Andhra Pradesh, like most other states in the country, is faced with an acute bed shortage amid the second wave of COVID-19. In the nearly 600 hospitals in the state, authorised to treat COVID-19 patients, all the beds from government hospitals, and at least 50% of beds from private hospitals, are meant to be allotted to COVID-19 patients through the centralised 104 call centre. However, the severe bed shortage has meant that most patients are only able to get a bed by guesstimating their chances and lining up outside the hospitals most likely to have a bed available, according to volunteers who are flooded with hundreds of requests for beds every day.
After the allocation of beds was centralised, several complaints arose in the initial days over lack of response from the 104 helpline. According to IAS officer A Babu, who has been tasked with ensuring the effective functioning of the 104 call centres, the number of lines has since been increased. He said that there are now around a thousand lines, and 270 staff members working three shifts round the clock, at the central call centre in Vijayawada. The call centre also connects patients to doctors who provide telemedicine services and advise patients on whether they should go to a hospital or a COVID-19 Care Centre (CCC), or remain under home isolation.
Several volunteers calling 104 multiple times in a day said that getting a response has now become easier, with a shorter wait time. However, while requests for information are easily met, reaching a doctor or getting a bed is very difficult, they said. To get a bed through 104, the patient needs to be registered with the call centre, and have an ID number allotted once it is decided that they need to be hospitalised.
According to A Babu, the 104 call centre has around 3,510 doctors, including 600 specialists, holding virtual consultations with nearly 20,000 patients each day. When a bed request is received on 104, a ticket is raised with the patient’s details. The patient is eventually connected with a doctor to ascertain if they need hospitalisation. “The tickets are also visible at the district level 104 call centre. Once a doctor advises hospitalisation, the district team follows up to get a hospital admission” he said.
Volunteers, however, say that in their experience, not all patients are able to even get the call back from a doctor for triaging the patient. Aditya, a volunteer from Vizag who has been handling bed requests on Twitter, said, “Although it has been easy to get through to 104, from there to go to telemedicine, it takes time.” Aditya’s team is independently working with a team of doctors who are triaging patients, he said.
Even in cases where triaging is done and a bed request is processed through 104, volunteers say that owing to the acute bed shortage, receiving timely information of available beds, and successfully being admitted on reaching the hospital, is highly unlikely.
“In some districts, where oxygen beds are nearly filled up, as soon as a bed becomes available, admission is done based on the severity of patient’s condition, and first-in, first-out basis,” A Babu said. But with multiple registered patients waiting at hospitals, prioritisation is done more often at the hospital level, according to volunteers. Vijju, a volunteer in Vijayawada said, “Earlier this week, a patient we were working with was even allocated a bed number at GGH Vijayawada through 104. But on reaching the hospital, they were not admitted. On contacting the call centre, they said their job is only to allocate, and it was up to the hospital to accommodate the patient.”
Volunteers said that in their experience, these decisions are being taken by the hospital solely based on the patients’ condition. However, there have been reports of alleged irregularities in bed allocations in a few places, like the Guntur GGH and Nellore GGH.
Once a patient is registered on 104, according to A Babu, the time frame given for bed allocation is about 3 to 4 hours. However, volunteers say that owing to the long waiting periods due to the severe bed shortage, many patients are lining up outside major hospitals, like GGH Vijayawada and KGH in Visakhapatnam, some of them waiting their turn in ambulances with oxygen support. “If we at least know which hospitals are more likely to have beds at the time, we can direct patients there so they have a better chance while waiting outside. But the government dashboard for beds never has accurate information,” said Vijju.
A Babu said that the 104 call centres have more accurate information than the dashboard, coming from the district control rooms. Each district control room has around 25 people working across three shifts, coordinating with doctors and nodal officers appointed by the government at every COVID-19 hospital and CCC. “Even if the dashboard is not updated, the district team directly talks to the nodal officers and gets accurate information,” he said.
“The district control rooms are not easy to reach, possibly because they’re overburdened,” said Aditya. While the nodal officers’ contacts are available to the public on the government dashboard, some of them do not work. “Some of the nodal officers themselves have COVID-19,” said Aditya. He added that his team has been reaching out to government officials for more accurate information, and updating bed details with the help of nodal officers on the covidbeds.info website. According to Vijju, while such volunteer-run websites also do not have real-time information, they have been more accurate than the government dashboard in helping assess the chance of getting a bed at a particular hospital.
The remaining beds at private hospitals, which are not allotted through 104, are almost entirely available only through personal referrals, said Aditya. “Since we have been in touch with the hospital help desks for weeks now, we are able to find out when beds become available and connect patients. But in most cases, it has only been possible through people’s personal contacts or their doctors’ networks,” he said. But ICU and ventilator beds are so scarce at private hospitals that they are mostly in use for internally escalating cases, he said, adding that waiting at government hospitals has become the only option for anyone without direct, personal access to private hospitals.
Several unauthorised hospitals that are not displayed on the state government dashboard have also been admitting COVID-19 patients. Vigilance and enforcement officials have been conducting frequent raids on private hospitals, and have been booking hospitals for treating COVID-19 patients without authorisation. But amidst the acute shortage, smaller hospitals and nursing homes have been the only option for some patients, Aditya said, as many of them have a few oxygen beds available. However, such hospitals lack ventilators and are unable to handle patients when they turn critical, sending them away to government hospitals, he added.