Procuring a bed in a hospital for Covid-19 is becoming increasingly tough in New Delhi. As on June 8, Delhi has seen up to 28,936 cases including 812 deaths. In an interview with BusinessLine , N Subramanian, Director (Medical Services), Apollo Hospital and co-chair, FICCI Health Services Committee explains that if the situation spirals out of control in the national capital, the State may take over private hospitals.

Availability of beds in Intensive Care Units with ventilators is becoming increasingly difficult in Delhi. Your take.

Many people, even for routine medical conditions have a preference for private hospitals. Hospitals such as Apollo attract serious patients coming from home as also from other hospitals. Our ICU beds since last several weeks are almost full, all nine of them reserved for Covid-19 patients. We have in all 82 Covid beds. It is worrisome. We would all like spare capacity, but this is a pandemic which has hit us very badly. Apollo was one of the first three private hospitals to come on board for Covid. All major tertiary care hospitals have a certain capacity about which the government has details. We are taking a pragmatic view on how to escalate infrastructure without letting other services get affected, but God forbid, if we reach the situation like that of New York, for instance, the government may not hesitate to take over hospitals.

How many emergency procedures has Apollo undertaken apart from serving as Covid-19 hospital?

Evidence from UK, US and Italy informs us that some of the treatments will have a more adverse outcome if a Covid-19 patient went through an unrelated surgical procedure. Post surgically, a higher percentage of them ended up in the ICU. So, we test all patients that need admission to the hospital for day care or surgical procedures. In April or May, of all patients who walked in for something else and had no Covid-19 symptoms, five to seven per cent would test positive for Covid. Then, we have to balance between delaying or going ahead with the procedure. For emergency cases postponing is not an option. So we do not wait for reports, and take all necessary precautions as if he was a Covid patient. We have operated upon close to thirty such Covid-19 cases. But if there is a positive patient who requires a prostrate surgery, we advise them to recover and come back as it can wait for a month.

How has the hospital’s business been affected during the course of the pandemic?

Private healthcare facilities in our part of the world, barely make enough profit to make investment into the services. Then there is a drop in routine volume work and it has hit us very bad financially. In first quarter of this year, and only for large private hospitals the expected loss is close to ₹22,000 crore. For people who come to seek consultation for non urgent medical conditions, the footfalls have dropped by close to 90 per cent. Our surgical list for routine procedures has come down by 70 per cent. People have the fear of coming to the hospital and lockdown has not helped. Work volumes were low, consultants come on rotation, and we have had to maintain the additional staff with required for segregation of Covid and non Covid areas.

Private hospitals including Apollo are being criticised for charging high fees. Your Comment.

At Apollo, we have shared rooms, a private room, and ICU. All rooms have to maintain a negative pressure flow. If some one was to stay in private room, including medications, required Personal Protective Equipment (PPE) care materials the charges would be approximately ₹30,000 to ₹35,000 a day in single room. In an ICU depending on whether the patient is on ventilator and other parameters, it would go up to ₹80,000 per day. It may increase, if patient has co-morbid conditions and may require additional medication for those.

There is increasing discussion on whether to put a patient on ventilator or not. What is your opinion?

All our Covid-19 ICU beds (up to nine) have attached ventilatory support. Till May, we have admitted 300-odd patients of which up to 35 to 40 have required ventilators, at various points. We have to monitor how quickly a patient improves with normal oxygen at various flow levels.

Delhi government has asked not to draw samples of suspected Covid patients brought in dead to hospitals. Does that not affect death count?

Delhi government had earlier advised that every person brought to the hospital, and even if brought dead,, we are required to take a sample. But recently they have changed the protocol because of challenges. However in Apollo, if someone is brought into into our emergency even, if the patient is dead, we would still take samples, if we have a clinical suspicion of Covid symptoms.

There have been many instances across private hospitals of pregnant women being driven away. Are pregnant women being taken care of at the hospital?

At Apollo, we have helped five pregnant women who are covid positive deliver their babies. Turning away somebody is only acceptable if you did not have a particular facility or an equipment. If I did not have a good obstetric service or a good neonatologist available, or a proper labour room and staff to deal with it then it would not have been possible to take care of the deliveries. But at Apollo we have all the facilities. In fact, four of the five Covid-19 positive pregnant women had delivered in emergency. This is because the hospitals in which they were registered earlier were not equipped to deal with Covid. Also, the plan on when the mother would need to deliver the baby purely depends on gynaecological condition and not on Covid status of the mother. We conduct emergency deliveries, not withstanding Covid status of the mother, with all due precautions in place.

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