Over the weekend, the Government constituted a high level committee to ensure "adequate and timely supply of medical oxygen". A day earlier, the Government ordered closure of OPDs and non-emergency admissions at SMHS Hospital, Kashmir's largest general specialty hospital. SKIMS Soura had ordered a halt to all non-emergency cases a week prior to that. The rising number of cases in J&K, the situation in Delhi, Maharashtra and some other parts of India, the changing face of the pandemic has the Government on toes everywhere. Somehow, it appears that we have been caught unawares by the Pandemic once again, just like we were taken by a surprise in April 2020.
A look at figures, at least for now, shows that not much has changed in terms of the patient load. J&K Government's Media Bulletin on COVID19 dated 18 April, shows 441 patients were admitted in hospitals of Kashmir for treatment. In Jammu, the number of admitted patients was 261. The total number of active cases in J&K stood at 11467. Therefore, of the known positive cases, just over 6 percent are admitted.
In November 2020, admissions were higher – approximately 12 percent of people who tested positive needed admission, the same media bulletin archives show. On a specific date, 17 November 2020 for example, nearly five months ago, 672 of the 5585 active cases were admitted; 414 of these were on oxygen support. When this piece was written, 462 patients were on oxygen support, not much of a surge in comparison to what J&K saw in 2020.
However, given the fact that a year has passed since the pandemic hit the World, it was expected that much would have risen in terms of infrastructure and oxygen capacity for managing severely sick COVID19 patients. The fumbling of directorate of health Kashmir and its over-reliance on expansive tertiary care hospitals in Srinagar is an indicator of how the preparedness has worked out in the year gone by. The "war footing" with which oxygen plants had to be installed across hospitals has not taken the peripheral system to any better degree.
Official figures show that across Kashmir, excluding those in tertiary care settings, 80 patients are admitted. If Indoor Stadium GMC Baramulla is taken out, just 39 patients are on oxygen support. If District Hospital Pulwama is discounted, the figure shrinks to 21. Patients admitted in 12 hospitals of Directorate of Health Services Kashmir – 21!
To add to the insult, not a single patient is on a ventilator in any hospital outside the tertiary care. The system claims to have 59 ICU beds available in these hospitals. In Chest Disease Hospital, no ICU bed is vacant, at SKIMS Soura, 7 are vacant. At SMHS Hospital, which has just closed for patients other than COVID19, 11 beds are available.
A record from SKIMS Soura shows out of 131 patients admitted on a particular day earlier this week, 79 (60 percent) were on low flow oxygen, a provision that could have been arranged in any other hospital. That arrangement would have opened up 79 beds in SKIMS, the beds that could have accommodated critically sick patients, COVID and non-COVID19. If 60 percent of the load at SKIMS Soura could have been reduced by an operational healthcare system in other hospitals, patient care in Kashmir would not have been reduced to rudimentary once again.
A senior doctor working in one of these peripheral hospitals said there was inertia in terms of capacity development in DHSK. He said that although oxygen plants for every district hospital and many sub-district hospitals had been procured, they were yet to be installed. "Now they have started to move on making arrangements to make more oxygen beds available in these hospitals," he said. He said that in 2012, two oxygen plants were procured and made operational within a month at JLNM Hospital and District Hospital Pulwama. "However, this time around, there is criminal delay, a delay that could cost so many lives here," he said.
Director Health Services Kashmir, Dr Mushtaq Ahmed Rather, when asked about the steps that had been taken to increase the capacity and facilities in peripheral hospitals said, "We never closed any hospital for COVID19." However, when asked about the number of oxygen beds available to cater to the growing load of COVID19, he did not come up with a figure. He said the Mechanical Division of J&K Government was working to make the oxygen plants functional but was not clear on the timeline of completion.
A doctor working in SKIMS Soura said it was a result of bad planning that hospitals like the Institute had to close doors. "We cannot be comparing ourselves with Delhi right now. We do not have the mammoth load that the National Capital has. In fact, we are more or less where we were six month ago in terms of patients," he said.
However, given the steep rise in positive cases and the subsequent hospitalizations, it appears that very soon, hospital beds in Kashmir, fitted with an oxygen port will run out. The reason for this catastrophe would not be the pandemic, but the epidemic of delays that mar the healthcare system in Kashmir. The year gone by, and the COVID19 patients in Kashmir would ask the administrators about what they did "on war footing" for increasing oxygen generation in hospitals and ensure manpower to run these beds.
"Management of COVID19", as a reputed doctor from Kashmir puts it, "is just an oxygen game".