Coronavirus | ICU beds filling up in Kerala

COVID-19 patients being treated inside the first unit of ‘Makeshift ICU’ set up at Aster MIMS hospital to cater the current COVID crisis in Kozhikode. File.   | Photo Credit: PTI

It might be at least two weeks before the second wave of COVID-19 tearing through the State peaks. But desperation for hospital beds and ICUs has already begun to be felt as both public and private sector hospitals are nearly filled.

Reports from many private hospitals across the State said that many had been turning away patients since last week or referring them to hospitals in the nearby districts. Many patients, who come demanding admission to private hospitals are being told to remain on home care and to be in touch with the doctors through tele-medicine links.

“The number of patient transfers from home to hospitals have been on the rise and there are plenty of patients in the younger age group who are now coming in sick. A proportion of them do become seriously ill and they occupy ICUs for a longer period, creating a huge wait list,” a doctor in a private hospital said.

Acute shortage of human resources is the major problem that both Government and private hospitals are facing at present.

“We cannot create more ICU beds on demand because patients requiring ICU care can be handled only by skilled personnel. Unless we have experienced staff to spare, we cannot expand ICU capacity,” he added. Also, all hospitals need to have buffer beds in ICUs for other medical emergencies like a snakebite or stroke

When the first wave of COVID in Kerala peaked in October last, the active case load had about 97,000 patients.

Disease transmission in the second wave has been intense and even though the Government has been preparing ahead to meet the exigency, enhancing the health system surge capacity, the number of active patients in the State (3.5 lakhs plus) and the daily hospital admissions (between 3,500-4,500 patients) has been quite overwhelming.

At present, there are 28,115 hospitalised patients in the State, of whom, 1,975 are critically ill in ICUs, with 756 of the patients put on ventilator support

Kerala had doubled the number of ventilators (3,776 both public and private) and ICU beds (9,735 both public and private) in the State and had increased the oxygen production to 219 .22 metric tonnes even though the daily requirement in the State was around 74 metric tonnes (two weeks ago).

As the epidemic curve began to rise steeply, the Government roped in 50 % of hospital beds in private sector and asked private medical colleges to set aside 75% of its capacity for COVID care. But then, surge capacity cannot be limitless. Unless there is an immediate reduction in new case numbers, the health system is likely to buckle soon.

As on May 3, the State had a stock of 270.2 metric tonnes of liquid medical oxygen, the daily demand for which had risen from about 74 to 108.35 metric tonnes in the past two weeks

On Wednesday, the Chief Minister, Pinarayi Vijayan, wrote to the Prime Minister that the overall projected requirement of liquid medical oxygen in the State had been rising and that the State urgently needed to augment its buffer storage. He requested that the State be given an additional 1,000 tonnes of liquid medical oxygen

The demand for medical oxygen has gone up in all hospitals over the past two weeks and the rising patient numbers has led to a lot of uncertainty among hospitals . While the current situation is being managed adequately by dedicated district-level teams monitoring oxygen demand-supply situation, there are plenty of logistics issues in supply at the periphery which need to be managed on a daily basis.

“At this stage of COVID crisis, we can bring down mortality if we focus on the 15 % of COVID patients who might become oxygen-dependent but are salvageable without taking them into ICUs. For these patients, hospitals should be creating non-ICU oxygen beds, which can be managed by support staff. Probably, this is what will save Kerala out of the current crisis,” says Rajeev Jayadevan, vice chairman, IMA research wing.

He points out that creating plenty of non-ICU oxygen beds was one of the primary strategies deployed by BMC Mumbai to keep patient mortality down and to reduce the pressure on ICUs, when second wave started in February. ICU beds could thus be kept open for patients who might suddenly worsen. During the second wave the case fatality in Mumbai was just 0.4%, he says.

All beds allocated for COVID treatment in government and private hospitals in Ernakulam, including ICU facilities were full as on Wednesday afternoon, according to the Health Department.

"It's full and there are no slots available," said personnel working at the control room opened by the district administration. "We are shifting emergency patients as and when there is a vacancy following discharge or death of a patient," they said. Those who need urgent medical attention are now being shifted to the stabilisation centres, according to the health authorities.

Both government and private hospitals were running short of ICU beds and ventilators following the spike in positive cases in the district. Nearly 160 ICU beds were set aside at private hospitals for COVID patients. There were around 250 beds with oxygen supply at private hospitals.

Of the 130 ventilators in 32 Covid hospitals in Kozhikode district , 42 are occupied. Of the 308 ICUs, including those with ventilators, 54 are occupied.

Of the total 2,667 beds (excluding ICU), 600 are occupied. Of the 1,139 non-ICU beds with oxygen supply, 356 are occupied. There are six Covid hospitals in the government sector.

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Printable version | Jun 18, 2021 3:21:09 PM |

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