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Gasping for breath

Patriot takes a tally of the availability of ventilators in ICUs in the Capital as the threat of Covid-19 pandemic moving to community transmission looms over the country 

The total number of ICU beds with ventilators in Central government-run hospitals of Delhi are just 227, including paediatric beds. This number comes from tallying the figure from Vardhman Mahavir Medical College and Safdarjung Hospital’s website, which take into account the status of ICU beds with ventilators in Safdarjung Hospital, Ram Manohar Lohia Hospital, Lady Hardinge Medical College and SKSC Associated Hospitals, AIIMS, NITRD & VBP Chest Institute.

The figures on the website come with the Centre’s decision in late 2019 to set up a control room in Safdarjung Hospital that would allow patients to track the number of ICU beds available with ventilators in Central government hospitals.  

Clearly, the availability of ventilators in ICUs in the Capital is dismally low,  even as the threat of pandemic Covid-19 exploding in the country has made the Centre decide on a nation-wide lockdown for 21 days from March 25. 

The virus has now a total of 472,381 cases worldwide with 21,304 deceased. India has not yet reached stage 3, which is community transfer of the virus – with a number of total cases at 678 with 13 reported deaths – but if it were to, the country would be grossly lacking in critical care with the shortage of ventilators.

Italy has seen the most number of deaths at 7,503 surpassing even China’s 3,287 deaths — the country where the virus originated in its city of Wuhan. Now, the United States is seeing a surge in cases with 68,489 total infected persons and 1,032 people who have died from it. 

The American Hospital Association estimates that 960,000 patients will need ventilators at some point in this coronavirus pandemic. The New York Times says the country has just 172,000 ventilators while 12,700 of those are in federal stockpile.

New York, which is seeing a surge in cases with about 60% of cases in America here, is also planning on how to best use its ventilators. Reports speak of how the state is planning on rationing its ventilators which are few as compared to infected cases which are soaring.This means the doctors here, like the ones in Lombardy, Italy may have to make a critical and hard decision on who to provide the ventilators to. 

Consider that in the case of India which has a population of 1.3 billion people and you’re staring at a disaster. Brooking says that out of 7,13,986 total government beds in India, 5-8% are ICU beds (35,699 to 57,119 ICU beds). “Assuming that 50% of these ICU beds have ventilators, we arrive at an estimate of 17,850 to 25,556 ventilators in the country. Even in the best-case scenario where all ICU beds are equipped with ventilators, we have a maximum of 57k ventilators to cater to a growing number of Covid-19 patients. Clearly, the growing demand for ventilators is going to outstrip the limited supply really soon.”

In fact, the government was still exporting ventilators produced in the country until March 24 when it issued an order amending its export policy on ventilators “including any artificial respiratory apparatus or oxygen therapy apparatus or any other breathing appliance/device and sanitisers”.

The Indian Railways then asked its rolling stock production units to explore the possibility of manufacturing medical equipment, like hospital beds, ventilators, masks and sanitisers.

Delhi’s lung back-up

Coming back to the Capital city if we take into account only the adult ICU beds with ventilators available in the Central government hospitals mentioned in the above website, then the total number is even lower at just 149 — out of which five are out of order, according to the figures provided.

Safdarjung Hospital puts its total number of ICU beds with ventilators at 79, out of which 20 are in the Paediatrics Department. Out of these 59 are for adults, out of which one  was not working and another was out of order, according to the figures from March 24.

At the Lady Hardinge Medical College and SKSC Associated Hospitals, there are a total of 29 ICUs with ventilators, out of which nine are for adults with one ventilator not functioning as of March 25.

Ram Manohar Lohia hospital has a total of 71 ICU beds with ventilators, out of which 33 are for adults while two are not working, according to their own figures from March 25.

At AIIMS there are a total of 37 ICU beds with ventilators, with 10 beds assigned for Covid -19 patients, ‘C2 ICU’ with a total number of eight beds with ventilators and ‘CT2CCU’ with a total number of 19 beds. The National Institute of Tuberculosis and Respiratory Diseases (NITRD) has five ICU beds with ventilators and Vallabh Bhai Patel Chest Hospital has six ICU beds with ventilators, all three figures from March 25.

However, AIIMS Medical Superintendent Amit Lathwal has refuted the number and said the site where we got the data from was probably not updated, “This is not the true picture, as many ICUs have not been updated into this”. He also said that while the government may be looking to procure more, his institute had no plans to do so as they had enough and AIIMS was preparing and “making a dynamic process” to deal with Covid-19.

Narrowing the scanner to hospitals under the Delhi Government, take into account the Delhi High Court’s observation from February of this year, where it criticised the dismal number of beds equipped with ventilators, which were just 348 out of over 10,000 beds. The 33 government-run hospitals, it was told, have only 10,059 beds, out of which only 348 beds are equipped with functional ventilators, that is 3.4% as against the minimum requirement of 10%.

The bench was also told that there are around 400 ventilator beds in all of Delhi’s government hospitals, out of which 52 are “not functional and efforts are being made to repair them.” It had then asked the Aam Aadmi Party government to provide a tally of the beds and other facilities on the government website. The order came after advocate Ashok Agarwal wrote a letter to the Chief Justice of the High Court, highlighting the death of a toddler because of lack of ventilator.

We looked at the Delhi State Health Mission website, where we found that the number of ICU beds available with ventilators were at 73 on March 25.

Ashok Agarwal said that he had serious doubts that more beds have been added since. “The situation is so grim. Patients don’t get ventilators and now with Corona if a patient requires a ventilator, it will not be available. The case is the same with Central government hospitals — be it AIIMS or Safdarjung. We have been talking about it for so many years and this is not just a problem for Delhi but the entire country, but the government never bothered”.

Reports now suggest that the Union health ministry is taking stock and on March 23 ordered  procurement of 1,200 new ventilators. There are also talks apparently taking place with automobile companies Maruti, M&M, Hyundai, Tata and Honda of the possibility of producing ventilators and other equipment in their factories so that the country is equipped to battle Covid-19 and deliver critical care.