In an interim report, the High Level Expert Committee in Karnataka for COVID-19 third wave management headed by cardiac surgeon Dr Devi Shetty, has recommended a minimum increase of 10% of healthcare facilities with increased focus on augmenting paediatric treatment. Dr Sathish Girimaji, Dr Basavaraj GV, Dr Ashish Sathapathy, Dr Ajaykumar, Dr Aravind Shenoi, Dr Raghunath U, Dr Yogananda Reddy, Vinod H Ratageri, Dr Prem K Mony and Dr PG Girish are the other members of the committee. Much of the report focuses on children as many experts believe they could possibly be a vulnerable demographic in the COVID-19 third wave. In its summary of recommendations, the Dr Devi Shetty committee has suggested augmentation of NICU (neonatal intensive care unit) / SNCU (Sick Newborn Care Unit (SNCU), pediatric ward beds, paediatric ICU/HDU (high-dependency unit) beds at taluk hospitals, district hospitals and medical colleges .
The committee in its interim recommendation noted that in the first and second wave, children aged between 0-18years constituted around 8% to 10% of the total infected population. While the report mentions that most national and international data indicates that a maximum of 5%-7% of such children require hospitalisation, a recent study from the USA suggests that children in the age group of 12-17years require almost around 31% ICU admission and among them 5% needed invasive ventilation. However no deaths were reported.
Using data from the past two waves of the pandemic, serological data and statistical models (data by union government and IISc), the committee arrived at three models of best, worst and moderate case scenarios depending on the virulence and transmissibility.
For the worst case scenario, Karnataka will need 27,205 general beds, 13,602 ICU/HDU beds and 54,409 COVID Care Centre beds. For the moderate case situation, the state will need 23,804 cases, 6,801 HDU/ ICU beds and 43,358 CCC beds. Similarly, for the best case scenario, the state will need 13,602 general beds, 6,801 ICU/ HDU beds and 30,605 CCC beds.
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For each of the three scenarios, the committee report has also presented a district wise need for necessary infrastructure.
Based on its own projections predicting three different scenarios at district levels, the committee has recommended upgrading the existing SNCU/NICU, PICU, converting existing HDU to PICU, upgrading existing pediatric wards as HDU with piped central oxygen and suction facility so that in short notice can be converted to PICU in case of surge in pediatric cases. Further it has recommended that 250-bed children hospitals with 20 intensive care beds for backward districts like Chamarajanagar, Yadgiri, Chikballapur, Kolar, Chitradurga, Koppala and Haver be built within the campus of district hospitals and medical colleges.
The report which is yet to be formally accepted by the government reads, “The existing Covid facilities and Special Neonatal Care units (SNCUs) should be augmented; the numbers of beds available should be enhanced by at least 10%. These facilities should have provisions to allow the parents to be with the child; separate areas could be earmarked within the COVID facilities for children and their parents.”
“These augmented facilities should have adequate provision for oxygen supplies, paediatric specific respiratory support devices, monitoring equipment for children, 38 paediatric formulations. Adequate number of trained manpower for managing paediatric cases should be made available,” it added.
Other than increase in infrastructure, the report recommended strengthening of HDU/ ICU care within existing paediatric facilities for managing multisystem inflammatory syndrome in children (MIS-C). “If the surge is excessive and the capacity of covid facilities is overwhelmed, then use of general beds/ wards/ ICUs in hospitals may be considered,” the report mentioned. It has also recommended setting up of a Centre of Excellence at Indira Gandhi Institute of Child Health, Bengaluru for MIS-C and five such regional centres across the state.
The report also noted that pandemics like COVID-19 can affect people at any point of time and there is a need to strengthen existing health facilities particularly district hospital and secondary care facilities for provision of assured non-COVID-19 critical care. The report further detailed the need for hiring adequate manpower like from specialist doctors to nurses and equipment from basic measuring tape to non-invasive ventilators at an institute level.