In September 2020, when COVID-19 cases were surging, Kerala began Plan C, which was part of its pandemic contingency strategy. As part of Plan C, the state government roped in private sector hospitals, asking them to set aside at least 20-25% of their beds to treat COVID-19 patients. Many private hospitals, including medical college hospitals, allocated 15% to 20% of their beds for COVID1-9 patients. Months later, in April 2021, private hospitals are running out of beds. “All COVID-19 beds are occupied,” at least 10 major private hospitals in Kerala told TNM. Here is a status report from three major districts.
Currently, Ernakulam district has the highest number of active COVID-19 cases in Kerala — 37,494. In early 2021, private hospitals in Kochi started seeing an increase in COVID-19 admission. Incidentally, Kochi has more private hospitals than other parts of Kerala. Three major private multi-speciality hospitals in Kochi — VPS Lakeshore hospital, Aster Medcity and Renai Medicity — said they do not have any beds left.
"Initially, we had allotted 15 beds for COVID-19 patients. A month ago, we increased it 20 beds. Now, we have 30 beds, all occupied,” a spokesperson for Lakeshore Hospital told TNM. Since most of the patients, of late, are critically ill, they have not been able to admit more patients, as their existing six ICU (intensive care unit) are occupied.
“We are struggling to increase the beds. There will be an increase in COVID-19 cases at least in the next week. However, we will increase it in the next two days,” said the spokesperson, adding that the patients seeking non-COVID-19 services are gradually coming down.
Aster Medcity is set to reopen its first-line treatment centres (FLTC) for COVID-19 patients with mild symptoms and those who require observation. They had shut it in late 2020 when the demand reduced. All of their nearly 100 beds for COVID-19, including 20 to 25 ICU beds, are occupied.
About increasing the bed capacity, the management will have to factor in various aspects before making a call. “We need to ensure non-COVID-19 services also continue. Besides, we cannot depute nurses in non-COVID-19 services for COVID-19 duty as they have their own shift,” the public relations officer of Aster Medicity told TNM.
Two big private medical colleges in Thrissur confirmed to TNM that their COVID-19 beds were almost completely occupied. As requested by the state government, the Amala Institute of Medical Sciences in the Thrissur town set aside 25% of their beds to treat COVID-19 patients. This is 250 beds. They are adding 100 beds, 11 rooms and 12 ICU beds to its COVID-19 section in the coming days. It has 99 non-ICU beds. “A majority of them have liquid oxygen supply. Only 30 beds do not have an oxygen supply. As of now, we have more than 60 patients occupying these beds,” said Dr Rajesh, Medical Superintendent of the hospital.
Currently, out of their 12 functional ICU beds, 11 are occupied. The private medical college hospital is arranging 12 more ICU beds in another building within two to three days, as there is an increase in COVID-19 patients requiring ICU admissions. “So, we will have 24 ICU beds by the end of this week. Out of these, we will have 10 ventilators and four high flow nasal oxygen beds (which provide high flow oxygen to patients). Three ventilators have been occupied so far,” he said.
Dr Rajesh also added that in the last few days, there has been an average of 10 COVID-19 admissions daily to the hospitals and that compared to the first wave, there has been an increase in the number of cases.
Jubilee Mission Medical College and Research Institute, another renowned private medical college hospital in Thrissur, has also reported full occupancy of COVID-19 beds. Father Francis Pallikunnath, Jubilee Mission’s Director, said that the hospital had 100 beds set aside for COVID-19, including 12 ICUs, all of which have been occupied.
“We have arranged two additional beds in the ward due to a shortage. So we have 102 COVID-19 patients now,” said Father Francis. Jubilee Mission also has six ventilator beds, which are occupied. Out of the four High Flow Nasal Oxygen (HFNO) beds, only one is vacant currently.
The hospital is completely oxygenated, which means that each bed has a pipeline oxygen connection. About 35 to 40 patients, who need oxygen supply, are admitted to our COVID-19 wing.
“Over the past week, we have had an average of 15-25 COVID-19 patients getting admitted to the hospital,” he said.
At KIMS Hospital in Thiruvananthapuram, there are about 140 COVID-19 patients being treated, including in the Intensive Care Unit (ICU). The hospital authorities say that they have expanded their capacity over the last few weeks to convert 20% of the beds to COVID-19 units. They are also considering expanding this further up to 25% of the beds.
"We are also looking at an early discharge of COVID-19 patients. As per the new rules, an antigen test is not required to discharge COVID-19 patients, we can discharge them and follow up with them through tele-consulting. We have stretched to our maximum capacity now and can have up to 150 beds in all," said a doctor at the hospital.
In Cosmo Hospital, too, two floors containing 46 beds, including the ICU beds, alloted for COVID-19 patients, are full. The two floors, which had been free on Monday morning, got allocated later in the day, said the PR staff at the hospital.
The Gokulam Hospital at Venjarumoodu in Thiruvananthapuram also has the same capacity, 46 beds for COVID-19 patients. All of these are now occupied and the hospital had an internal meeting on Monday to discuss expanding the number of beds, said a hospital official.
“Some patients, as soon as they test positive for coronavirus, come to our hospital to ensure quality treatment,” said the PR official at Aster Medicity in Kochi. “Some families want to shift to our hospital when their situation turns critical while undergoing treatment at another hospital. Some who are in home isolation, call us to enquire about the beds as they start experiencing shortness of breath,” he said.
According to Dr NM Arun, an Internal Medicine Specialist in Palakkad, such scenarios add pressure on the private health sector. “Such private hospitals, especially in Ernakulam, offer multispeciality treatments and patients from Palakkad, Idukki and other parts of the state go there. So, in the current situation, they are under pressure to turn away non-COVID-19 patients. Besides, many critically ill patients may want to move to big hospitals for treatment.
Dr VK Shameer from the Kozhikode Government Medical College also said that many government-referred COVID-19 patients continue the treatment at private hospitals free of cost. “This is in addition to the COVID-19 patients who directly go to the private hospitals for treatment,” said Dr Shameer.
Incidentally, in 2020, most of the patients with all categories of symptoms were admitted to hospitals. Now, critically ill patients, who mostly require oxygen, approach hospitals, especially private hospitals. Patients with moderate symptoms are encouraged to undergo treatment at home while volunteers check up on them on phone every day. Besides, first-line and second-line treatment centres are also slowly reopening.
With the second wave, however, hospitals are mostly seeing critical cases of COVID-19. “This wave was quick and hard-hitting,” said Dr Shameer. “When we thought the cases were dipping, the disease spread in the blink of an eye. We were shaken up. In the first wave, hospitals did not have non-COVID-19 patients, partly due to the lockdown. We could free up space to accommodate COVID-19 patients. Now, since the transmissibility of the disease has increased, we are just freeing up hospital space,” he added.
Despite the surge in COVID-19 cases, doctors said that they are confident they will be able to manage. "However, every day, we still fear if the virus will upend our calculations as it has become unpredictable,” said Dr Shameer.
“That is why private hospitals will have to increase their bed capacity, as the government hospitals will not be able to bear the weight alone,” said Dr Padmanabha Shenoy, a rheumatologist based in Kochi.