explained the “non-availability” of beds thus: “When patients come, a few things are required. First they have to have a COVID-positive report to get a bed. Without that they cannot get a bed. When they have the report, they ask about the cost, and are told the rates depending on how each hospital charges. Shocked, many of them bargain, want very low rates, and are told no beds are available at that rate.”
The high cost of treatment at private hospitals, that have packaged the costs, has only added to the woes of patients. Post Kejriwal’s charge that some private hospitals were indulging in profiteering, Saroj Hospital, one of six private hospitals that the Delhi government has converted into a dedicated COVID-only facility, issued a circular of its treatment costs:
- A minimum bill of Rs 3 lakh even if the patient is in the hospital for less than a day,
- Advance payment of Rs 4 lakhs for a shared room
- Rs 5 lakhs for a single room and Rs 8 lakhs for ICU.
- The treatment charges are in packages –from Rs 40,000 a day in a shared room to Rs 75000 a day in ICU and Rs 100,000 a day for ICU with ventilator.
“In the ICU, attending to every patient, means 5 to 6 PPE kits, each costing at least Rs 1000,” said Dr Arvind Kumar of Sir Ganga Ram Hospital justifying the high costs. “So about Rs 10,000 is spent on PPEs alone. Then there are the charges for ventilators and ICU beds.”
The hospital, he pointed out, runs on patient money, and 5000 employees have to be paid their salaries. He underscored the fact that the Delhi government does not pay to run the hospital.
For those who think it is the capital’s VIP culture which possibly makes hospitals block beds for the ministers, politicians, bureaucrats, judges, senior lawyers and corporate biggies, it is scant consolation that they too, like senior Congress leader Manish Tewari, have sad stories to share.
In a heartwrenching story, 52-year old Anil Goyal of Shahdara in east Delhi knocked at the high court doors on June 3, seeking directions to the Centre and Delhi government to provide a bed and a ventilator in a government facility, for his 80-year-old father who had tested COVID positive on May 31. By the time his plea was listed for hearing on June 5, Moti Ram Arya was dead. Amarpreet who works for Gates Foundation, too had a terrible experience. She took her father who was running high fever and had serious breathing problems to Lok Nayak Jaya Prakash Hospital, a central government run dedicated COVID hospital, where they refused to admit him. He died later in the day. On the evening of June 4th, Varun Vats, a resident of Rohini in West Delhi, shared on Facebook his travails of trying to get himself tested for COVID-19 as he had come into contact with his cousin who had tested positive on June 1st and had himself developed fever, cough, cold and headache. He was bounced from hospital to hospital, and lab to lab, including private labs, with all of them telling him the same thing: there were no testing kits, so he would have to wait for a couple of days. At Dr Lal Path Labs, the lady who took Varun’s call told him “Sir these are Government Orders. There’s no testing at least for the next 2-3 days”.
This correspondent has learnt that the embassy of a central European country attempted to block 10 hospital beds and offered up to Rs 1 crore per bed. But it failed to clinch a deal.
Building capacity: Short term plans
All this only highlights the fact that providing for the rapidly increasing need for hospital beds given the projected exponential surge in COVID cases is going to be a Herculean task for the Kejriwal government. For now, the government is looking to convert four and five star hotels in the neighbourhood of big hospitals as treatment centres.
“The Health Department is extending COVID Hospitals by linking big hospitals and nearby five and four star hotels with an upper price cap of Rs. 10,000 per day per bed,” according to a Press Release issued by Lt Governor Baijal’s office. “The hotels would provide beds, housekeeping, food etc as well as medical services.”
The government has, so far, linked eight hotels to hospitals, to act as extended COVID hospitals, and is in the process of similarly linking 19 more hospitals with hotels, to tentatively add another 2000 beds by June 15th, even though two hotels have moved the courts against this order.
It does look like a minuscule number in the face of the massive requirement. So the government is exploring the possibility of creating additional bed capacity in its sporting facilities. For now, they are considering Pragati Maidan, Talkatora Indoor stadium, Thyagaraj Indoor stadium, Indira Gandhi Indoor stadium, Jawahar Lal Nehru Stadium and Dhyanchand National Stadium to be used as make-shift hospitals. Sources in the AAP said they could “swiftly convert these into hospital beds, including beds with ICU facilities” if the need arises.
But there is little clarity on how all the necessary personnel and equipment will be procured.
As Dr Dang said, “It is not just about creating beds somewhere. A patient needs doctors, oxygen, nursing care… just because you declare a hotel a hospital, it will not become one. A stadium will not become a hospital just by putting beds in it. They need to do a lot of things. Can all the required arrangements be done fast enough? Delhi is going to go the Italy way.”