With news of shortages on every front: Beds, oxygen supply, medicines, ventilators, vaccines and even RT-PCR tests — the question on everyone’s minds is: A year down the line, how are we running short already?
Is the wave really that bad or is our planning terrible? Or worse, both? To clear the fog and allay the panic, FIT speaks to Dr Swapneil Parikh, an internal medicine specialist in Mumbai and Dr Sumit Ray, HOD, Critical Care Medicine, Holy Family, Delhi.
Rather than the numbers of beds and supplies, the crux of the matter is the rising cases. This means, the shortages are a result of the rapid spike in cases — and unless we curb the surge, shortages will worsen, warns Dr Parikh.
As of Thursday, 15 April, India reported 200,739 COVID-19 cases in the last 24 hours, taking the total to 14 lakh cases, said the health ministry.
He adds, “We had built capacities, all our tools have already been scaled up and the groundwork is there.” We did learn from 2020 and have more expertise, vaccines that work, therapeutic and faster tests this year. But we are still running short of essentials as the rise is too sharp.
Yes, we are exasperated about shortages but hospital systems – including human resources like doctors, nurses, wards, beds, ventilators – are all finite. Unless we curb the surge, infections will rise exponentially.
After a year of fighting from the frontlines, Dr Parikh says we cannot expect more from medical professionals, as “they are doing everything they can.”
Dr Parikh says we must look at the rapid rate of increase and not only absolute numbers to understand how the graph is going upwards.
He adds, “This surge was predicted and there were early warning signs. It is a catastrophic failure of leadership to ignore public health experts who warned of this.”
He says if our leaders roam around mask-less, blaming the public is futile. Dr Ray adds that public health communication is all wrong.
As states begin to impose night curfews and restrictions, is there a silver lining?
He adds grimly, “Even if we suddenly stop the rise tomorrow — it may be too late (as we will be dealing with yesterday’s fallout.) It will get worse before it gets better.”
Dr Parikh says we have “boxed ourselves in, with very few good options left”.
To lockdown or not: Public health experts believe restrictions are urgently required to curb the rise.
“A delayed repose results in requiring stricter restrictions for a longer duration and the fallout of such restrictions increases. Locking down late is worse than locking down early, and we let thing get horrific, other strategies won’t have the impact now that they would have had earlier. The economic fallout gets worse the longer we take to react,” says Dr Parikh. However, Dr Ray feels a graded response is better right now, where we can learn from our past mistakes and protect the vulnerable socio-economically as well.
Dr Ray says that even 100 percent COVID hospitals cannot be the answer — “There needs to be 10 percent reserved for trauma and emergency services. But in our Delhi hospital, there is no single room anymore, it's all shared. For now, in larger hospitals, we are managing, but the rapid rise can overwhelm systems.”
On Wednesday, Delhi reported 17,282 fresh infections, the highest-ever daily spike (including in 2020).
They have to account for current patients, and so cannot shift all beds into COVID wards so fast to meet the rise.
Dr Ray also adds that it is not just about adding beds, “We got offers from hotels but that is not helpful as we need entire systems — beds in the hospital, nurses etc.”
Certain states like Tamil Nadu and Kerala have good public health systems — not just facilities but also robust systems and protocols in place, and are “flattening the curve, but this has been forgotten in other states,” says Dr Ray. "I have been on the phone non-stop trying to arrange beds.”
A source at a government hospital in Mumbai said that one patient died due to the lack of oxygen, “forget ventilators, even oxygen ports are getting used up”.
On Wednesday, 14 April, the Centre said that “India’s Daily Production Capacity (7287 MT) and Stock (~50,000 MT) remains comfortably more than Daily Consumption (3842 MT) at present”. But a scroll through social media or conversations with frontliners paints a different picture.
Dr Harshil tells me that medicines and drugs are also almost over in their wards. Social media has become an outlet for harried, urgent requests of Remdesivir as pharmacies across India are running out of the vital drug. FIT reported in detail about this here.
Reports of unavailability of tests, delays and closures of testing centres are coming in from all states. Results that used to be ready within 24 hours are now taking up to a week, and sometimes more, to be available.
The rising case numbers, deaths and socio-economic downturn seem to suggest we are in for a bumpy ride.
We can stay in, mask up and change the trajectory.
“There is evidence that younger people are getting hit harder, but we can’t wait to be sure before we react. It’s okay and better to overreact,” says Dr Swapneil Parikh, Internal Medicine Specialist.
If there are gatherings – political, religious weddings – we need to test diligently.
“When there’s a mass congregation even with testing, there will be the transmission. We need to stop all mass congregations. We also need to scale up testing and utilise innovations in the testing space — there are testing options beyond PCR and antigen tests and we should leverage those,” he adds.
Dr Ray says that we can learn from past pandemics and predict that it will shift to smaller areas, “We are already seeing tier 2 and 3 cities being hit. They don’t have the infrastructure and so mortality increases.”
He adds that we need to take lessons from Kerala. Like Kerala Health Minister, K K Shailaja said to NDTV, “The numbers will remain high but we need strategic containment.” This means that for some time, there will be spikes or waves, but not massive jumps.
The shortage of beds is also due to the desperation felt by people who want to ensure they have access to ventilators and drugs if their condition worsens. “So if coordination between tertiary and primary hospitals increases, these cases can be handled,” adds Dr Ray.
(This story was first published in FIT and has been republished with permission.)
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