City hospitals brace for month end

They are readying for a possible peak in Covid-19 cases. A Metrolife status check

Hospitals in Bengaluru are gearing up for a possible outbreak of coronavirus cases towards the end of the month.

Dr Devi Shetty of Narayana Health City expects the state to experience a peak of 80,000 cases by April end.

Victoria Hospital, Bengaluru’s biggest government hospital with a capacity of 1,000 beds, is now a dedicated hospital for Covid-19 cases.

Metrolife asked around at other hospitals about their preparedness.

Narayana Health City

Tent, special team, dedicated wards

Dr Mahesh Kumar, consultant-internal medicine with Narayana Health City, says R0 (the basic reproduction number) determines the speed at which a virus spreads.

“The third or fourth week of the outbreak is when the numbers start peaking -- this is what happened in Italy, US and could happen in India also,” he says.

Narayana Health City has taken three steps to combat Covid-19, including setting up a coronavirus screening wing. “An isolated Covid-19 OPD, which is far away from the other buildings, is functional. A separate team of doctors is screening, examining and, if required, sending patients for testing. Two isolation wards have been allotted for Covid-19 cases, 30 beds for the critically ill and 60 for stable patients,” Dr Mahesh says.

The facilities are equipped with oxygen cylinders and ventilators. Outside the hospital, in an open space, a tent has been set up where patients can be screened. “Any individual with symptoms will be directed to the Covid-19 screening wing, which has been active since four weeks,” he says.

The number of beds in the isolated wing may need to be increased in case of an outbreak, says Dr Mahesh. “Infected seniors and diabetic patients could end up with respiratory failure fast. There will be an increased need of oxygen cylinders, noninvasive ventilators, ventilators, essential drugs and PPE in such a situation,” he says.

Fortis Hospitals

Total beds: 500
Three segregated zones

Fortis Hospitals have about 500 beds across four branches — Bannerghatta Road, Cunningham Road, Rajajinagar and Nagarbhavi.

Dr Manish Mattoo, zonal director, says if community spread is seen, some of these beds can be dedicated for Covid-19 patients, while at the same time non-Covid-19 patients are safeguarded. “Fighting the virus is not just about beds, but also about PPE, testing and manpower. While hospitals can provide beds and manpower, the hospitals are dependent on external agencies for PPE and all of these need to come together,” he says. Not all rooms can be used for isolation, as an air handling unit and HEPA filter are needed for isolation.

“Our strategy is to create three segregated zones: Covid-19 suspect cases, positive cases that don’t require ICU support, and a Covid-19 intensive care area. We have also earmarked an area for Covid-19 negative patients but with symptoms of Acute Respiratory Distress Syndrome, as they could be possible carriers,” he says.

Columbia Asia Hospitals

Total: 650 beds
Ready for isolation and training

Dr Nanda Kumar Jairam, CEO, Chairman and GMD, Columbia Asia Hospitals, says a coordinated healthcare provision is needed now.

“We have identified the space and beds required in the case of an outbreak. Our five branches — Hebbal, Yeshwanthpur, Whitefield, Sarjapur and Doddaballapur — have approximately 650 beds in total. If needed, we will be able to allot around 25 beds, as these beds need to be isolated,” he says.

PPE for staff handling patients, masks for patients, and additional support like nutrition and physiotherapy are other requirements. “The isolated beds will work for both observation and critical care,” says Dr Jairam. If the number of cases is huge, more medical personnel will need to be trained accordingly, he adds.

Sakra World Hospital

Total beds 300
Approved for Covid-19 testing

Dr Deepak Balani, chief of medical services at Sakra World Hospital says, “The healthcare system is better prepared now compared to a few weeks ago. The reality is that the number of Covid-19 patients might increase over time. The key is to ensure a safe and secure environment for patients as well as caregivers,” he says.

The situation is not only dependent on beds, ventilators, PPE, and infrastructure, but also on competent clinical and paramedical staff and that could become the biggest challenge for all hospitals going forward, he says.

Sakra World Hospital is a 300-bed facility. Dr Deepak says, “We have created an isolated area at our Emergency Room, which is converted to a Respiratory Zone. This can be used to manage Covid-19 suspected or positive cases. About 50 per cent of the beds are critical care-ready beds and the remaining 50 are High Dependency Unit beds.” ICMR has accorded approval for Covid-19 testing and the hospital hopes to commence it in a week after due validation, he told Metrolife.

The hospital has already put in place a three-level screening process and commenced counselling at secure portable cabins erected outside the main building. Video consultations have also started, he adds.

On the other hand...

While what Dr Devi Shetty, chairman of Narayana Health City, is saying is being considered seriously by the health authorities, Dr Sylvia Karpagam, Bengaluru-based public health doctor and researcher, has some contrary views.

In an article titled ‘Why Dr Devi Shetty’s 25 (or 2500) ways to manage Covid-19’ should be rejected outright’ published on Ambedkarite website Roundtable India, she spells out various points
‘Dr Devi Shetty, cardiologist and chairman of one of the largest chain of corporate hospitals in Karnataka, has become, and is projected as, the singular advisor on all types of healthcare issues. Being a cardiologist, he is unlikely to have expertise in public health, epidemiology, statistics, and planning and management. Also, she says, he comes with a conflict of interest.

No genuine policy decision with far-reaching impact on thousands of people can be taken without diversity or representation in decision making. She asks if ‘this individual will be penalised if the decision was found to be wrong?’

By keeping the discussion centred to Bangalore, he has left out the rest of the state. She says ‘comprehensive planning cannot just take a convenient sample.’

She objects to his suggestion that the state government should close two busy 1,000 bed government hospitals in Bengaluru and convert them to critical care beds, as this could jeopardise the lives of patients who are too poor to access any other care.

She rubbishes the suggestion that ‘the government should take care of those who don’t require advanced critical support while those who do … be sent to large private hospitals.’

She says the statement that ventilators are crucial to preventing coronavirus deaths is not good public health practice. Several other treatment protocols can reduce the need for ventilators, she argues.

She describes these aspects as key: prevention of spread, early diagnosis of complications, and having well-paid and well-trained staff and affordable drugs.

Sweeping statements about India being an ‘example for the world to follow’ just help ‘the government look good and also make the elites feel good’, she says.