To manage the overwhelming number of patients arising out of the coronavirus outbreak, the government of Maharashtra has taken over 80% of beds across all private hospitals and nursing homes in the state till August 31 this year. It has also capped the treatment tariffs that can be billed to patients and will now regulate the usage of private hospitals bed capacity. The key challenge for the government is to manage the inflow of patients in the right way so it doesn't overload the system, and if the patient to bed ratio can be managed with the help of logistics.
Dr Girdhar Gyani, DG of the Association of Healthcare Providers, says it is necessary to get the private healthcare sector involved to combat the epidemic. Speaking to BOOM about the shortage of hospital beds, Gyani said, "This is happening because most of the initial cases that were admitted to the hospital were patients who were asymptomatic or had mild symptoms. They should have ideally been put in hotels and other quarantine centres. These patients didn't need hospitalisation, and we were utilising our healthcare facilities for them, which was a misstep."
The number of confirmed active COVID-19 cases in Maharashtra is 54,758, with 23,684 confirmed active cases in Mumbai as of 26 May, making the city COVID-19 hotspot in India. But the Brihanmumbai Municipal Corporation plans to add more beds to deal with the growing numbers.
BMC Commissioner Iqbal Singh Chahal addressed the media about Mumbai's lack of hospital beds, "The centre estimated that Mumbai will have over 40,000 active cases by the end of May. However, if we see the city currently has only about 22,000 active cases. By the end of this week, it can go up to 26-27,000 cases at best. Our current bed capacity at 30,000 is being strengthened with an additional 14,000 beds in the next few days."
In Mumbai, as of 27 May, there are 7856 isolation beds of confirmed cases in Category-I Dedicated COVID Hospitals (DCH) having fully equipped ICUs, ventilators and beds with assured oxygen support for comprehensive care primarily for those who have been clinically assigned as severe,1037 isolation beds of confirmed cases in Category-II Dedicated COVID Health Centre (DCHC) for cases that have been clinically assigned as moderate, and 29,076 isolation beds of confirmed cases in Category-III Dedicated COVID Care Centres (DCCC) for patients who exhibit mild symptoms.
According to data given by the Ministry of Health and Family Welfare, 70% of the COVID-19 cases exhibit mild symptoms and don't need hospitalisation. Dr. Shivkumar Utture, President of Maharashtra Medical Council tells BOOM why home quarantine is not effective in Mumbai. He says, "We have to understand the uniqueness of Mumbai. Mumbai is over-populated, and the majority of cases we see come from the slums where a lot of people stay in a small space. According to the new ICMR guidelines, asymptomatic and mildly symptomatic can stay at home. But imagine if you are going to put this COVID-19 positive person who already lives in a small place in close contact with their family. It's impossible for these patients to be home quarantined. 75% of patients come from backgrounds where they can't be quarantined at home."
Help from the private healthcare sector can provide more beds. Dr Girdhar Gyani says, "Many small clinics are closed down because they don't have the paraphernalia of what it takes to handle a COVID-19 patient if there is one in their OPD. The government needs to take a special incentive to get them to open."
Dr Utture explains why clinics were shut down. He says, "This was a new disease we didn't know much about. We have to understand that doctors are also human beings, and we get scared. The worst part was when the disease came in, we didn't have any protection. No masks, no PPEs, and a lot of doctors, health workers were falling sick in the beginning."
But there's hope, if doctors are provided with proper protection, they'll come back to work. He says, "Dharavi is one of the worst-hit regions, and only two to three clinics were open there. We tied-up with the municipal corporation, started supplying doctors with PPEs, and we assured the doctors that if you were infected, you'll get treated. Now, more than 100 clinics are open there."
This was confirmed by BMC Commissioner I S Chahal on Monday when he said that they are working with small clinics across Mumbai to open their facilities for COVID patients. The clinics have been assured of adequate resources like PPEs on a daily basis.