Chennai has seen a steady increase in the number of cases over the past two weeks. The city hit 10,000 cases on May 24th. In just over two weeks from the date,  the total number of cases has more than doubled, and the tally on June 11th stood at 27,398. The number of deaths stand at 279. 

Recent days have seen citizens share harrowing accounts of  their inability to find beds and timely care for COVID+ family members. There are several reports of patients being forced to wait hours at public hospitals to be accommodated. 

With the rising number of cases, is the city’s health system, renowned world over for affordable and quality care, crumbling?

Where can you get treated?

When the COVID pandemic reached the city in late March, Chennai’s first patient was admitted at the Rajiv Gandhi Government General Hospital, the largest public hospital in the state. As more cases trickled in in April, all of the city’s premier public hospitals – Kilpauk Medical College Hospital, Stanley Hospital and the Government Medical College Hospital, Omandurar – started taking in COVID patients.

The four major hospitals have a capacity of around 2000 beds designated for COVID patients, with scope for expansion, such as the recently promised addition of 400 beds to Stanley Hospital. 

Since then, nineteen other government specialty and peripheral hospitals have been designated for COVID treatment with a total capacity of around 6700 beds under category 1 (Dedicated COVID Hospital) & category 2 (Dedicated COVID Health Center) facilities. But only 12 of these facilities are in use at present.

Private hospitals began treating COVID patients on April 5th. The state released a list of 112 hospitals across Tamil Nadu, including 34 hospitals and medical colleges in Chennai, Kanchipuram, Thiruvallur and Chengalpet where patients can get treatment. The pool of beds in private hospitals and medical colleges exclusively for COVID-positive patients stands at around 5300 today.

Identifying private hospitals treating COVID-19

Despite the numbers on paper, locating private hospitals which are treating COVID patients, and ascertaining bed availability have proven to be challenging. The list of private hospitals treating COVID+ patients has not been updated since April. 

Health Minister Vijaya Baskar promised to operationalise a dashboard that showed real-time bed availability in private hospitals on June 4th. The dashboard went live on June 6th. However, the information on availability of beds as listed in the dashboard is unreliable due to the dynamic nature of the situation. Some hospitals on the dashboard were found not to be accepting COVID patients.

A representative of a private medical college hospital, which is listed on the dashboard but is not taking in COVID patients, said, “Lack of staff due to the lockdown and inadequate ICU facilities constrain us  from accepting COVID+ patients. Only regular outpatient operations were resumed recently in the facility and even that is running with limited staff. We regret our inability to cater to COVID patients at present.”  

During calls to 17 other Chennai-based private hospitals with bed strengths ranging from 75 to 400 (not part of any list shared by the government) the hospitals confirmed that they were not accepting COVID patients at present. In fact, some of them required a COVID negative certificate for hospitalisation.

How is bed capacity information shared with COVID helplines?

Dr Pradeep Selvaraj, who leads a team in the Chennai Corporation’s COVID Control Room said, “With the recent increase in cases, accommodation of vulnerable patients and those with comorbidities are prioritised. Nodal officers in the hospitals communicate bed vacancies to us twice a day and that information is shared internally. Those who reach out are being guided to the hospitals accordingly.”

Dr Pradeep added, “The helplines only direct patients to available government facilities.We cannot send patients to private hospitals without an idea of the potential charges they will incur, their spending capacity and bed status.” The dynamic nature of information shared and the volume of patients handled by the government hospitals make the creation of a dashboard, similar to the one shared for private hospitals, unlikely any time soon.

Dr Kolandhaisamy who served as the Director of Public Health until April of this year, also spoke of this approach. “We were managing the control room information inflow through dedicated teams manually, by making calls. Since the number of cases were low back then, there were no hitches. But this could be running into some issues now with such rapidly rising cases.”

Reasons behind confusion and mismatch

Doctors attached to the government hospitals corroborated that nodal officers communicate the information on bed availability to the health department authorities thrice a day. However, they pointed out that the accuracy of information on beds could be hampered by the high turnaround of patients in recent weeks, which has overwhelmed the system.

When there is a high volume of patients, bringing patients into the facility and starting the treatment is of utmost priority. The admission procedure and accommodation of patients however require time. A limited number of personnel are designated to manage inflow and outflow of patients in order to limit exposure and associated risks. This in turn leads to a lag in communication regarding bed availability. 

As for the discrepancies between the bed capacities captured in the dashboard of private hospitals and the reality on ground, a source attached to one of the private hospitals stated that this could be due to the difference in the number of physical beds available and manned capacity. Even where beds are empty, the shortage of healthcare workers prevents them from accepting more patients.

Vijay A narrates his experience while trying to find a bed for his ailing aunt Dr Subhashini Chandrashekar. “My aunt is a cancer survivor who was undergoing chemotherapy. When she fell ill we took her to the private hospital in Kilpauk that treats her. She tested positive for COVID there and they asked us to leave immediately.”

“I called 108 ambulance and was told to wait but didn’t get a response. The hospital was pressuring us to take her away in a private vehicle. I started tweeting about this issue. 108 called back and said they don’t take patients from a private hospital. Some private ambulances said they would only take patients to other private hospitals,” said Vijay. 

“We got the results at 3pm and got a private ambulance at 9pm. We were turned away from Rajiv Gandhi Hospital as there were no beds. At Kilpauk Medical College Hospital they didn’t accept cancer patients. As we were heading to Omandurar, my tweet got a response from the Health Secretary Dr Beela Rajesh who said that Rajiv Gandhi Hospital has been notified. She was admitted at 10.50 pm and passed away the following day.”

“I cannot imagine what kind of help is available to those who cannot make their voices heard by the authorities at the highest level,” says Vijay.

Dr Vijayaprasad Gopichandran, a public health expert feels that a technological solution could cut the time lag on information about bed capacity. “Right now the process that is followed at the hospital level is manual. If there is an automatic system, it would be better. In large government hospitals the matrons monitor the bed capacity at each stage and share the information. The central government is creating a repository of data on COVID patients through a portal that the hospitals have been feeding information into. A similar effort for bed capacity management can eliminate discrepancies.”

But till that is accomplished, patients and their families continue to have harrowing experiences trying to ensure hospitalisation and medical attention for their kin.