Residents claim that both local and well-known laboratories are refusing to collect new samples citing a massive backlog of pending tests; experts warn a patient could lose the golden hour of treatment due to delay in being diagnosed
Pic/Ashish Raje
With rising cases of SARS-CoV2 in Mumbai and rest of Maharashtra, non-availability of hospital beds and delay in getting RT-PCR test results from laboratory and getting chest scan results from scan centers to ascertain COVID-19score has become a matter of concern for health experts, as they say ‘The golden hour’ in the emergency medical care is forgotten for COVID-19’ thereby increasing the risk of patients slipping into severe conditions, which otherwise could be dealt easily, if they patients are brought for treatment with the Golden window hours.
A long queue of people waiting to get tested for Coronavirus outside (Topiwala) Municipal Maternity Home, Goregaon, on Monday. Pic/Satej Shinde
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On Sunday, family doctor of Chembur resident Anthony Gonsalves (name changed), who had initial flu symptoms since Thursday, advised him to get the RT-PCR test done. But to his surprise, almost all the laboratories that he contacted, including the local private labs, refused to collect samples, citing a huge backlog of pending tests. He is now compelled to stay in home quarantine, anxious about his symptoms.
Belinda Dokras, a family friend, tried to help Gonsalves, but in vain. “Today [Sunday] morning was a kind of a nightmare for me when I was calling labs in Chembur to enquire about the RT-PCR test. A private laboratory said they were not taking any new tests for the past two days, due to a backlog of 40,000 pending tests." A well-known laboratory also said it had a pending backlog and hence, stopped conducting tests.
“While the public did not follow the COVID-19 protocols when the city relaxed the restrictions, the government was lax as well, and not prepared for the second wave. Entire healthcare system is overwhelmed. The government needs to invest in healthcare infrastructure rather than focussing on Coastal Roads or Metros,” she said.
Most of the city's well-known hospitals, including Breach Candy, Jaslok, Hinduja, Wockhardt, Mumbai Central, Leelavati, are running short of COVID-19 beds and the waitlist in most private hospitals is running at over 100. Admission to private hospitals or nearest civic COVID centres or hospitals is routed through the BMC war room at each ward. Even if people are able to connect to their local war room for admission to a private hospital, the employees are helpless due to non-availability of beds.
A health worker collects a swab sample of a woman for an antigen test at CSMT station on Monday. Pic/Suresh Karkera
At M West war room, on an enquiry for bed availability at any private hospital in and around Chembur, an employee said, “We can only register your patient's details with us at present, as hospitals are running short of bed. If you can arrange a bed at your end, let us know, we will facilitate the patient transfer from home or COVID-19 centre or smaller nursing home to bigger set ups. If your patient has got a bed, we would suggest you let him continue treatment there.”
Dr Subhash Hira, professor of Global Health at the University of Washington, said, “Since June last year, several national and global epidemiologists had been anticipating and predicting a second wave of COVID-19 in India around mid-February in 2021. Moreover, the speed with which the virus is transmitting in several states during the second wave is much higher than the first. A person infected with SARS-CoV-2 [virus that causes COVID-19] is spreading the virus to 16 others in the community. During the first wave, the spread was limited to two to five people. This is one of the reasons why the second wave is expected to stay for a longer duration, causing a large number of infections and deaths."
"As of now, the epidemiologic predictions are seen to be correct in over 60 cities across six severely affected states, including Maharashtra and Punjab. Many of the fast spreaders are infected with South African and Brazilian mutants, and the role of indigenous Indian mutants is still unclear,” Dr Hira added.
Dr Hira said, “The roots of India’s COVID-19 crisis lie in the first wave. The SARS-COV-2 hit the country hard, and India took a determined decision of national shutdowns based on scientific fundamentals. The economic blow of the resulting lockdowns was severe, but at the cost of saving thousands of lives. The sheer speed of new infections leading to the second wave has surprised health officials, who now wonder whether variants might be a factor. Yes, the new variant viruses that are fast transmissible, complacency of the public and pandemic controllers who were over-confident of success after the first wave, and unplanned dismantling of COVID-19 hospitals/quarantine centres and trained staff etc are responsible for the resultant chaos. The mutant variant screening during January-March 2021 was done on 10,787 samples although the ten governmental sequencing centres have a monthly capacity of 30,000 tests! The critical number of sequenced samples helps to determine the proportion of mutants circulating in these cities. The second wave that is likely to peak and stabilise in the next couple of months, and will cause more damage. Simultaneously, some European countries and Australia that are ahead of the Indian epidemic are already going through the third and the fourth waves of the COVID-19 outbreak.”
“Even as we go through night curfew, micro containment zones and massive scale-up of vaccine delivery, measures like wearing masks, social distancing, and hand washing or sanitisation have to be strictly implemented. In addition, let’s not forget that patients require ‘the golden hour’ emergency care by standardising PCR or rapid antigen test report within 12 hours, provision for rapid hospital admission if required, and post-COVID-19 follow-up after treatment. Contact tracing, sexual and hygiene counselling to reduce transmission at home, and COVID-appropriate behaviour requires strict implementation. There can’t be start-and-shut systems of pandemic control in any country for the next several years till the WHO gives pandemic clearance.”
“India has 47 million healthcare and frontline workers and an additional 50 million emergency service workers. These cadres need to be gelled under a single ‘Commander’ to ensure a smooth national operation,” said Dr Hira.
Dr Prashant Borade, senior consultant and head of department, Critical Care at Gleneagles, Global Hospitals, said, "It takes between five and seven days for a patient to recover, unless the patient has severe disease. Before advising a patient to get admitted at a hospital, the severity of the disease should be assessed. And for those patients who are on the waitlist, it depends on severity, if the condition is critical, the waiting period can be about 24 hours to get a bed, and if the condition is less severe the process could take three days at our hospital.”
Dr Borade added, “A good solution is to have a good screening done of the patient along with some baseline tests in the emergency room and measure the severity of infection. If the condition is severe, then bed is allotted, depending on availability, and keeping in sync with the BMC ward war room. If the patient does not have symptoms indicating severe infection, then they should be recommended home quarantine. The clinical team keeps in touch with the patient periodically to keep a track of their symptoms and severity of the infection. This reduces the burden on the beds."
Dr Wiqar Shaikh, professor of Medicine, Grant Medical College and JJ hospital, said he is not at all surprised at the second wave in India. This is a pandemic, and the history of Medicine teaches us that all pandemics in the past, be it plague, cholera, measles, Spanish flu, etc, had several waves before going into a plateau or abating, he explained.
Dr Shaikh also clarified that human beings have co-existed with microorganisms such as bacteria and viruses for centuries and he would expect that COVID-19 will remain in the world, albeit at a low virulent level. He added that indeed North America and Iran are in the middle of a fourth COVID-19 wave and Europe is in the grip of a third wave.
Dr Shaikh expressed alarm and serious concern with overburdened healthcare facilities in the country, particularly in Mumbai. He said most hospitals in the city have a waiting list of more than 100 patients. He added that this was the scenario in several countries across the globe. He quoted a BMJ report of January 22, 2021, which studied the health systems in China, Thailand and the USA and found that they were overwhelmed by COVID-19. Scientific American on January 27, 2021, said that these are the worst days for healthcare facilities and workers and that hospitals in the USA are looking like war zones. Scientific American also said that COVID-19 has shifted focus and attention away from all routine health care, including surgeries, which could prove disastrous. The Journal of the American Medical Association reported on March 17, 2021 that we are witnessing an advanced health system stretched beyond its capacity. On March 28, 2021, 680 News reported that hospitals around the world are reporting being so overwhelmed by COVID-19, doctors fear they may be forced to choose “who lives and who dies”. Indeed, doctors in some overburdened countries are already making that heart-wrenching decision.
Between October 2020 when the first wave subsided and February 2021 when the second wave of COVID-19 outbreak hit the nation, the government had over four months to ramp up healthcare facilities, including hospital beds, critical care units, ventilators, oxygen, medications, etc. India, particularly Mumbai, is suffering from an overwhelmed healthcare system due to a lack of homework and poor planning, concluded Dr Shaikh.
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