Bengaluru

IT hub Bengaluru and its struggle for healthcare

Relatives and friends wait outside the Sumanahalli crematorium with the bodies of their loved ones in ambulances, during the weekend lockdown, in Bengaluru on April 25, 2021.   | Photo Credit: MURALI KUMAR K.

On the night of May 2, Sajidunnissa, 56, who had been diagnosed with COVID-19, developed acute respiratory problems. She experienced a rapid drop in her oxygen saturation levels. What followed was a harrowing 14 hours, as her family did the rounds of seven hospitals in Bengaluru desperately searching for a bed. They finally got her into the emergency room of a private hospital by which time her saturation levels had dropped to 40. Although she was administered oxygen, Sajidunnissa did not make it.

On the morning of May 3, 65-year-old Jayesh R. took a turn for the worse as his oxygen saturation levels dropped to 68. His family hired a private ambulance and went knocking on the doors of hospitals for an oxygenated bed. They watched helplessly as his saturation levels dropped further. He died in the ambulance four hours into the frantic search.

IT hub Bengaluru and its struggle for healthcare
 

In both instances, the Bengaluru civic body’s central hospital bed management system had shown that there were no oxygenated beds available.

Sushma G. recalled the lonely and terrifying six days she spent waiting to hear back from the Bruhat Bengaluru Mahanagara Palike (BBMP) war rooms, which allot beds to COVID-19 patients based on their position on the waiting list and severity of disease, about a bed for her brother. That call never came.

While Bengaluru’s less-than-adequate public medical infrastructure is under severe stress with an exponential rise in cases, an alleged scam in the South Zone has also raised questions on the integrity of the bed allocation system in the city. All war rooms are currently under investigation by the Central Crime Branch police. So far, two doctors are among the four people who have been arrested and hospitals are under the scanner. The civic body has conceded that such cases may have occurred but may not be widespread.

Bed allocation racket

On May 4, Bengaluru South Member of Parliament Tejasvi Surya, with three BJP MLAs in tow, stormed into the BBMP South Zone war room and accused staff of blocking beds for cash. “As soon as a bed is released from the hospital, people in the control room block it in the name of some asymptomatic patients, only to later manually change it and allot it to a person who pays them. This ensures beds are always blocked to the full and are not available for the needy,” alleged Mr. Surya, who live-streamed the ‘exposé’.

Mr. Surya and the MLAs, while exposing the racket, made it a point to target 16 Muslim employees of a total workforce of 206. Citizens, political leaders in the Opposition and activists have criticised the BJP for communalising a problem at a time when the city is fighting a vicious second wave, with many calling for an apology or police action. Volunteers from minority communities and organisations such as Mercy Mission, spearheaded by Muslims and at the forefront of relief work from providing oxygen to cremating bodies, have expressed dismay at how the ruling dispensation continues to demonise the community.

Mr. Surya claimed victory of “reforming the system” and announced hours after his ‘exposé’ that the BBMP website was showing 1,500-odd beds as available. That claim was, however, misleading.

 

The bed allocation racket, which senior police and civic officials say is not as widespread as it is being made out to be, exposes the lack of preparedness and poor medical infrastructure in a city that wears its ‘IT capital’ tag with pride.

Given how oxygenated beds, ICU beds and ventilators are hard to come by, touts have entered the fray. They charge anywhere between ₹25,000 and ₹30,000 to find a bed, but their “business” is constrained by the dearth of beds. “Oxygenated and ICU beds are hard to come by. People are ready to pay up to ₹2 lakh to get an ICU bed, but even I am struggling to find one,” said Dhanraj (name changed), a tout in the city. A social worker and her nephew who were arrested by the police in a sting operation for selling beds are suspected to have ties with war room staffers.

Caught on the back foot

Why is the health infrastructure in Bengaluru, once touted to be a popular medical tourism hub with affordable world-class facilities, crumbling during this second wave? Karnataka’s highest case load per day so far has been 50,112 and deaths, 592.

As daily new cases rose from 210 on March 1 to 23,706 on May 6, and the number of deaths from four to 139 during the same period, the government was caught on the back foot. An inadequate number of ICU and oxygenated beds, scarcity of life-saving oxygen, and shortage of vaccines and drugs like Remidesivir, Favipiravir (Fabiflu) and Tocilizumab have pushed citizens to despair, allowing touts and black marketeers to thrive.

 

Giridhar R. Babu, epidemiologist and member of the State’s COVID-19 Technical Advisory Committee (TAC), which had sounded the alarm of a second wave last year, said a surge such as this, which is nearly five times higher than the first wave, simply cannot be managed by a system that was barely augmented to take on the pandemic. “In addition, a far more contagious variant has resulted in a high number of cases in a very short span of time. Adding to the woes is the complete mismanagement of the bed distribution system. This shows poor management and coordination by urban local bodies. Even today, mechanisms have not been evolved to cater to the critical care needs of the people of Bengaluru,” he said.

However, according to officials from the State Health Department, Karnataka did ramp up its health infrastructure to increase its bed count to 1.20 lakh. With a population of nearly 7 crore, the bed to patients ratio is 1:583.

Compared to pre-COVID-19 days, the bed strength in public hospitals has also increased. While the number of general beds has risen from 37,817 to 42,584, oxygenated beds have gone up from 1,970 to 18,593. Intensive Care Unit (ICU) beds have been ramped up from 1,054 to 3,190 and ICUs with ventilator beds (ICU-Vs) have more than tripled from 610 to 2,034.

In Bengaluru, 157 hospitals — government, private and medical colleges — have allocated a total of 6,002 general beds, 4,299 high dependency units (HDU), 591 ICUs, and 500 ICU-V beds. The numbers may seem impressive until you look at the demand, especially for ICU and ICU-V beds. As on May 5, 562 ICU and 494 ICU-V beds were occupied. For a brief time that day, the bed management system showed only 13 ICU-V beds as available, as per BBMP’s records.

Mass cremations take place at a crematorium ground between Magadi Road and Tumkuru road in Bengaluru on May 2, 2021

Mass cremations take place at a crematorium ground between Magadi Road and Tumkuru road in Bengaluru on May 2, 2021   | Photo Credit: MURALI KUMAR K.

 

Officials claim that Karnataka and Bengaluru’s infrastructure is much better in comparison to other States, but numerical comparisons are no solace to people running from one hospital to another looking for beds for their friends or family members.

One of the biggest problems in providing affordable medical aid seems to be the high dependency on the private sector. Nearly 60% of the patients are treated in private hospitals, a trend that is playing out across the country. While the government is trying to make private hospitals hand over 75% of their total beds to government-referred COVID-19 patients, this is yet to happen. The beds ceded by the private hospital to the government are added to the government’s database.

As on May 6, private hospitals had allocated 2,054 general beds, 1,554 HDU beds, 291 ICU beds and 174 ICU with ventilator beds. In private medical colleges, 3,578 general beds, 1,849 HDU beds, 146 ICU and 161 ICU with ventilator beds were made available for government-referred patients. As on Thursday, all ICU and HDU beds were occupied.

 

But numbers are also manipulated for profit, since private hospitals get paid far less for government-referred patients. In Bengaluru, BBMP health officers have found well-known hospitals attempting to “hide” beds by showing them as occupied when patients have either died or been discharged.

The BBMP’s bed database is not foolproof either and it is not clear if it is by design or human error in an overwhelmed system. Last week, a 41-year-old COVID-19 patient who was isolating himself at home with his wife took a turn for the worse. As his oxygen saturation levels started to drop, he contacted the BBMP control room seeking a bed. After several calls, he was sent an ambulance and asked to go to a private hospital in south Bengaluru. On arrival, he was told that there had been “a mistake” and that no beds were available. He waited in the lobby of the hospital for nearly two hours after which the hospital authorities asked him to wait outside in the ambulance. He was eventually allotted a bed at another private hospital in the opposite end of the city.

There have been multiple cases of patients being allotted beds only for them to arrive at the hospital and learn that there is none available. However, the system, which is currently being fine-tuned to weed out illegal sale of beds, does give patients an idea of the resources available.

Such a system did not even exist for private sector beds. It was only towards the end of April that the Private Hospitals and Nursing Homes’ Association (PHANA) agreed to roll out a database so that citizens can monitor availability of beds in real-time. At the time, Dr. H.M. Prasanna, president, PHANA, told The Hindu, “The situation is so bad that, as president of the Association, I myself don’t know where beds are available.” The portal was yet to be updated at the time of going to press.

As the clamour for resources grows louder with each passing day, civic officials, legislators and even the police are inundated with requests for HDU and ICU beds. An opposition MLA said every morning his office sees a flood of people requesting him to get an oxygenated or ICU bed for a relative. “There are absolutely no beds. And how do I even prioritise among them? Why am I playing God here,” he asked.

Confusion and testing delays

In thousands of instances, confusion begins even at the time of testing. When a person’s COVID-19 test returns positive, he or she is assigned a patient identity or BU (Bengaluru Urban) number. A delay in this early stage of the process has a cascading effect as the identity number is essential for citizens to avail themselves of any health facility, be it ambulance service or hospitalisation. With more people lining up to get tested, however, the pipeline choked, and laboratories, especially privately run facilities, started taking days to upload the results on the Indian Council of Medical Research website.

 

False negatives and people developing severe symptoms while still waiting for their report became a common problem. The Karnataka High Court directed all laboratories and testing agencies to provide RT-PCR test results within 24 hours, but the problem persists. The BBMP administration has repeatedly appealed to private laboratories to give the test results within 24 hours, but to no avail. Over the last few weeks, civic officials have issued show cause notices to over 20 such private laboratories and sealed over six for non-compliance.

Many, either because of the long wait for RT-PCR reports or a false negative report, have resorted to taking CT scans despite high costs to ascertain infection. It was only a few days ago that the government took cognisance of this issue and decided to issue BU numbers for those who test positive on CT scans.

For Arvind, a taxi driver in Bengaluru, the change in rules came too late. When his mother-in-law suddenly started showing symptoms of COVID-19 and complained of breathlessness, he didn’t have a BU number to get her hospitalised. He drove all night in his taxi from one hospital to another but couldn’t get a bed. He took her home where she died. “I couldn’t afford beds in high-end private hospitals,” he said.

Shortage of oxygen

The government plans to augment Bengaluru’s ICU bed count by 4,000. But many health experts point out that it may prove to be an exercise in futility when there is shortage of oxygen for the existing beds.

On May 4, two patients, including a 38-year-old mother of two children, died in the wee hours of Tuesday at Arka hospital in Yelahanka, allegedly due to non-availability of oxygen. Hospital authorities said both patients had come in a critical condition and the families had been informed about the oxygen shortage. The previous day, 24 people died due to alleged oxygen shortage at a government hospital in Chamarajanagar, 170 km away from Bengaluru.

 

Hospitals sending out letters to patients’ relatives to shift them out as they are running out of oxygen has become an everyday routine. Doctors and management of hospitals attribute the crisis to logistical issues in the oxygen supply chain. Health Commissioner K.V. Trilok Chandra corroborated this. “We are streamlining supply and addressing the logistical issues,” he said.

Dr. Prasanna of PHANA said, “Quantity is not an issue, but the problem lies in the supply chain. With very few supply tankers, vendors are unable to visit hospitals two-three times a day for refilling.”

Karnataka does not have a system in place for the storage and distribution of oxygen. Chamarajanagar, where the 24 patients died, has no manufacturing facility of its own and depends on Mysuru for supply. There is no State-monitored mechanism to ensure that each district is assured a certain quantum of supply depending on its need, and so the districts try and procure supply on their own.

On May 4, Dr. Babu, who also heads Life Course Epidemiology at the Public Health Foundation of India in Bengaluru, tweeted: “In a country where ice creams, chilled coke and chips reach villages, it is simply astonishing to believe that the industry cannot help in solving the logistic crisis of oxygen distribution. How many governments have reached out to industry for help or partnership?”

Unlike the previous year, the strain prevalent in the city is pushing more patients to hypoxia and hence the demand for oxygen is several times more, said a senior health official. As per Union government norms, the State placed a demand for oxygen in the range of 1,471 MTD to 1,791 MTD between April 30 and May 5, but said a minimum of 1,162 MTD was absolutely necessary. However, the Union government first allotted only 300 MTD, increased it to 802 MTD and later 865 MTD. During an ongoing hearing of a PIL in High Court, the Centre offered to further raise it to 965 MTD. However, the Karnataka High Court ordered the Union government to allot 1,200 MTD for the next four days to the State and asked the State government to place new demand. The Union government appealed against it to the Supreme Court, which refused to interfere noting that the Karnataka High Court’s order is a well calibrated and thought-out one. “We will not keep the citizens of Karnataka in the lurch,” the Supreme Court said.

How did it come to this?

TAC had on November 30 last year submitted a report to the government recommending that ICUs, ICU-Vs, oxygen, etc. be kept ready by the first week of January to meet levels that the city had witnessed during the first COVID-19 peak in October. More importantly, it recommended restricting mass gatherings like fairs and festivals, religious congregations and cultural events.

However, the State government, which had initially announced certain restrictions including night curfew during the New Year week (which was later rolled back), did not consider the report in toto. It waited for by-elections and urban local body elections to end before announcing stringent measures. “Restrictions for cinema halls too were rolled back a day after the announcement. If the report was taken seriously then and stringent measures were initiated early, the situation could have been controlled,” said V. Ravi, TAC member and nodal officer for genomic confirmation of SARS-CoV-2 in Karnataka.

 

“Declaring elections was the biggest blunder. Elections could have been postponed considering the pandemic as a national medical emergency. However, the State followed a wait-and-watch policy and we are seeing the consequences,” another expert said. Citizens wanted to believe that the worst was over and ignored the warning signs as neighbouring Maharashtra and Kerala saw cases rise.

As the death toll mounts in Bengaluru, furnaces in the 12 electric crematoriums are breaking down. The district administration has set up open crematoriums on the outskirts of the city with a capacity to burn more than 20 bodies at a time.

Another makeshift crematorium is coming up at the Mavallipura landfill, where the civic body is working towards building a capacity to cremate 50 bodies at a time. At these open crematoriums, pyres burn simultaneously and the air shimmers in the haze of smoke and orange flames. Within Bengaluru, the silence in residential neighbourhoods observing lockdown is regularly broken by the wails of ambulances.

Experts have once again urged the government to finalise a plan for the long haul, one that will enable Bengaluru to withstand multiple waves of COVID-19.


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Printable version | Jun 22, 2021 8:00:49 AM | https://www.thehindu.com/news/cities/bangalore/it-hub-bengaluru-and-its-struggle-for-healthcare/article34510448.ece

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