As it is becoming more evident that the State would be fighting the COVID-19 pandemic for many more weeks or months, the entire focus of the health administration is now on managing the surge capacity in districts.
(Surge capacity generally refers to the ability of a health system to maintain a sudden, unexpected increase in patient volume that would otherwise severely challenge or exceed the present capacity of the system.)
The number of patients who are critically ill has spiked in all districts. However, not all districts are well-placed to manage the increasing number of patients requiring ICU care or ventilator support.
Though the private health sector has stepped in for COVID-19 management, even now, a clear picture of how many private hospital beds, ICU beds and ventilators would be available for COVID-19 management in districts is not available.
A senior Health official said that private hospitals had been told to compulsorily set aside 10% of their beds for COVID-19 patients.
“It is not easy to create more ICU beds because it requires enormous human resources support. We need at least 36 staff nurses to run 10 ICU beds round the clock, which is unthinkable in the current situation,” he said. There are not enough doctors also to put into service.
Category B patients
The focus is shifting to Category B patients now, who have more than mild symptoms, which might aggravate, because of various co-morbidities like diabetes or their immuno compromised state.
“The attempt is to manage Category B patients well so that their condition does not worsen, requiring ICU care/ventilator support. In all districts, district authorities have been asked to take over small and medium hospitals to create COVID-19 second line treatment centres where high flow nasal oxygen facilities to give supplemental oxygen to patients, and physicians would be available round the clock,” he said.
District wise
As for districts, Thiruvananthapuram, which has some 1,200 beds with oxygen support (including 397 ICU beds) and 360 ventilators, is one of the best-equipped districts and is expected to manage COVID-19 very well. Case graph does show signs of plateauing but the high daily caseload of around 900-1,000 cases is extremely worrisome as the hospital stay for every patient is an average of 10 days.
Kozhikode and Ernakulam are expected to do fine because of the strong presence of private hospitals. But Kozhikode already has a high caseload and it will also have to bear part of the load of Malappuram, which is mostly dependent just on Government Medical College Hospital, Manjeri, for critical-care patients.
Similarly, situation in Alappuzha and Kasaragod are also worrisome. Kollam (with 2,163 beds in all, and 246 oxygen supported beds, including 68 ICUs, 108 ventilators) is another problem district, which has been experiencing a surge and is leaning heavily on Thiruvananthapuram for providing critical-care support.
There are District Programme Management Support Units in every district, which are supposed to have a daily dashboard with real-time monitoring of hospital beds/ICU occupancies. However, there are inherent problems of reporting from hospitals and hence the functioning of these control rooms have not exactly been perfect, it is pointed out.