Living a Covid nightmare
A gloom has set in upon the staff of King Edward Memorial (KEM) Hospital, the biggest municipality-run hospital in central Mumbai’s Parel area. Everyone associated with the hospital looks dejected. Around 1,000 resident doctors work without adequate food, nurses fear for their safety as they file in, all norms of social distancing ignored, into packed buses meant to ferry them to their homes. Relatives of the COVID-19 patients admitted in the 3,000-bed hospital are terrified, some of them clueless about how to cremate the infected bodies of their loved ones.
KEM is just the tip of iceberg that is Mumbai’s overburdened health system. A video that went viral in the first week of May exposed the ill-preparedness of another large civic facility in the city, the Lokmanya Tilak Municipal General Hospital, popularly referred to as Sion Hospital. The viral video showed patients in a Covid ward lying close to dead bodies wrapped in black plastic. A worrying situation as around 80 per cent of the symptomatic and critical patients are admitted in civic or government hospitals.
The conditions at KEM Hospital, says a senior doctor, who did not wish to be named, are worse than at Sion Hospital. According to him, the sweepers and class-four staff at the hospital have refused to pack the dead bodies saying it is not their job. “I have seen patients’ relatives carrying infected bodies without any protection,” he adds. “This is not only inhuman, but it also makes them highly vulnerable to infection.”
The Brihanmumbai Municipal Corporation (BMC) has been paying a daily allowance of Rs 300 to class-four employees working in Covid wards. They are expected to maintain cleanliness, take the patients’ blood samples for testing and pack the dead bodies. But due to lack of cooperation and volunteers, the BMC has started offering Rs 1,300 per body to anyone willing to pack it. It does not matter whether they can do it properly or not. The patients’ relatives are forced to carry the blood samples to the doctors. Many have been seen entering the Covid wards wearing only a mask whereas a personal protection equipment (PPE) kit is a must.
KEM has divided its patients into its two wings. The biggest wing in the hospital’s old building, is now a dedicated Covid ward. The non-Covid patients are being treated in the new building. However, KEM is likely to run out of beds by May 31. The senior doctor says with restaurants not an option and the hospital cafeteria shut, resident doctors were skipping meals because of lack of proper food arrangements. “The Tata Group has been providing them with snacks and juice since day one, but it is a supplement, not a meal.” The resident doctors were having to stand in long queues to get the food packets. “It has happened many times that several doctors did not get any food because they were busy treating patients.” The situation has improved since May 15 after some NGOs stepped in to ensure proper meals reach doctors.
On May 18, a delegation of resident doctors called on state medical education director Dr T.P. Lahane and apprised him of some of the issues they were facing. He assured them that their issues will be resolved soon. india today reached out to Dr Lahane, but he declined to comment, as did Amey Ghole, chairman of the BMC health committee.
The sorry conditions at Sion Hospital were again highlighted after assistant inspector of police Amol Kulkarni died of COVID-19 on May 15. Kulkarni, who was posted at the police station in Dharavi, a Covid hotspot, complained of difficulty in breathing on May 13. Sion Hospital advised him to home quarantine instead of admitting him. Two days later, he was found lying unconscious in his bathroom and since his family could not get an ambulance in time, he died on the way to the hospital. The report for his Covid test came after his death.
Like KEM, Sion Hospital, too, is taking non-Covid patients. Dr Avinash Saknure, president of the Sion unit of the Maharashtra Association of Resident Doctors (MARD), admits overcrowding of patients has resulted in chaos. “No doctor will want two patients on one bed, but you need to understand the situation,” Saknure told India Today TV. “Sometimes we have been admitting patients two and a half times over our capacity. Treating everyone is important.” The doctors, too, feel bad about the situation, but are helpless beyond a point. “We are on the brink of an emotional breakdown watching patients die. It’s difficult,” says Dr Rishabh Chheda, a resident at Sion Hospital. “We are facing a pandemic at a time when hospitals are not ready for it. There is a severe crunch of resources.”
Mumbai has been recording an average 1,200 Covid cases every day. On May 17, it recorded 1,595 cases, the largest one-day number so far. The Maharashtra government has maintained that 70 per cent cases are asymptomatic, 27 per cent symptomatic, and three per cent are critical. The state government has divided the health facilities into three categories, Covid care centres (CCC), dedicated Covid health centres (DCHC) and dedicated Covid hospitals (DCH), depending on the severity of cases. The CCC is further divided into CCC1, to quarantine high-risk suspects, including those who cannot maintain physical distancing at home; and CCC2, for asymptomatic positive patients, or those with mild symptoms. Patients with moderate symptoms like continuous cough, cold and fever are admitted in DCHCs. The government has decided to admit co-morbid patients, those with pre-existing conditions like hypertension, heart ailments and diabetes, in DCHs. It is also where critical patients who require ventilator support or need to be monitored in the ICU are admitted. Those who have difficulty breathing or whose oxygen levels are below 94, or whose health condition can turn critical are also admitted in DCHs.
At present, there is no dearth of beds in CCCs and DCHCs, which have 57,000 and 10,000 respectively. The problem arises in DCHs which have only 4,800 beds. Manisha Mhaiskar, an IAS official on special duty in BMC, says they plan to increase the number of beds to 8,000 by the end of May. “We are constantly augmenting beds, from 1,900 beds on April 15 to 2,900 on May 1, to 5,200 on May 17,” she says. “However, as about 1,000 patients are testing positive daily, we need to be adding 100 to 200 beds every day. BMC is adding 100 beds daily, and with discharges, hospitals are being able to accommodate another 100. But it is a constant race to be ahead of the virus.”
Mumbai’s growth in Covid cases has slowed down from doubling every three days in the first week of April, to every 13 days by May 17. It needs to reach a point where cases double every 17 days to reduce the load on hospitals. Health minister Rajesh Tope admits availability of facilities in DCHC and DCH categories is a problem. “The problem in DCHC is that oxygen is required, and in DCH more beds are needed. The work of augmenting the number of beds is going on,” he says.
If the whole of KEM Hospital were to be designated as a COVID-19 hospital by the end of May, its current capacity of 3,000 beds will be cut down by half considering the ideal distance that needs to be maintained between two beds. Mumbai’s KEM and B.Y.L. Nair hospitals have already started reducing the gap from eight feet to four to accommodate more beds. Mhaiskar, though, does not see any problem with this. “Even if the distance between two beds is reduced, the doctors and health workers are wearing PPE kits. No one is allowed there without a PPE kit. The BMC is trying to optimise the space by giving equal importance to safety safeguards and to bed augmentation.” While Dr Mohan Joshi, dean of Nair Hospital, says a space of eight feet is ideal, he realises hospitals have to be pragmatic to accommodate the growing number of patients. “Idealism cannot work when there is such an influx of patients. No government hospital can turn away a patient. We have to be accommodating,” he says.
The BMC officials are facing a problem in updating the availability of beds in private hospitals. The protocol states that if a patient is discharged from DCH, the hospital has to inform BMC’s disaster cell. Since this will be real-time data on vacant and occupied beds, the BMC can direct patients to a hospital accordingly. However, Dr Daksha Shah, BMC’s executive health officer, says, “The hospitals are not keeping the BMC updated about discharge of patients.”
The government believes the decision by the Indian Council of Medical Research (ICMR) to discharge asymptomatic patients in 10 days will improve availability of beds. A state-level task force led by Dr Sanjay Oak, former dean of KEM Hospital, has recommended that 70 per cent beds in around 30,000 private hospitals, including nursing homes, should be acquired for DCHCs and DCHs. Tope mooted an idea to reserve 30 per cent beds in private hospitals for five kinds of treatments, deliveries, brain stroke, heart disease, cancer and accidents, and the rest for Covid. “We can pay private hospitals to recover their losses,” he says. Private hospitals are negotiating with state authorities over the rate of treatment. The government has assured them it will bear the cost of treatment of Covid patients, hoping it encourages them to treat more patients.
Looking at the trend of growing number of cases, the state is expecting a surge in June and July. If the virus races ahead of the health preparations, the nightmare will only get worse for the Maximum City.