Mumbai claims to have enough Covid-19 beds. So why are hospitals turning patients away?

On Friday, Maharashtra recorded 1,567 new cases of Covid-19. At least 933 of these cases were from Mumbai, which accounted for 34 of Maharashtra’s 46 new deaths reported on May 15.

For more than a month, Mumbai has been India’s biggest coronavirus hotspot, with over 18, 027 cases recorded so far. This accounts for 60% of Maharashtra’s 29,100 cases and one-fifth of the 85,538
coronavirus cases across India.

Delhi, the city with the second-highest number of Covid-19 infections, reported 8,895 cases by Friday while Ahmedabad reported 7,171 and Chennai 5,625 cases.

Statistics emerging from Mumbai on Covid-19 deaths are just as grim.

Of the 2,649 Covid-19 deaths reported in India up to Thursday, 621 were from Mumbai. In comparison, there have been 465 deaths in Ahmedabad, and 115 in Delhi and 44 in Chennai.

Mumbai has more than 2,800 containment zones, and its Covid-19 detection rate – the number of persons testing positive out of every 100 people tested – has increased from 20% on May 1 to 33% on May 11. Civic officials have attributed this to the “targeted testing” done in Mumbai’s containment zones. By the end of May, Mumbai’s municipal commissioner IS Chahal estimates that the city will record up to 46,000 coronavirus cases.

How did the situation deteriorate like this? What led India’s financial capital to also become the country’s coronavirus capital?

One major reason is the Mumbai’s inadequate health infrastructure, say a string of recent news reports. One report claimed that the city has run out of critical care beds for coronavirus patients. Another pointed out that in some densely populated wards, the wait for a Covid-19 bed for critical patients is as long as three days. On Thursday, NDTV reported thatalmost all of Mumbai’s 3500 Covid beds are “taken”.

Scroll.in called the city’s 1916 Covid-19 helpline number multiple times to inquire about beds, and the response was no different. The operators claimed that there were absolutely no intensive-care or oxygen-supported beds available in any of Mumbai’s Covid hospitals, public or private.

But has Mumbai truly run out of Covid beds? Are the number of beds set aside for coronavirus treatment incongruent with the number of cases the city currently has?

According to data provided by the state government and various civic officials, the numbers do not add up.

Are there enough beds?

According to the Maharashtra state government website, Mumbai has 3,690 isolation beds for confirmed and suspected cases, and an additional 1,023 ICU beds in 34 dedicated Covid hospitals meant for critically ill patients. This means that there are a total of 4,713 beds for critical cases in the city. These hospitals also have 794 ventilators.

At dedicated Covid health centres for the moderately ill, there are 996 isolation beds, 79 ICU beds and 59 ventilators at 22 centres. At Covid care centres for those with mild symptoms, there are 19,382 isolation beds at 263 facilities, as per the government website.

In an interview with the Hindustan Times this week, however, the city’s municipal commissioner IS Chahal cited different figures. Chahal claimed that Mumbai has as many as 35,000 beds in Covid care centres meant for mild and asymptomatic cases, and 4,200 beds in Covid health centres and dedicated hospitals meant for moderately ill and critical patients respectively.

All these numbers suggest that Mumbai has many more Covid beds than the 16,738 positive cases it has reported so far. How, then, can the city run out of Covid beds?

The question holds true even if one were to focus on the availability of critical care beds.

According to a daily Covid-19 report published by the state government, at least 5% of the 16,801 coronavirus patients admitted in hospitals across Maharashtra – 850 patients in all – are critically ill. This means that Mumbai alone has hundreds more critical Covid beds than the number of patients who need them across the state.

If the number of beds is more than sufficient on paper, why is the ground reality so much harsher for Mumbai’s coronavirus patients?

Why are hospitals turning patients away?

For more than a month, news reports have highlighted the harrowing testimonials of Covid patients and their families struggling to get beds in city hospitals. In mid-April, for instance, a 66-year-old Covid-positive woman had to spend 30 hours in the parking lot of the state-run KEM hospital before she was allotted a bed at another hospital. On May 11, the family of a 67-year-old coronavirus patient suffering from breathlessness and chest pain was rejected by five hospitals before a sixth one finally agreed to admit her. Many other families claimed that the civic body’s 1916 helpline offered no help and claimed there were no beds available in any part of the city.

Dr Daksha Shah, the spokesperson for the municipal corporation’s health department, claimed that the administration is making continuous efforts to ensure bed availability. “Every evening we reshuffle patients so that no beds are occupied by those who don’t need them, and vacancies are created for new patients,” said Shah.

According to Shah, all hospitals are supposed to provide updates to the civic body three times a day about the vacancy and availability of various Covid-19 beds, so that the helpline can provide centralised information to callers. “It could be that some people have tried to call the helpline at a time when beds were not available, but the situation changes every day,” said Shah.

According to senior surgeon Dr Sanjay Nagral, some hospitals – particularly private ones – have their own reasons for denying admission to Covid-19 patients. “Sometimes they feel that a patient may not be able to afford a private hospital,” said Nagral. “And in my view, sometimes they just claim they don’t have any available beds because they are afraid about admitting Covid patients.”

The fear is not unfounded. Although there is no collated data on the number of healthcare workers who have contracted coronavirus, dozens of doctors, nurses and support staff in Mumbai’s public and private hospitals have tested positive for Covid-19. Among the first to be impacted was Wockhardt Hospital, which had temporarily shut its operations in early April after 29 staff members got coronavirus. Hospital staff have also complained that when health workers fall sick with Covid-19, they often struggle to get beds in their own hospitals and are left to fend for themselves.

Daksha Shah claimed that both public and private hospitals are working to ramp up the number of beds available in Covid wards, with the aim of reaching 7,000 critical beds by the end of May. Chahal, meanwhile, announced plans to add up to 500 ICU beds at large quarantine centres established at the BKC grounds and the Worli NSCI sports complex by the end of the month.

On Friday, the Mumbai Mirror reported that the state government is now planning to set aside 22,000 beds – 80% of all of Mumbai’s critical care beds in public and private institutions – for Covid-19 patients, in anticipation of the city reaching its peak in the coronavirus crisis.

But bed availability is not the only reason why Mumbai became India’s top Covid-19 hotspot. A number of other factors have been responsible for this situation.

Delayed response

One reason is the city and state administration’s slow response to the initial threat of Covid-19 in the city.

Maharashtra reported its first two coronavirus cases on March 9, in Pune, among passengers of a flight from Dubai that had landed in Mumbai. Despite this, the state did not begin thermal screening the thousands of passengers arriving in flights from the UAE and other Covid-hit countries until March 22.

Maharashtra was also testing very few people for the virus in the early weeks of the pandemic. In late March and early April, for instance, Maharashtra had conducted one test per 4,208 citizens, while Kerala, which had a similar number of Covid-19 cases, was conducting one test per 2,794 citizens.

This delay possibly allowed several coronavirus carriers to go about their normal lives in Mumbai before the nationwide lockdown, sowing the seeds for community transmission in the city.

Hospital selection

Mumbai has five major public hospitals, 16 peripheral municipal hospitals and six speciality hospitals in addition to a large number of private hospitals. But in the early weeks of the pandemic, the only facility appointed for Covid-19 isolation and treatment in Mumbai was Kasturba Hospital, an infectious diseases speciality centre.

In early April, Dr Akshay Baheti, an assistant professor of radiodiagnosis at Mumbai’s Tata Memorial Hospital, pointed out the problems with this odd decision. At the time, Kasturba Hospital had limited ventilators, no intensive care unit, dialysis unit or other advanced facilities and a lack of staff trained to deal with critical cases.

Meanwhile, none of Mumbai’s four largest public hospitals – JJ, Sion, Nair and KEM – were initially designated as Covid treatment centres despite being well-equipped with large campuses, advanced ICU facilities and multi-speciality staff skilled at managing critical cases. It was not until mid-April that Nair, KEM and Sion hospitals were designated as Covid hospitals, while JJ Hospital has been left for treatment of non-Covid patients.

Population density

Almost half of Mumbai’s Covid-19 cases have been reported from eight civic wards with high population densities. These include the fishing settlement of Worli Koliwada, which was Mumbai’s biggest Covid hotspot in mid-April, and Dharavi, which is the city’s current hotspot.

On April 17, at least 389 cases had been reported from G-South ward where Worli Koliwada and its surrounding slums are located. After weeks of being designated as containment zones and living under strict lockdown, large parts of Worli were re-opened this week, since no new cases were reported from there in the past 15 days.

Dharavi, however, is proving to be a harder battle for city officials. Once labelled Asia’s largest slum, Dharavi has more than 8.5 lakh residents living in dense clusters, with around 1,400 people sharing a single community toilet. The area has recorded at least 1,061 cases and 40 deaths so far.

Even though it has been declared a containment zone, and ward officials claim they have made 3,000 quarantine beds available in the area, practicing physical distancing as a virus containment measure is nearly impossible for the residents of Dharavi. Hutments and apartments in the area often house up to eight or ten people. Many of the slum’s inhabitants are migrant daily wage workers from across the country. Without jobs or an income since the lockdown began on March 24, these workers have been lining up in long, tightly-packed queues for food and other relief materials distributed by non-profit groups.

Ward officials have now started the process of door-to-door screening of Dharavi’s residents for symptoms of coronavirus, and claim to have screened 90,000 people so far. For those with symptoms, officials are trying to promote institutional isolation for the slum rather than quarantining at home.

Affordability

To tackle a public health crisis affecting thousands of people, it is essential for testing and treatment to be affordable even when the private healthcare sector is roped.

In India, however, private laboratories have been allowed to charge as much as Rs 4,500 for a coronavirus test, and some laboratories in Mumbai are charging up to Rs 7,000. The city’s private hospitals, too, have been burdening patients with huge bills.

A Santacruz resident who lost his 74-year-old father to Covid-19 received a bill of Rs 16 lakh for the 15 days that his father was in intensive care at the private Nanavati Hospital. Of the total amount, he claimed that Rs 2.8 lakh was dubbed as “Covid charges”. In South Mumbai’s Saifee Hospital, a man whose brother died of coronavirus was charged Rs 80,000 for just eight hours of treatment.

In a Mumbai Mirror report on May 6, additional municipal commissioner Suresh Kakani claimed that the civic body was going to reserve 20% of beds in all private hospitals for poor patients, for whom the municipal corporation would foot the bill.

However, health department spokesperson Daksha Shah claimed she was not aware of this announcement. “If beds were being reserved like that, something would have come to us in writing about it,” she said.