ICU patient load not falling in Bengaluru despite dip in Covid-19 cases

Coronavirus infections may have fallen in Bengaluru but that has not relieved the fearsome pressure still being exerted on the city’s Covid ICU infrastructure.

Officials and experts say this is due to a crisis of testing hesitancy and delayed treatment, exacerbated by the lockdown. At the same time, people on the ground say that reservation of ICU beds for VIPs and other people of influence is preventing these beds from being made available to the general public.

As per the BBMP, 587 ICU and 597 ICU-ventilator beds have been allotted for government-quota Covid patients in the city. As per a DH tracking of bedding numbers, a smattering of ICU beds were available until the last few days of April, until daily case numbers began to skyrocket. Since then, none of these has been free. Of 20 ICU beds open at Rainbow Hospital on Saturday, all are reserved for children.

Dr Prasanna H M, president of Private Hospitals' and Nursing Homes’ Association, acknowledged that while general beds are available in large numbers, there continues to be a severe crunch of ICU and ICU-ventilator beds.

"No ICU bed is vacant for more than 30 minutes. In fact, there is a long line of people waiting to take the beds," he said.

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But why should there be a continued load on ICU units in the face of declining Covid numbers? Health Department data shows a 50.9% decline in daily infections in the city since the lockdown began on May 10. But experts say the lockdown has caused unintended side effects.

"I do not necessarily agree that the case numbers have come down because testing is low," said Dr P G Girish, Director, Directorate of Medical Education, which oversees 950 beds at Victoria, Bowring, HSIS Gosha, Charaka and PMSSY hospitals.

"Since the lockdown, people are not coming out of their homes to get tested. This is one reason why testing rates have declined. They are not coming out even when their conditions worsen, consequently deaths are also happening in homes. This is what prompted the recent discovery that 778 people had died in home isolation,” Dr Girish added.

Dr Prasanna concurred that a low turnout for testing is to be blamed but added three factors: people taking the infection lightly and buying into the myth that this is just another "flu", people not following prescribed medication even after being diagnosed with Covid and a misconception that this is the same virus as last year.

"Among vulnerable people, the progress of the disease under the new virus variants is extremely fast," he added.

But sources on the ground say the inability of people to get ICU beds is prompting thousands to stay at home. They also point to ongoing problems in bed management whereby available ICU and ICU-ventilator beds are being reserved for VIPs with hospital compliance.

A source in the private medical industry confirmed this. "There is huge pressure, especially on big chain hospitals, by local officials and the BBMP to keep aside beds. Hospitals face threats. Consequently, many have no choice but to set aside 10 to 20% of their beds," the source said.

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This is said to be the case at PMSSY hospital, a 200-bed facility which has allotted 70 beds for Covid-19 care, including 20 ICU-ventilator beds. "Most of the beds, including ICU beds, are empty," sources said. On the BBMP's bedding management website, however, PMSSY has no vacant ICU beds.

Dr Girish said this is not the case currently, although he said underutilisation was a problem earlier.

Triage centres

The government, meantime, has staked its hopes on triage centres to ensure that only critically ill Covid sufferers are allotted beds. On May 10, Deputy Chief Minister Dr C N Ashwath Narayan acknowledged that triage centres could help address the bed shortages.

"In Bengaluru, about 950 beds are vacated every day. But there is a demand for 7,000 to 8,000 beds. Even after triaging patients, there are over 2,000 patients requiring beds. Hence, we need to have a proper triaging facility at the ward level," he said.

While 48 Covid care/triaging centres have been listed in the city, many appear not to be operational. On Friday, a 67-year-old resident of Jayanagar who sought triaging at a 24x7 centre found it closed. "We went there around 8 pm. However, a second centre, at Carmel Convent, helped to get the patient admitted to a hospital," said the patient’s attendant, Asim Khan.

A DH survey of other centres revealed other problems. At one of the largest triage centres, at Padmanabhanagar, extra toilets were pending installation while some "oxygenated beds" did not yet have oxygen lines. In other places, operational timings were contingent on the attendance of assigned doctors.