Karnataka: Pandemic situation out of control

Karnataka faces a severe challenge with shortage of hospital beds and vaccines as the infection spreads and cases surge.

At a new crematorium built for COVID-19 in Bengaluru on April 28. Crematoria in the city are overwhelmed by the number of bodies brought for cremation.

ON April 28, the first day of the 14-day lockdown announced by the Karnataka government, there was an eerie calm on the streets of Bengaluru. The silence was punctuated by the sirens of ambulances. It was unclear whether these vehicles were transporting patients or bodies as ambulances were doubling up as hearses. People gathered only at three sets of locations in the city: COVID-19 vaccination centres, which were running out of vaccine stocks; government and large private hospitals, which were still accepting COVID-19 patients, and crematoria and burial grounds that were working round the clock to deal with the bodies that were piling up.

The lockdown was necessitated by the massive increase in cases in the State in April. The daily numbers of new cases had risen from 4,991 on April 1 to 39,047 on April 27 (the highest single-day spike since the start of the pandemic). Chief Minister B.S. Yediyurappa went ahead with the lockdown decision in spite of considerable opposition from industrial bodies such as the Federation of Karnataka Chambers of Commerce and Industry whose president, Perikal Sundar, said the State exchequer “would lose at least Rs.800 crore daily in the case of a complete lockdown”. The surge in cases ensured that the lockdown decision was inevitable. On April 13, the Chief Minister had said that there was “no question of a lockdown in Karnataka”. However, on April 22, he acknowledged that the “pandemic situation in Karnataka was uncontrollable”.

Bengaluru district reported 22,596 cases (the highest single-day spike in the city) and more than 2.2 lakh active cases on April 27, the highest in the country. Unlike Maharashtra and Uttar Pradesh, which have a high caseload spread across several cities, the cases in Karnataka are concentrated in Bengaluru. The city had reported around 100 deaths every day for a few days until April 27 when it recorded 137 deaths. It has around two-thirds of the active cases in the State. Raichur, Bidar and Belagavi, which saw hectic campaigning for the byelection to two Assembly seatss and one Lok Sabha seat on April 17, witnessed a rise in cases in end April. The positivity rate stood at 22.7 on April 27, while more than 92 lakh vaccine shots had been administered by that date.

Numbers tell one part of the story but conversations with friends and family members of some patients reveal a humongous crisis. With every life lost, the novel coronavirus is leaving a trail of emotional wreckage. Rajeev S.B., a lawyer in Bengaluru, told Frontline that one of his friends, a 45-year-old physical trainer, was seemingly recovering from COVID affliction in a premier hospital in the city when his wife was informed that he had passed away. “It came as a surprise and shock to her. There is no sense of closure and the death remains a mystery. What happens inside the hospital? No one knows as no one is allowed inside the ward,” Rajeev said.

Rajeev’s friend passed away when he was being shifted to the intensive care unit (ICU). He was one of the few who was able to get a hospital bed almost immediately when he was admitted on April 21. On the same day, a 41-year-old house painter died in an ambulance after being turned away from six hospitals in Bengaluru over the course of 12 hours even as his oxygen saturation level plummeted.

Satish B., an employee with a multinational company in Bengaluru, had a poignant story to tell. He said his 35-year-old colleague was eight months pregnant when she contracted COVID-19. At around the same time, she discovered that her foetus was not responding and rushed to the hospital. The baby, a girl, was delivered prematurely, but the mother passed away.

Syed Alam, whose brother-in-law is being treated at a hospital in the city, is desperately scouring pharmacies and making incessant calls to helplines for Remdesivir, the antiviral drug given by injection to hasten recovery of severely ill patients. “Hospitals say that they do not have stock. Black marketers are selling each vial for up to Rs.25,000. Can you help me get Remdesivir through your sources?” Alam asked this correspondent in earnest. Other drugs such as Tamiflu, Tocilizumab and Itolizumab are also reportedly not easily available.

Warnings ignored

What went wrong in Karnataka, more specifically, Bengaluru? In November last year, the State’s COVID Technical Advisory Committee warned the government of a second wave but the administration was blase about the imminent crisis. Some of the suggestions offered in November were to “strengthen contact tracing and community-based surveillance” and to restrict “mass gatherings like fairs, festivals and religious congregations”.

The government ignored these suggestions. It is shocking that earlier this year the Bruhat Bengaluru Mahanagara Palike (BBMP) dismantled Booth Level Teams, consisting of more than 2,000 persons, that were instrumental in contact tracing during the first wave of COVID-19. According to sources, thousands of volunteers who were involved in implementing quarantining protocols were relieved of their duties. Besides, morale among doctors and laboratory staff recruited by the BBMP last year on an ad hoc basis is low because they have not been paid their salaries for several months. According to the latest information from the BBMP, these temporary employees were paid their dues only in the third week of April.

Commenting on the government’s lack of preparedness to face the pandemic, former Assembly Speaker K.R. Ramesh Kumar of the Congress said: “The government had more than a year to prepare for COVID-19. If the situation is such that people have to beg for hospital beds in private hospitals, when will the government fulfil its duty? Even now there is no policy.”

With hospitals running out of ICU beds, Health Minister Dr K. Sudhakar mandated that private hospitals reserve 75 per cent of their beds for COVID patients. Speaking to mediapersons on April 26, he said last year “during the peak of the pandemic, 4,500 beds were given for government-recommended COVID patients. Unfortunately, this year, despite discussions and the situation, patients are being turned down and private hospitals have given 1,000 fewer beds than last year. I agree these are at subsidised rates and so they may face losses. But the situation is bad.” (The ceiling of Rs.25,000 a day fixed last year for an ICU bed with a ventilator in a private hospital continues to prevail.) There have been several reports and accounts on social media of touts brokering hospital beds at inflated prices.

The government has denied that there is any shortage of oxygen in the State, although according to a submission made by Dr H.M. Prasanna, president of The Private Hospitals and Nursing Homes’ Association, in the Karnataka High Court, “private hospitals are able to get only 50 per cent of their oxygen requirement”. Prasanna made this submission on April 27 when a division bench was hearing a bunch of public interest litigations petitions on issues relating to COVID-19. The State’s requirement of oxygen soared to 1,471 tonnes a day in the last week of April while only 812 tonnes a day could be generated domestically with Praxair India Pvt. Ltd., the largest oxygen manufacturer, capable of manufacturing 160 tonnes a day at its plant in Ballari.

Crematoria and cemeteries in Bengaluru are overwhelmed by the number of bodies. The BBMP has reserved seven of the 13 crematoria for COVID victims and has, in an unprecedented move, allowed the cremation and burial of the dead in private land. The stream of hearses and ambulances in front of crematoria and the long wait to get the bodies cremated has led to suspicion that the BBMP is undercounting the casualties.

An investigative report posted on The News Minute (TNM), which analysed the deaths in Bengaluru between April 18 and 24 owing to COVID-19, vindicated this suspicion. According to data from the BBMP, 527 persons died in Bengaluru during this period but TNM’s report, written after ground-level verification at various crematoria and burial grounds, shows that there were at least 300 more victims whose bodies were cremated or buried.

Another serious problem in Bengaluru has been the substantial delay in the uploading of RT-PCR results. The results of this correspondent who was tested at the Frazer Town Primary Health Centre (PHC) on April 21 took 96 hours to be uploaded on the State’s Indian Council of Medical Research (ICMR) portal. In the event, COVID patients could be spreading the virus while waiting for their results. Admitting that there was a delay in the procedure, BBMP Commissioner Gaurav Gupta said four medical laboratories had been suspended.

Since mid-April, as the infection spread across Bengaluru and the rest of the State, a number of people in the 45-plus age group made a beeline for the vaccination centres. The sudden increase in demand led to a shortage of vaccines in both government and private hospitals. P. Rajendra Cholan, BBMP’s Special Commissioner (Health), admitted that the civic body was unable to meet the demand. He said that “around 40,000 vaccinations are being given a day but there is an increased demand from private hospitals, which we are unable to meet.”

Beginning May, the Yediyurappa government will face the challenge of vaccinating those in the 18-44 age bracket. The Chief Minister has assured the people that vaccinations would be administered free of cost at all government hospitals and PHCs. Another challenge the government could possibly face is a surge in cases in other parts of Karnataka. This is a real fear as thousands of migrant workers left Bengaluru for their hometowns following the lockdown announcement.