As the proportion of serious COVID-19 patients goes up in the State, Kerala should do meticulous planning and develop indices for understanding how and when the State’s intensive care facilities could reach the saturation point.
This will help to rationalise investment in infrastructure and human resource, according to Santhosh Kumar S.S., Deputy Superintendent of Thiruvananthapuram Government Medical College Hospital, who had been in Mumbai where he had been part of a medical team running a 120-bed ICU facility.
In Mumbai hospitals, non-availability of critical care beds and ICU facilities has significantly contributed to COVID-19 mortality. With over 200 cases a day now, the current situation in Kerala is quite manageable, with only about 30 patients in ICUs and about five in ventilators. But this is the crucial time for the State to make a realistic estimation of its functional ICU facilities because the current level of facilities in Kerala hardly fulfils the requirements of serious COVID-19 patients, says Dr. Santhosh Kumar.
Liquid oxygen plants
He has now submitted a report of his team’s Mumbai stint and the lessons that Kerala can learn from Mumbai to the B. Ekbal committee.
“A COVID ICU would require more oxygen supply than is normally required. Oxygen intensive therapies which are critical for serious COVID patients need 10-15 litres of oxygen per minute. This cannot be fulfilled with oxygen cylinders and instead we will need liquid oxygen plants to cater to ICU requirements,” Dr. Santhosh Kumar says.
COVID-specific beds
“Just looking at ICU bed numbers alone will not give an assessment of our capacity because we need functional beds, specific to the requirements of a critical COVID-19 patient. Standardisation of our ICU facilities is needed in the light of high oxygen requirement and other human resources demands,” he adds.
While Kerala is focussing on prevention and containment strategies to hold down a possible surge in patients, it also needs to keep a sharp eye on the increase in proportion of its critically ill patients region/district wise so that one can estimate the doubling time, the time when the ICUs could be overwhelmed and devise suitable mitigation plans.
The report also details the need for creating negative pressure systems in ICUs to protect health workers in a highly contaminated environment, the need to plan for additional human resource to run a four-shift system (health workers cannot work in a PPE kit for more than six hours) and the additional investment in facilities for accommodation, food and laundry services for health-care workers as they cannot return home.
“Mumbai was a great learning experience. Kerala is managing very well now but once community transmission happens, the spike in in caseload and the demand for ICU care can surge in a matter of days. Planning ahead alone will help us keep the mortality down,” Dr. Santhosh says.