“I am running on fumes. My daily delivery of oxygen is only 10,000 litres and my daily use is 12,000 litres.”Subramanian Swaminathan, Director- Infectious Diseases and Infection Control at Gleneagles Global Hospitals
“The pressure on ICU beds is massive and we need professionals with expertise to handle this.”Dr Jayaprakash Muliyil, Epidemiologist
“The house will be on fire till the end June.”Dr Jacob T John, former head of ICMR’s Centre for Advanced Research in Virology
With nearly 34-fold rise in new daily cases since 1 March, Chennai is headed towards a 'Delhi-like situation', warn epidemiologists. Is the city adequately prepared with beds, ventilators, oxygen for the potential surge?
The Quint does a deep-dive to understand how the government plans to ramp up the infrastructure for the coming weeks and speaks with epidemiologists, virologists and doctors to understand if that is sufficient to handle the COVID surge.
Positivity Rate Around 23% in Chennai
Chennai, with a population of nearly 11 million, recorded over 6,000 COVID-19 cases with a positivity rate of 23.6% on 5 May. The city has registered a total of 3,64,081 cases, 4,952 deaths and a mortality rate of 1.14% as on May 6.
Data Showing the Daily and Cumulative Rise in Coronavirus Cases in Chennai From April-May 2021:
To compare, Delhi, with a population of 22 million people, recorded nearly 20,000 cases (down from last week) with a positivity rate of 24.29% on May 6 (down from nearly 35% a week before). The national average positivity rate is at 6.99% and death rate is at 1.32%.
Data Showing Delhi's Positivity Rate Since April 26-May 6:
Hospitals at 90% Occupancy, ICU Beds Running Out
Government and private medical colleges are stretching themselves thin by converting most of the beds into COVID bays, while cancelling non-emergency consultations and surgeries. The occupancy in all major hospitals in the city is at 90% and the private hospitals in the peripheries is over 50%, with average vacancy of 30% as on 5 May. But when it comes to oxygen beds and ICU beds, the numbers are shrinking.
Chart Showing Availability of Normal Beds in Chennai as on 4 May 2021:
Chart Showing Availability of Oxygen Beds in Chennai as on 4 May 2021:
Chart Showing Availability of ICU Beds in Chennai as on 4 May 2021:
As on 5 May, 1pm, there are 9,636 normal beds in government and private hospitals in Chennai of which 3,687 are vacant. There are 5,264 oxygen beds of which only 347 beds are vacant. With the surge in serious infections, the ICU beds are depleting fast. Of 1,673 ICU beds available, only 30 beds are vacant.
'The Situation is Grim,' Warm Experts
The Quint spoke with health experts to understand the rapid rise of COVID cases in the coming weeks and if the state government has equipped the system to handle the surge.
Dr Jacob T John, former head of ICMR’s Centre for Advanced Research in Virology explained, "The second wave peaked on 30 April but that is no comfort because for the next three weeks we will continue to have over 3, 00,000 cases per day nationally and a similar rise in Chennai as well. There is no room for complacency and the pressure of oxygen and hospital beds is going to pile on."
The number of ICU beds that are vacant are less than 35 at the time of writing this article, which was a matter of concern raised by many doctors.
Dr Jayaprakash Muliyil, epidemiologist at Christian Medical College Hospital (CMC), agreed that while the government has ramped the number of beds,
“The pressure on ICU beds is massive and we need professionals with expertise to handle this. Tamil Nadu has a good healthcare system but the hospitals are not evenly distributed. Also the state needs to monitor hospitals and insist on judicious purchase of equipment and medication.”Dr Jayaprakash Muliyil
“People are panicking and rushing to the hospital and it is impossible to triage everyone. And what is worse is that many young people who are falling sick and told to stay in home quarantine want iron-clad promises: ‘Will I get sick if I go home?’ If I go home and fall sick, will you assure me a bed?’ And my answer is ‘I don’t know,’" said Subramanian Swaminathan, Director- Infectious Diseases and Infection Control at Gleneagles Global Hospitals.
He explained that the situation is quite grim and “the answer to this is a strict lockdown and even this is not going to control the cases immediately. It is an impossible situation we are preparing for and no matter how much we pad up, we will fall short.”
Red Alert on the Bed Situation in Chennai?
The state health department told The Quint that they will be adding 2,900 more oxygen-COVID beds in the next two days and another 2,000-odd beds next week. Private medical colleges have been asked to set aside 50% of their bed capacity, which most hospitals have already done, and this they believe will contribute to 3,000-odd beds during an emergency.
The Quint spoke to epidemiologist Dr Jayaprakash Muliyil, Dr Jacob T John and Dr Subramanian who said,
“While this is a necessary move and will take care of the caseload for now, the government will need to add an additional 2,000-3,000 beds next week and the week after and only then can we say that we are equipped to handle this.”
Dr R Narayana Babu, Director of Medical Education said that the government is planning to increase bed capacity and other essential services every three days. "We have been planning meticulously for a year and not working based on the predictions of a surge but by planning for today and for two weeks ahead. We have additional plans to stock up medicines, oxygen, beds," he added.
But there are no clear answers when it comes to ICU beds for critically-ill COVID patients.
Ramping up Before Health Systems Get Overwhelmed
In response to the barrage of SOS requests for bed availability, the Tamil Nadu government has introduced an exclusive website to check the availability of beds in the state - https://tncovidbeds.tnega.org/ - along with updating the state COVID website in real-time and even a new Twitter handle @104_GoTN for the benefit of people seeking beds for patients with COVID-19.
The Greater Chennai Corporation (GCC) has opened 24/7 screening centres for triaging COVID-19 patients.
On an average, 150-200 patients are admitted per day at Rajiv Gandhi Government General Hospital (RGGGH), the largest public hospital in Chennai treating COVID-19, and most of them are in critical condition. Nearly 70-80 persons are discharged everyday. The hospital has only 167 normal beds vacant of the 360 beds and they are desperately trying to increase the capacity.
RGGH hospital is bringing in 550 additional oxygen lines, thus from 810 oxygen points, the hospital will increase it to 1,100 points. The RGGH hospital has formed a four-member committee to exclusively monitor consumption of oxygen and is planning to add 20,000 kilo litre oxygen from other blocks, to meet the demand for COVID-19 treatment.
At the Government Stanley Medical College Hospital, 500 more oxygen-supported beds, 100 more beds in the ICU and 100 ventilators will be set up. The hospital has added 50 more beds with oxygen points to the 20-bed zero delay ward.
As on 5 May, there are 139 COVID health facilities in Chennai, that have been introduced to reduce the burden on the healthcare system. Over 500 beds are being set up for the COVID Care Centre to come up in Chennai Trade Centre that will also be oxygen supported.
Hospital Beds are Here, But Where is the Staff?
Experts believe Tamil Nadu is equipped with beds if they continue to increase it at the pace promised, but there are several other roadblocks that need to be cleared to ensure shorter stay at the hospitals and quicker recovery.
Dr Babu told The Quint, "After the postponement of the National Eligibility cum Entrance Test Postgraduate (NEET-PG) 2021, we have recruited 970 doctors and over 665 doctors and nurses will be transferred from the Director of Medical Sciences (DMS). We are setting up mini clinics and even have a telemedicine facility where people in home quarantine can call to seek medical help."
Several doctors appreciated this as the hospitals in the city were short-staffed during the first wave in May 2020; however Dr Subramanian raised a serious concern:
“There is a major problem here. Are all these young students vaccinated? Most of them are not. Imagine putting a highly vulnerable person who is not very experienced in a space of open contact with an easily transmissible virus. This could lead to a different surge by itself.”Subramanian Swaminathan, Director- Infectious Diseases and Infection Control at Gleneagles Global Hospitals
He also proposed that, "the government should employ more people to fasten the insurance process and technicians in the testing labs. The supply of medicines needs to be stepped up as some of these can be used not only for survival but for early recovery too. This will help free up beds quicker, thus reducing the dependance on oxygen and staff."
Dr Muliyil insisted that the key to smooth functioning of the healthcare system is “bringing down unnecessary admissions, ensure easy access for patients to come to hospital and get a bed.”
A senior cardiologist at a government hospital told The Quint, "Tamil Nadu has a structured healthcare system and so we have been able to manage but it is going to get worse. In fact, every populated hub will face a Delhi-like situation. But what the government can do is, ensure every hospital has access to machinery and manpower and also educate the people to not panic."