On September 19, Mumbai's active COVID-19 cases rose to 30,512 with an addition of 2,211 new cases. The total tally of COVID-19 cases in Mumbai stands at 1,82,077. With the rising number of cases, there has also been a shortage in COVID-19 ICU hospital beds which was not seen in the last two months.
But there's more than one reason for the shortage of COVID-19 hospital beds, according to an expert.
Dr Bhansali, who is the chief coordinator between BMC and private hospitals discussed the reasons behind the shortage of hospital beds in Mumbai and a specialist in general medicine and infectious disease at the Bombay Hospital, says the reason is two-fold.
In an interview with BOOM, Dr Bhansali highlighted the fact that COVID-19 ICU bed shortage is also attributed to the fact that now that the lockdown has opened up, patients from outside the MMR region come to Mumbai seek care. He further elaborated that the number of this constitutes 30-40% of the cases are from outside the MMR region and come from districts like Bhiwandi, Thane, Kalyan, Navi Mumbai, Dombivilli, Ulhas Nagar.
Watch the whole interview here.
The edited excerpts from the interview can be found below.
Govindraj Ethiraj: The total number of COVID cases in India is now approaching the five million mark. But somewhat worryingly in cities like Mumbai, it is now over a hundred and seventy thousand with over eight thousand hundred and eighty-one deaths. It is not showing any immediate signs of slowing down. The larger issue, right now, is not the number of cases or deaths but the number of hospital beds and particularly intensive care units which seem to be under much greater pressure than they were until a few weeks ago. So why is this happening and how is the administration responding to this. To understand this a little better, I am joined by Gautam Bhansali. Dr Bhansali is a specialist in general medicines and infectious diseases at the Bombay Hospital, which is in South Mumbai. He is also the chief coordinator between the civic body—that is the Mumbai Municipal Corporation—and all the private hospitals for managing the beds. Dr Bhansali, thank you very much for joining us.
So, broadly why is it that after a long time, when I say a long time I obviously mean a few months, that we are suddenly seeing a sudden pressure on hospital beds including....
Dr Gautam Bhansali: If you see the graph, we were in a much much better position in July and August. In the month of September, we have definitely seen a big surge in the number of cases. There are two or three reasons for that. One is, the lockdown is almost open plus that people are coming from different …..states also for treatment and other things also. Because of that, you can say, it is like a second wave only, Cases have increased in a city like Mumbai. But why lockdown was there that we need to understand. Lockdown was there to educate people, give awareness to people as to what is to be done to fight with this kind of disease. It is a new learning, new disease and new challenge for everybody. Meanwhile we need to prepare health infrastructure. See, our health infrastructure was not ready at that time when this disease came to our country, somewhere near March, at that time we were not prepared for this disease because we need to create negative pressure in the ICU, in the ward, we need to have different entry and exit for this kind of situation. Whole world is facing different kind of problems in this pandemic era. So, now that the number of cases are increased, we are totally geared up with the number of beds. Yes, there were some shortage of beds in between. We closed down some nursing homes ( one month back) because there were some issues there—people were saying that over charging issues were there, mortality rate was a little high in Mumbai. It was 5.5. After shutting down that nursing home, now our mortality rate is 2.6 in the city of Mumbai. And that issues has been almost sorted out. Over charging and all those things.
Govindraj Ethiraj: You are talking about that 72 or 73 nursing homes that were stopped, of which I understand 27 has been reopened
Dr Gautam Bhansali: Yes, ...yesterday we had a meeting with the Municipal Commissioner and Honorable Chief Minister Saheb because the number of cases has increased and we assume that the number of cases is going to increase in the near future. Plus there is an influx of patients from the other states also, not only from Maharashtra but also from Sangli, Dhulia, Kolaphur, Nasik, Pune. All over the state people are coming to Mumbai, people want to take treatment in Mumbai because they feel Mumbai has better health infrastructure. Health professors/professionals are there in Mumbai and they will get best treatment. That is why people are coming to Mumbai. That is why we need to open 27 nursing homes, which have more than 25 bed hospital, which are well regulated, which hospital has MD doctors, critical case.... only that 27 hospital nursing home we allow to open... yesterday onwards.
Govindraj Ethiraj: Can you give me a rough sense, Dr Bhansali, for instance if you say for instance you have 100 beds with you, I will come to ICU and non-ICU, how many are now populated by non-Mumbai people, as compared to pre-COVID times, percentage.
Dr Gautam Bhansali: The number of people admitted in these hospitals, like nursing homes and big private hospitals, 30-40% of the patients who are admitted are from outside the MMR region. They are from Bhiwandi, Thane, Kalyan, Navi Mumbai, Dombivilli, Ulhas Nagar....
Govindraj Ethiraj: And what would that number be for a pre-COVID? What would the number have been last year this time?
Dr Gautam Bhansali: Last year this time, patients always across the country or you can say, across the world, come to Mumbai for treatment because Mumbai has the best health infrastructure, especially private hospitals. Medical tourism is also there in Mumbai....so definitely you can say that 60-70 % of the patients come from other parts of the country, not only from Mumbai. This is the COVID time, and COVID patients come more across the state and across the country. That is why we are facing...we are particular different kind of situation for the COVID bed arrangement, bed management and the staff is …
Govindraj Ethiraj: Dr Bansali, can you explain the Maths to me a little bit. If you are saying that 60-70% of the patients even during pre-COVID times were coming out of Mumbai, whereas now you are saying 30% of patients in all are coming from out of Mumbai. So, that should not be a problem or is it?
Dr Gautam Bhansali: This is a problem. Because I am talking about 30-40% of COVID patients. I am not talking about non-COVID patients.
Govindraj Ethiraj: Those non-COVID patients are not coming now....
Dr Gautam Bhansali: Yes, yes... There was a misconception that all industries have collapsed except the hospital industry... they are flourishing. But the situation is that hospitals, mainly private hospitals are in big loss. Why? Because of the COVID situation, the rate is capped by the government. We cannot charge more than that particular amount. Non-COVID patients are not there. So hospitals are in big loss...
Govindraj Ethiraj: I will come to the financial part Dr Bansali. You are saying that proportionately today, you have a much higher ratio of patients coming from outside Mumbai, which is placing a load on your systems because most of your beds or a fair number of beds are dedicated only for COVID. Is that correct?
Dr Gautam Bhansali: Correct. So like Bombay Hospital we have two separate buildings. One building is only for COVID, one building is non-COVID different kind of building. COVID building is always full. Non-COVID people have started coming. People were in panic, they did not want to go to hospital. They felt that if they went to hospitals they would get COVID virus. That is why they were not coming. But now people are coming but still surgeries are only emergencies, very few elective surgeries are going on. Because there is a lot of fear in the public. No no....we do not want to go to hospital. That is why non-COVID is not that much filled up, which was earlier in the pre-covid time.
Govindraj Ethiraj: So, you are saying that if a patient was to have a non-COVID situation, they are likely to get a bed, and for that matter also an ICU admission in Mumbai?
Dr Gautam Bhansali: Yes, non-COVID is open, it is totally open, beds are there, there is no problem with the availability of the beds in the non-COVID are there.
Govindraj Ethiraj: Dr Bansali, can you give us a top down view, the total number of beds you are managing in a way, in the private hospital space in Mumbai, what is the current fill rate?
Dr Gautam Bhansali: Right now, if I say the conditions of Mumbai, the private hospital, 33 big private hospitals like Bombay Hospital, Breach Candy, Hinduja, Lilavati, Jaslok, these kinds of hospitals, we have 2600 (twenty six hundred) COVID beds. I am talking only about COVID, 2600 COVID beds, out of which 1600 are oxygenated beds(all are having oxygen), plus we are having 590 ICU beds in these 33 big private hospitals. Yesterday we opened those 27 small nursing homes where we added 390 ICU beds and 1700 oxygenated beds in the 27 nursing homes and this is 33 private hospitals. In the government hospital, we reduced the capacity of COVID bed because we opened the non-COVID part also...in the Nair, Sion. Nair was totally dedicated COVID hospital. Now 50% COVID, 50% non-COVID.
But we have increased capacity in our jumbo facility. We have 11000 beds, all of them are oxygenated beds, in the jumbo facility. Jumbo facilities like in NSCI Worli Dome, BKC, NESCO, Dahisar, Mulund ......where all the beds are oxygenated beds, it is not a isolation center...jumbo facilities are not quarantine centers. They are full fledged hospitals, with oxygenated beds, with ventilators, we have bi-pap machines, nasal cannula machine, plus xray, sonography, 2D echo machine, plus we have a pathology lab in each and every jumbo facility. One more thing we have added in a jumbo facility…...We have all kinds of medication--Remidesivir, Tocilizumab--we have all medicines, totally free of cost in jumbo facilities. One thing we added, why people are not coming to the jumbo facility....( breaks off saying you were asking something)…
Govindraj Ethiraj: Go ahead
Dr Gautam Bhansali: I took a tour of the jumbo facility and we did a proper inspection. Why are people not coming to the jumbo facility? There is a perception that jumbo facilities are only a quarantine centre, isolation centre. No it is a full-fledged hospital....Secondly, they feel the doctor may not be good. So what we did, all the jumbo facilities will be run now by all the government medical college hospital staff like Sion, Nair, KEM....they already deployed two two units...means each unit is having 14-15 or 40-50 doctors in that hospital. Plus all jumbo facilities will be monitored by private hospitals...like Bombay Hospital and Breach Candy they will monitor the NSCI Worli Dome. Lilavathi and Hinduja have top expert doctors, they will look after BKC jumbo facility, NESCO Goregaon facility will be looked after by Kokilaben Hospital and Nanavati Hospital, Mulund Hospital will be looked after by Fortis Hospital. That kind of arrangement we have done today only….
Govindraj Ethiraj: Just to go back and look....you said 2600 beds, plus and 590 ICU in the private hospitals in Mumbai. What about the number of doctors and nurses to manage this and the jumbo facilities that you have talked about?
Dr Gautam Bhansali: Yes, in private hospitals and nursing homes there was no shortage. In government certain hospitals there was no shortage...in MGCM Hospital there was no shortage of doctors and nurses. The only facility, staff shortage and manpower shortage, we were facing in the jumbo facility...that is why we deployed the medical college staff...two two units in all the jumbo facilities plus we deployed private hospitals top expert doctors in the ICU care in the jumbo facility. So from yesterday there is no shortage of any staff in the jumbo facility.
Govindraj Ethiraj: You are an infectious disease specialist as well. What is your sense, looking at the patient flow, looking at the conditions in which they are coming to the hospital today, what is your sense in terms of where we are in the management of this disease?
Dr Gautam Bhansali: See, management of the disease...again I tell you...this is a new disease, there are new challenges, and there are new learnings everyday. Everyday we are learning new things and we change our guidelines. Sometimes we say that patients who are above 50 should be hospitalised. Sometimes again we say that asymptomatic patients, home isolation is better. What we are seeing the virulence of this disease...virulence has decreased...we are not seeing that much critical patient that we were seeing in April, May June. That was a horrible time. That much critical patients are not coming now, maybe patients are educated enough, they are very well controlled their diabetes, enough precautions and enough medications are available like Remdesivir. That helps us a lot, it will not stop the virus. It will reduce the viral load....so I feel with the availability of the medications and the availability of the bed and oxygen,main thing is oxygen requirement is more important not ventilator. Every patient does not need ventilator at all. Patient has the fear, the public has the fear....they should go to the hospital, they will have a ventilator...no,....all patients do not need at all ventilators. They need oxygen. Oxygen is more and more important.
Govindraj Ethiraj: You are saying that most of the additional load that we are seeing, particularly in the intensive care units is because of patients coming from outside, is that likely to reduce or increase, therefore are we back to a situation like in May or June...where the disease itself has not spread, which it did in May –June, but the patient load is continuing to rise
Dr Gautam Bhansali: I feel patient load will rise till the end of this September. After that things will settle. This is my personal opinion. That after the first week of October the number of cases may decrease. But if the number of cases increases, we are totally geared up with the facilities. We have the beds in the jumbo facility, 30-40% are still vacant, in private hospitals 10-20% beds are vacant, in ICUs 1-3% beds are vacant ….vacant means patient goes new patient comes, patient goes new patient comes, it is like a turnover sort of things are there.But all facilities , all that things are available. Earlier we were doing 4000 tests per day in Mumbai. Mumbai is the only city or you can say the first city in the world who recommends that patients can do tests without doctor prescription. Now everyday, we are doing 15-16000 ( fifteen to sixteen thousand) tests per day. We are chasing the virus. We are not worried about the number game...like the number of cases will increase….no. We are just changing the virus, we want to decrease the mortality rate and we are able to decrease the mortality rate.
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