Like most other states, Andhra Pradesh has its COVID-19 hospitals nearly filled up. Many hospitals are unable to admit new patients due to unavailability of beds and many patients have complained of struggling to find hospital beds in different towns or cities. In an attempt to address the worsening situation of bed shortage, Health Department officials have been instructed to increase the number of beds at COVID Care Centres (CCCs) across districts. On April 29, Chief Minister YS Jagan Mohan Reddy told officials to arrange 1000 oxygen beds and 2000 non-oxygen beds in CCCs in every district, as part of the government’s efforts to increase availability of beds.
So far, however, many CCCs continue to mainly serve as isolation wards for people from low-income households unable to isolate from other family members at home, or migrant workers, according to health officials. In most cases, oxygen supply is only available in the form of concentrators on standby. These are available to be used as an intermediate measure when a patient’s blood oxygen levels start to drop before shifting them to a proper hospital bed, health officials said.
As of April 29, around 6,348 patients were admitted in CCCs, according to the state Health Department. COVID Command and Control Centre chief Jawahar Reddy had said at the time that many people were showing up in hospitals with mild to moderate symptoms, and triaging centres must be set up to decide if they can remain under home isolation or in a CCC so that hospitals are able to admit severe patients.
Principal Secretary (Health) Anil Kumar Singhal said on May 1 that the number of patients at CCCs was increasing day by day. The number of patients admitted in CCCs was expected to go up from 8,709 at the time to 15,000 in the next two to three days, he said. “As CCCs are strengthened, patients are showing interest in being admitted there,” he said. However, as of May 6, 13,356 people were being treated in CCCs across the state, against the 30,880 CCC beds that were available. As of May 7, there were 14,654 people admitted in CCCs. On the other hand, the number of beds available in hospitals continued to shrink.
Authorities say that the main reason for occupancy remaining low is that patients are preferring home isolation and directly move to hospitals when their condition gets severe, thereby negating the need of going to the CCC. This, in turn, means that the problem of bed shortage in hospitals remains unaddressed.
While some districts, like Krishna, Guntur and Prakasam have separate triaging centres set up (apart from regular Primary Healthcare Centres (PHCs) and Area Hospitals) to decide whether a patient needs to be hospitalised or sent to CCC or home isolation, Kadapa DMHO (District Medical and Health Officer) Dr Anil Kumar said that triaging is also done through home visits by medical officers for those who have tested positive for the coronavirus.
“During the first wave, people were much more frightened to isolate at home. Now that they are more habituated to the virus and precautions, many of them are preferring home isolation. When the medical officer visits and feels the patient won’t be able to isolate properly because of the size of their home, they will be referred to the CCC. But at present, the majority are accepting home isolation,” he said.
A doctor overseeing a CCC in Vijayawada’s Ajit Singh Nagar said that most of the patients admitted were those living in small houses unable to isolate, or migrant workers. The CCCs have doctors and basic medical care available round the clock, along with food for the COVID-19 patients. Patients are kept under observation for around ten days, and sent home if their oxygen saturation level doesn't fluctuate much, he said. However, less than half the beds at the CCC were occupied. According to Visakhapatnam DMHO Dr Surya Narayana, in most patients who are turning critical, the shift is not happening gradually like last time but with a sudden drop in oxygen levels, indicating that moderate patients needing an in-between option might be fewer in number.
On April 29, Jawahar Reddy said that a few oxygen beds must be made available at CCCs, for the convenience of the patients with moderate symptoms admitted there. He added that each district must try to arrange around 1000 oxygen concentrators, to be available at the CCCs as well.
According to district health authorities, CCCs are mostly able to provide emergency oxygen supply with the help of concentrators on standby. However, this may also not help the issue of bed shortage in hospitals as these are available as a temporary relief, to be used in the time taken to shift the patient to a proper hospital bed, once their condition turns critical. “Some CCCs have oxygen concentrators available. PHCs too have oxygen concentrators. If a patient is having shortage of breath, they will be given temporary oxygenation till their oxygen levels are increased, and then moved to a COVID-19 hospital,” said Dr Anil Kumar.
In Anantapur, while none of the CCC beds had oxygen pipelines or cylinders, oxygen concentrators were available at six CCCs. In Guntur, district health officials said that two or three CCCs had concentrators available. At the Ajit Singh Nagar CCC in Vijayawada for instance, there is no oxygen support available. For important medication and oxygen supply, the patient would have to be moved to the Government General Hospital.
Patients are referred to hospitals if their blood oxygen levels drop below 92 when they have comorbidities, and below 90 if they don’t have such conditions. Authorities also said that for oxygen supply, CCCs would have to rely on cylinders, which would be a hassle as it was important to have timely refilling of cylinders amid rising demand.
“Oxygen pipelines can only be provided at hospitals. Visakhapatnam has around 4,000 CCC beds available, and more CCCs are planned to be set up in each constituency. However, as of May 7, around 400 CCC beds were occupied, according to DMHO Dr Surya Narayana, who also said that around 10% of the beds have immediate access to oxygen in the form of cylinders or concentrators.
On May 6, Principal Secretary (Health) Anil Kumar Singhal announced that the government plans to set up temporary facilities akin to CCCs, to address bed shortage amid rising cases. Facilities with 200-300 beds will be set up under huge tents in the premises of major government hospitals in cities like Guntur and Vijayawada. Oxygen will also be made available at these facilities, where patients with less severe symptoms will be treated, Singhal said. CM Jagan announced that the hospital doctors will also serve the patients in these extended facilities.
While this may address the issue of bed shortage, oxygen supply in the state is limited at present. Though the government had anticipated the daily requirement of liquid medical oxygen to shoot up to 1000 metric tonne (MT) and made a request to the Union government accordingly, the state has been allocated 500 MT per day as per the recent supply plan announced on May 5. The state government on May 9 sanctioned an amount of Rs 309.87 crore to enhance the oxygen generation, storage and transport facilities in the state. The funds will be used for cryogenic tanker vehicles, oxygen generation plants and oxygen pipelines.