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Almost three weeks into a national COVID crisis, Delhi is still in SOS mode. Indians are in collective mourning, and everyone is reeling from a deadly, heartbreaking second COVID-19 wave.
Other cities like Mumbai or indeed states like Kerala, which are also suffering from a high number of COVID cases, are seemingly staying afloat. So, what are they doing differently? And what does Delhi need to do right now to help its citizens?
“We need to get a structured system in place,” says Dr Anant Bhan, Adjunct Professor & Researcher in Bioethics at Mangaluru’s Yenepoya University.
Here’s how:
Social media platforms have become helplines and triage centres all in one. And while this is remarkable, it’s not sustainable. “Good quality healthcare does not work through social media,” says Dr Bhan.
Put simply, it’s the prioritising of medical emergencies to decide the order of treatment in a large number of cases. Authorities in Delhi have directed that dedicated COVID hospitals ensure no delay in transferring a patient from a triage area to an ICU to reduce the mortality rate.
Often patients in critical condition lie waiting in ambulances while looking for beds or oxygen – and since ambulances have a limited supply of oxygen, it's a risky situation to be in. Doctors have reported that many patients of differing severity wait in the waiting areas, and so the most urgent cases don’t get the immediate help they need.
As per the latest COVID protocol, patients suspected of COVID-19 are to be given immediate medical attention. This is especially helpful given the dearth of RT-PCR tests and delays in getting reports.
Dr Sumit Ray, a critical care specialist and medical superintendent at Holy Family Hospital, a 345-bed facility in New Delhi that has been converted into a fully COVID hospital, says that the need is critical as without triage systems, hospital workers are “helpless”.
He says, “Being an intensivist, I have seen many deaths, but never like this. These are cases where we know that a person needs critical care but are not able to provide it. Not just here, but in any hospital. My resident doctors cry, not because they complain about the load, but because they are helpless.”
Dr Suranjit Chatterjee concurs and says to The Indian Express:
In an earlier FIT video, he describes the horror of patients “lying in causality for hours without beds - we want to move them to another hospital but where can they go? Our systems are getting overloaded. This is where the government has to pitch in to help with the logistics of moving patients and essentials.”
Dr Anant Bhan adds that proper planning can help quell anxieties and reduce crowding at hospitals. He says that there are multiple angles to handling the crisis – from fixing the oxygen supply issues urgently, to ensuring transportation to the hospitals, to engaging the community to explain which cases need to come into the hospitals and which can be managed at home.
The main thing doctors in Delhi have appealed for is a centralised triage system for patients who are relying on social media to check for beds.
The structured system would include:
He adds that triaging can not only help patients who need help most, but also help ensure equitable distribution of healthcare.
Dr Bhan says that authorities should simultaneously be addressing the rise in cases, and look at the preventative side: From issuing curbs to working out vaccine supply.
So far, bureaucratic hurdles and a lack of decisive leadership from the Delhi or Central government has created a situation where the public is panicking and further straining the fragile and fragmented healthcare systems.
On 5 May, the Supreme Court told the Centre to “look to Mumbai and take note” of its successes in managing the supply of oxygen. So far, Mumbai has had no reported deaths from a lack of oxygen.
Despite reeling from high numbers, Mumbai is surviving the wave through transparent reporting and clear communication.
Additional BMC commissioner Suresh Kakani spoke to News18 about the basic robust systems they had in place.
With standardised systems and keeping its guard up, Mumbai has managed to stay mostly afloat despite its rising numbers and floating population.
Chahal told The Indian Express they were prepared and their system is now on “auto-pilot” adding, “When calamity hits, there is no time to learn, don’t have the cushion time to copy those models.”
They managed to avert any reported deaths due to a lack of oxygen, and they avoided a calamity on 16 April when 168 patients – including 40 critical – were evacuated in an emergency operation from six civic hospitals with low oxygen supplies and rushed in cardiac ambulances to Mumbai’s ‘jumbo’ COVID care facilities.
Since then, they acted fast and the BMC met with the state task force to devise a protocol for oxygen consumption which was circulated to each hospital.
While Delhi is taking steps to address its crisis, it must move fast to address patients needs and help take the burden off hospital systems.
(The article was first published in FIT and has been republished with permission)
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