India’s Shortages: Why Are We Running Out of Beds & Drugs Already?
“It will get worse before it gets better,” say experts as we deal with rising cases and lax political attitudes
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.
We’re Asking the Wrong Question About Shortages
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.
“We have already pushed up the supply of beds, PPEs, etc.. We did prepare but there is a threshold and systems are overwhelmed.”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
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.”
What we can focus on is stopping the spread to help ease the burden on hospitals and frontliners.
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.
“This is the pandemic we were warned about. 2020 was a prelude, what’s coming now is much worse.”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
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.”
How Did We Get Here?
Here are the 5 big reasons:
- “There was a palpable sense at all levels that pandemic was over. This was a mistaken belief, and many public health experts said it was mistaken, but this fell on deaf ears. There were these notions of herd immunity and that Indians have great inherent immunity which is a myth,” says Dr Parikh.
- “There is some evidence that we are dealing with more transmissible variants like the VOC in the UK or the ones here,” says Dr Parikh. In an earlier FIT article, Dr SP Kalantri, Medical Superintendent of Kasturba Hospital and MGIMS, Wardha, Maharashtra added that, “The virus is much more transmissible than last time,” and Dr Ray concurs the rate of rise is much more - “perhaps due to new mutations and young people roaming around”.
- “No healthcare system in the world can deal with this exponential growth,” says Dr Parikh. When asked if hospitals should have scaled up infrastructure, he tells me that we are looking at the problem the wrong way. “Our systems are crumbling because they are stretched thin: No one can deal with this kind of surge.”
- “There is a massive failure of political leadership. Mass gatherings and mask-less crowding is seen by our leaders,” says Dr Parikh. This leads to lax public attitudes too. “There has also been a lack of transparency on deaths and case numbers from certain states like Uttar Pradesh,” adds Dr Ray, which again impacts public perception. Like virologist Dr Jameel said earlier, “We can predict a massive rise in numbers from election states too.”
- “There were no restrictions till just a few days ago, so of course, healthcare systems get overwhelmed,” says Dr Ray.
“We expect the populace to have COVID appropriate behaviour but we don’t see COVID appropriate attitudes from our political leaders.”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
He says if our leaders roam around mask-less, blaming the public is futile. Dr Ray adds that public health communication is all wrong.
“Many leaders believe they are vaccinated or have had COVID and are publicly meeting groups of people without masks or distancing.”Dr Sumit Ray, HOD, Critical Care Medicine, Holy Family, Delhi.
‘It Will Get Worse Before it Gets Better’
As states begin to impose night curfews and restrictions, is there a silver lining?
“The worrying part is that even if there are no further infections tomorrow, the record number of infections today are going to translate to hospitalisations and even deaths. The current overwhelmed hospitals and deaths that we are seeing are a result of the initial rise in cases we saw.”Dr Swapneil Parikh, an internal medicine specialist in Mumbai
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.”
Moving Forward: ‘Stuck Between a Rock and a Hard Place’
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.
“Last year’s lockdown was criticised as being too early, but now that we have something to compare it to (this wave) we can see how it helped control the spread.”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
Restrictions can help flatten the curve and ease the burden on healthcare systems. “It’s not just doctors, nurses ward boys, etc. who will suffer, it’s all of us,” warns Dr Parikh, “we have to stop the wave so healthcare systems can respond.”
Lack of Beds, Oxygen, Meds: ‘Healthcare Systems Are Overwhelmed’
“Every hospital is struggling. There are literally zero beds - we are having to turn patients away again already.”Dr Harshil Shah, Resident Doctor at the Dept of Orthopedics, Rustom Narsee Cooper Hospital.
Dr Ray says that even 100 per cent COVID hospitals cannot be the answer - “There needs to be 10 per cent 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 overwhelmed systems.”
On Wednesday, Delhi reported 17,282 fresh infections, the highest-ever daily spike (including in 2020.)
“In 2020, with the lockdown, the surge was slower and we could increase capacities. Now with people moving around and mass gatherings - weddings, Kumbh Mela etc -, to immediately transform hospitals into COVID hospitals is difficult.”Dr Sumit Ray, HOD, Critical Care Medicine, Holy Family, Delhi.
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 a lack of oxygen available, “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.
- Tests & Testing Centres
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.
What Can We Do? Act Now!
- Non-medical interventions
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.”Dr Swapneil Parikh, Internal Medicine Specialist, Mumbai
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 utilize innovations in the testing space - there are testing options beyond PCR and antigen tests and we should leverage those,” he adds.
Use the Lessons From 2020
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.
“State governments need to come in again to streamline hospital systems. Last time, we had clear demarcations where severe patients came to larger hospitals, and less severe cases were sent to periphery hospitals and fever clinics. This helps reduce panic also as right now people are just running around helter skelter in bigger hospitals.”Dr Sumit Ray, HOD, Critical Care Medicine, Holy Family, Delhi.
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.
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