Kerala struggles, stretched to the limit

With a sudden spike in infections straining the State’s public health infrastructure, the government is ramping up ICU/bed capacity and other resources as it anticipates grim days ahead.

The centralised COVID control room in Ernakulam that monitors round the clock the availability of beds and oxygen at government and private hospitals, besides coordinating the shifting of patients to COVID care facilities based on their symptoms.

With intensive care units (ICUs) and ventilator beds fast filling up in most districts and the number of people getting infected or dying rising every day, Kerala declared a nine-day total lockdown from May 8. On May 14, the State government extended it to May 23. Public health experts had called for a total lockdown much earlier, and with the trend of rising number of cases continuing, they said it would be prudent to extend the lockdown further. Chief Minister Pinarayi Vijayan had said that the government would take a call on the extension of lockdown only after a thorough review of the emerging situation. “Kerala is facing a grave situation,” he added.

As on May 10, there were 72 panchayats in Kerala with a test positivity rate (TPR) of over 50 per cent. In over 300 panchayats, the TPR was above 30 per cent. For instance, in Ernakulam district alone, there were 19 panchayats with a TPR above 50 per cent. There were 57 panchayats across the State with a daily active caseload between 500 and 2,000.

On April 28, Kerala had 35,013 new COVID-19 cases, which was the highest per day rise until then. The State had 2,66,646 active cases under treatment and the death toll on that day was 41, taking the total number of COVID-19 deaths until then to 5,211. The State-wide TPR stood at 25.34 per cent.

On May 12, there were 43,529 new COVID-19 cases. Kerala had 4,32,789 active cases under treatment and the death toll on that day was 95, with the total number of deaths having risen to 6,053. The TPR was a high 29.75 per cent and the average TPR in the previous seven days was 27.88 per cent.

ICU, ventilator capacity

The number of people requiring ICU and ventilator support more than doubled in the first 10 days of May. On May 1, 1,808 people were in ICUs and 1,650 were on ventilator ICUs; 10 days later, the respective figures were 2,641 and 1,340. According to data released by the government, on May 12 there were 2,752 patients in ICUs and 1,446 on ventilator support. The State government said it had been augmenting its ICU/ventilator capacity, adding that the number of ICU beds was 9,735 and that of ventilators, 3,776 (including both government and private hospitals.)

However, the situation was reported to be grim in government hospitals in districts such as Ernakulam, Idukki and Malappuram, and public health officials have warned that the State may soon find the facilities grossly inadequate with the rise in COVID-19 cases. Even though the (official) death rate was still only 0.3 per cent of the total number of cases, there were 10,016,47 patients “under observation”, 9,67,211 “under home isolation” and 34,436 undergoing treatment in hospitals in Kerala, as on May 12.

The government expects these numbers to rise further in the coming weeks.

The government has decided to convert fever clinics in all hospitals into COVID outpatient clinics to provide consultation, lab services and medicines for COVID patients. As per revised guidelines issued on May 9, the Health Department has asked all government hospitals to focus on the management of COVID cases until the end of May and cater only to emergency services for non-COVID patients.

It has also asked all taluk hospitals to provide oxygen beds and, wherever possible, arrange at least five beds with Bipap ventilators to provide oxygen support to patients being referred from the field. All COVID second-line treatment centres (CSLTCs) are to be attached to the nearest taluk hospital.

The government has also asked private hospitals to increase COVID oxygen and ICU bed facilities to at least 50 per cent of their capacity. They have also been asked to start COVID out-patient clinics, with facilities for investigation and treatment.

With COVID bed occupancy reaching saturation levels in both government and private hospitals in many districts, the State has also decided to set apart 50 per cent of beds in all hospitals, including private medical college hospitals, cooperative and ESI hospitals, for the exclusive treatment of “COVID-19 patients requiring hospitalisation”.

Treatment costs

Meanwhile, in view of the exorbitant rates charged by some private hospitals for treating COVID-19 patients, the Kerala High Court ordered the State to decide treatment package rates for walk-in COVID patients in private hospitals. Multiple rounds of discussions were held by the government with private hospital associations and the rates were notified on May 10 (with some associations complaining about them). The government also announced that if hospitals were found charging more than the notified rates, it would levy a penalty equal to 10 times the additional rates charged by them.

The government also said that all hospitals must publish their treatment rates in a place accessible to the public inside the hospital as well as on their websites. District Medical Officers have been appointed as Grievance Redressal Officers in their respective districts to receive complaints regarding overcharging by hospitals.

Earlier, the government had fixed treatment rates for beneficiaries of the Karunya Arogya Suraksha Padhathi or KASP, which provides health cover up to Rs.5 lakh to 42 lakh poor and vulnerable families in the State, and patients referred by the government to avail themselves of free treatment for COVID-19 in all empanelled private hospitals.

Vaccine woes

There were long queues of elderly people and those above 45 years from 5 a.m. before the few government vaccination centres that were still open, after the State government, in a strange directive, asked those in the 45-plus category to get vaccinated through spot registration and that only others should opt for online registration.

K.K. Shailajah, the Health Minister, said that shortage of vaccines was a big challenge for the State. Kerala had placed an order for 1 crore doses, comprising 75 lakh doses of Covishield and 25 lakh doses of Covaxin from Serum Institute of India and Bharat Biotech, respectively. But only 3.5 lakh doses of Covishield had been delivered as of mid-May, with the manufacturers indicating that further doses may be delayed.

The government’s grand plans for vaccination in all districts by opening registration for vaccination on May 1 for people in the 18-45 age group have gone awry because of a severe vaccine shortage. The State government had announced that it would provide free vaccines to those in the 18-45 age group too, and has been insisting that the Centre ought to have done it on its own, just as it had promised to do for those in the 45-plus category.

Meanwhile, with the substantial increase in COVID-19 patients requiring hospital care, the State has informed the Centre that it will not be able to provide medical oxygen to other States any longer, as it expects the COVID-19 patient caseload to cross 6 lakh by May 15. In a letter to Prime Minister Narendra Mod on May 10, the Chief Minister said the State would need 450 metric tonnes of medical oxygen by May 15.

He said the State’s daily production was only 219 tonnes, but it had kept a buffer stock of 450 tonnes without putting pressure on the national grid. But with rising demand in neighbouring States, its buffer stock was shared with other States and Kerala’s emergency stock fell to 86 tonnes.

The Chief Minister said that Kerala would be able to supply 40 tonnes of oxygen to Tamil Nadu until May 10 but it will not be able to ensure supplies to other States after that date. The State’s internal production would be sufficient only for its own needs in the coming days.