HOUSE FULL: The Goa Medical College covid wards which treat the most serious patients

By Rajan Narayan

In the wake of the breakdown of infrastructure for treating a worsening covid-19 crises in the country, the Supreme Court bench headed by retiring Chief Justice SA Bobde, has declared a national health emergency. Chief Justice Bobde who is retiring on Friday, April 23 asked the Modi government to submit a national plan to tackle the covid crises. The SC has ask the centre to set up a national council for equitable distribution of resources needed to fight the pandemic. Substantiating the allegation that the Central government is discriminating in the supply of oxygen, key drugs and medical equipment, with regard to non-BJP ruled states. The SC has directed the Modi government to declare equipment needed for treatment of covid patients as essential commodities under the Essential Services Maintenance Act (ESMA). The SC is likely to pass order and form an all-party committee for preparing an action plan for dealing with the crises which touched a new peak on April 22. In yet another record India added 3.3 lakh more cases on Thursday marking a new global record. In an unprecedented development the country has witnessed over 1,000 deaths for ten consecutive day. The situation in Goa continues to be grim with 1,410 new positive cases and 21 deaths…

THE number of active covid-19 cases have gone up to over 10,000 as we have predicted with 1410 fresh cases on April 22 with 21 deaths. The total active cases have risen to 10,228 and the number of deaths which is 965 may cross a century by the weekend. The state government has admitted the shortage of oxygen cylynders with reports that last night the GMC ran out of oxygen on Friday April 23 early morning. Even the testing centres have broken down because of the huge pressure on them with results taking three days to a week. The state has decided to outsourced the sample of those who have been tested to the private laboratory Thyro Care.
The state government has sought the help of the Goa shipyard to increase supply of oxygen concentrators. The state has decided as placed in order for five lakh doses of vaccine for free vaccination of those between ages of 18 and 45 from May 1. Registration for vaccination of the 18-45 group will start on the CoWin app on the 28 April 2021. Patient are also complaining that there is no supervisor of monitoring of those who chose home isolation. Though Directorate of Health services and doctors are supposed to monitor home isolation patients, no numbers have been provided and the doctors have not been responding to DHS and IMA numbers that they have provided.

empowering hc

The central government has issued notices to state government as to why the HCs should not be permitted to give direction on the distribution of oxygens and the shortage of other equipment needed to treat covid. It may be recalled that the Allahabad bench of the UP high court had ordered complete lockdown in Varanasi, Lucknow, Kanpur and Gorakhpur. The election commission has taken notice of the warning from the SC and has banned roads shows in Bengal and other states which are going to the polls. The Prime Minister Modi who has been spending the whole of last month addressing political rallies ignoring covid has decided not to address anymore rallies. Indirectly the SC has accused modi of neglecting the covid crises. In preference to campaigning for the BJP in the five states which are going to the polls on April 29. The EC has also limited the crowd that can attend public meetings to 500. Meanwhile with Goa imposing night partionate curfew air passengers have started cancelling ticket. From an average of 9000 arrivals there were only 2000 arrivals on Friday. The night life does not seem to be worth the risk of getting covid. Not only other states in the country but other countries including the UAE have banned arrivals from India and Goa from April 25 to May 4. Even a transit passenger they can enter UAE only if they have done quarantine in some other country and produce covid-19 negative certificate.
The positivity rate in Goa which means the number of people testing positive when they get themselves tested is 30% of those who undertake the test. The recovery rate is 84.50% which was as high as 97-98% a month ago. In view of the delay in receiving the test results, the Dean of the GMC Shivanad Bandekar has advised patient to start taking treatment if they have symptoms without waiting for the results. He has advised individual waiting results to call the helpline 104 to consults doctors of the DHS headed by Geeta Kakodkar Deputy Director. Bank Unions in Goa are demanding to work on rotation to cut covid risk. They are also demanding that pregnant women employees should be exempted from duty and will start crowd management to regulate entry of customers.
disastress april!

The months of March and April have been disasters for Goa with the number of cases going up with an average of 250 to 300 to almost a 1,000 every day. With the recoveries going down the death toll is going up. On Sunday, April 18, Goa registered a death toll of 11 as against an average of two to three a month ago!
Chief Minister Pramod Sawant talks about setting up more beds at the Fatorda Stadium. The Dr Shyama Prasad Mukerjee Stadium has also been converted into a Covid-19 centre. The ESIC hospital in Margao which was abandoned as a special covid-19 facility is back in action anew. All that it means is that if a particular facility has been labelled as covid-19 centre, if someone tests positive and has no facility for home isolation, he or she may occupy a bed at the centre. You will be under some kind of medical supervision but even that is doubtful as the number of medical staff available particularly for covid-19 cases is much less than what is required. In fact, you may contact covid-19 from the health workers as only 37% of the frontline health workers who come in touch with covid-19 patients, have been vaccinated themselves.
The covid-19 centres have no other facilities. The covid-19 centres do not have a CT scan equipment which is the first diagnostic method used to check whether you are a serious patient. The CT scan reveals if you have developed pneumonia. Which means collection of water in the lungs. We do not know if the so call covid centres even have oxymeters. When they don’t even have oxygen beds to provide to serious patients! The last stage in attempting to save serious covid-19 patients is to put him on a ventilator in the intensive care unit of a mainstream hospital. But very few hospitals have ICUs which cost a lot of money. And those who have the facility charge between Rs 10,000- Rs14,000 per day or more.

CT SCAN MACHINE SHORTAGE

I UNDERSTAND from my doctor friends that there are only about 100 CT scan machines in Goa. At the most they can do a chest CT scan of eight to ten patients a day. This is because after each CT scan the entire premises have to be sanitized so that in all covid-19 patients do not catch the infection. Even optimistically speaking not more than 2,000 to 3,000 patients can undergo a chest CT scan even if you take over the Radiology department of the government and private sector together.
To overcome the shortage of ICU beds, the state government has set up a new category of oxygen beds. These beds provide oxygen to a patient who has started having respiratory problems. All the government hospitals put together in Goa have less than 200 ventilators. If the number of covid-19 positive patients keep going up at the current rate there will be no ventilators available for treating critical patients.
Forget about CT scans, and oxygen-aided beds and ventilators, there are not enough beds available in either private or public hospitals to accommodate new covid-19 patients who are testing positive in increasing numbers every day. When a close friend called me in desperation seeking a bed for a relative, I discovered that beds in the government hospitals, including GMC and south and north Goa district hospitals, have together only 550 beds for covid-19 patients. The private hospitals put together have only 75 beds for covid-19.
As long as the number of patients remains below 700 or a 1,000 they may be lucky to get place on a stretcher placed on a trolley in the passage ways of the covid-19 wards. If the number of serious covid-19 patients requiring oxygen or ICU facilities exceed even a 1,000 the chances of their survival are low.
The shortage is not limited to equipment like radiology equipment, oxygen stocks and beds in ICUs. There is also a desperate shortage of staff. There are not enough consultants who are willing to attend to covid patients. Senior consultants like Dr Oscar Rebello have been working 24×7 for over a year now. He is attached to the Manipal Hospital in Dona Paula, Heathway hospital in Carambolim, and Campal Clinic at Campal. Consultants attending to covid-19 patients are on duty 24 hours a day. They may not be physically present in covid-19 wards but are on call for condition of patients may worsen at any time.
Similarly, in may private hospitals the staff available and trained to attend to covid-19 patients, is far less than the demand. The medical staff needed is not limited to the consultant but also includes nursing staff and attendants. Moreover every time they are on covid duty, which is for a maximum of six hours per shift, they have to be attired in these Personal Protection Equipment (PPE) suits which cover them from head to toe. They cannot drink water or go to the washroom or do anything as long as they are in their PPE suits which can become very suffocating if the material is plastic.

CREMATION GROUNDS

IN GOA the problem has not arisen so far. But if the number of covid-19 deaths goes into 100s per day instead of the maximum of 11 patients we have witnessed so far, there will be shortage of cremation grounds! There is no question of burial irrespective of whether you are a Catholic or Muslim. Dead bodies are suspected to be contagious and can spread infection.
So much so the bodies of dead covid-19 patients are wrapped in leak proof plastic bags and burned. In some cities of Gujarat which is the home state of Prime Minister Narendra Modi cremation charges have shot up to Rs 10,000 or more. Surat is in such a dilemma because the dead bodies are so overwhelming that there is a shortage of cremation facilities in existing places.
There may be any numbers of maternity and nursing homes in Goa. But the majority of maternity homes do not have ICUs or at best have one or two ICU beds. Some nursing homes may have ICU beds for newly born kids. Only corporates like Manipal, Healthway, Victor and SMRC hospitals, have a reasonable number of ICU beds. The majority of district hospitals in the country do not have ICU bed facilities.
We recently not only read about but saw photographs of the dean of School of Neuro Sciences at Gujarat Central University, Prof Indrayani Banerjee, being shunted from hospital to hospital gasping for breath. This happened in Ahmedabad. She eventually died for want of an ICU bed treatment. Recently, Union Minister of State for Transport & Highways Vijay Kumar Singh posted on Facebook that he desperately needed a bed for a close relative in the city of Gaziabad in Uttar Pradesh.
The bitter ground reality is that not just in Goa but in the country as a whole we have not taken the pandemic seriously. Home Minister Amit Shah has admitted that the Kumbh Mela reported more than 50,000 positive cases, contributing to the huge increase in covid-19 cases in the country.
And in Goa despite the thousands if not over a lakh tourists coming every weekend Chief Minister Pramod Sawant refused to even insist covid-19 negative certificates from them. Anyone can drive to Goa, fly to Goa, take the train to Goa – no covid-19 certificates, no problem. The only reason why the number of tourists have gone down dramatically is because the tourists are now afraid they be able to get back to their home states because of the belatedly and currently imposed mini-lockdowns in Maharashtra and Karnataka. In Karnataka there is a weekend lockdown and in Maharashtra and Mumbai there is a complete lockdown till May 1, 2021.

LOCAL OR TOURIST?

HOW Vulnerable are you to contacting covid in Goa regardless of whether you’re a local or a tourist? I can understand the reluctance of many Goan residents about taking a vaccination out of fear of vaccination outcome. But there is no excuse for not getting vaccinated. Friends tell me that they are waiting for symptoms to get tested! They don’t understand that after vaccination it takes a few days before anti-bodies offering protection build up. Even after vaccination one may experience mild symptoms of covid-19. If symptoms turn serious you have the option of going to a government hospital where treatment is free but chances of survival may be not the best! Or go to a private hospital if you have in your bank account anything from Rs5 to 10 lakh or more depending on treatment.
We do not realise that each time we step out of the house we are running the risk of being infected. When you go to the market to buy vegetables or provisions, you are dealing with vendors who are untested and have not been vaccinated. In the various super shopping centres staff may staff may be untested and not vaccinated. Panaji has thousands of migrant workers living in tiny rooms with no good sanitation facilities. Landlords and landladies are not concerned about being infected by Covid-19 from the migrants to whom they rent their quarters. Fancy co-operative societies do not let servicing or delivery people into the complex for fear of infection, if you order something to be delivered you have to go to the gates to collect it. Plus, there is the security staff in need of testing and vaccination. You may pick up the infection from a security person as it has happened in Mumbai amongst the celebrity community!
Home isolation will not work for the small people who have terrible sanitation facilities where they stay or work. They too fear being infected and passing on the infection to their family. Also think of the 500 over healthcare community which has to isolate itself because of their duty shifts and cannot meet their families. If they get infected will they get a bed in hospital or in the ICU?
So what should we do? At the very least we must wear good clean masks which cover nose and mouth and not take them out the moment we meet up with family or friends. A mask may not be a scarf or a hankie or a dupatta! In Delhi citizens are fined Rs500 for not wearing a mask properly. Demand covid-19 negative certificate from all shops certifying that all staff have been tested and vaccinated. Don’t take his word but demand the certificate.
Check with the municipality if all the venders including vegetable venders have tested themselves for covid-19. Refuse to employee a maid who has not got herself tested. If your domestic workers do not want to go to a government hospital take them to a private hospital in your own interest. Rs1,200 per test or a little more for vaccination is a small price for protecting both sides from Covid-19, for once infected the cost of treatment may add up to Rs10 lakh plus, plus in these same hospitals.
Prevention is the only solution. If you test positive get yourself admitted and treated. If your symptoms are mild and you are covered by insurance it will not cost you about Rs2-3 lakh. Only if you reach the stage where you need oxygen or admission to an ICU your expenses will go up to even Rs10 lakh. Penny saved is penny earned.
So test yourself, vaccinate yourself if you are eligible. One in a million cases of those who have taken vaccines have experienced serious side effects. Which is the same risk that you run from getting run over by a rash driver on Goa’s road.
In Mumbai big business and industrial houses have come together to counter and help those affected by the pandemic in a united way. Many leading industrial houses, banks and even online service providers like Amazon, are involved in cooperating with the Mumbai municipality and other government agencies. I understand the Ambani family has contributed 10,000 ventilators.
Some other corporate houses have revived a hospital in Andheri and turned into a covid special hospital. The Jaslok hospital and the Hiranandani hospital at Powai increased beds for covid patients from 105 (including 20 ICU beds) to 125 last week, and now it’s further increased to 180 out of 240 that are operational. Holy Spirit Hospital’s Sneha Joseph said that their hospital’s total Covid bed count has gone up to 159, including 22 ICU beds. Of the city’s 20,044 beds allotted for covid, 6,190 are in the private sector.
Unlike the corporate houses of Mumbai we have not heard of any corporate house in Goa, including the pharma units in Verna minting money, contributing in any way towards combating the covid-19 pandemic menace.