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Doctor In India: Emergency Room Is So Crowded, 'It's Nearly Impossible To Walk'

May 6, 2021
Originally published on May 6, 2021 11:21 am

Updated May 6, 2021 at 10:20 AM ET

India has been setting daily records for positive coronavirus tests — more than 400,000 people on Wednesday alone.

In New Delhi, the Holy Family Hospital is at 140% capacity.

"It's nearly impossible to walk sometimes in the [emergency room]," said Dr. Sumit Ray, the hospital's critical care chief. "Sometimes we have to keep the patient in the ER for hours, for a day or two, because we don't have a bed in the wards or in the [intensive care unit]."

"Many of the public areas, some corridors, etc., have been cordoned off right next to my office behind a wall," he said in an interview with NPR's Morning Edition. "There is about 30 patients in a common area, which used to be the outpatient department. We have used those rooms also and put beds there, monitors there, oxygen cylinders there."

"Individual hospitals are standing up and doing the best they could. But as a system in different parts of the country, we have collapsed," he said.

Below are highlights of the interview, edited for length and clarity.

On his hospital's shortage of ventilators and ICU beds

Our staff is stretched. They're working more hours, working harder, longer. ... We need more ventilators because as the timeline of COVID is such that once the peak of number of cases happens about two to three weeks down the line, a certain percentage of those patients become sicker and end up in the ICU. And that's what exactly we are seeing now. And the number of deaths are increasing now. And what we are now having a problem with is that we have many patients who need ICU beds, but we do not have ICU beds for them. So we are managing them in high-dependency units, on wards, etc. Obviously, the quality of care is not the same because the level of monitoring, etc., cannot be managed as it is needed in the ICU.

So these are the problems which we face now. We kind of predicted this a few weeks back because we know the timeline, how COVID behaves. And we had tried to tell the government that there has to be a surge capacity building so that patients who will need this may have to be shifted. And that cannot be organized by an individual hospital. It has to be built by the government. It's starting to happen, but it's not come through yet.

On how hospital staff are worried about COVID's impact on their own families even as they treat patients

While taking care of patients in the hospital, we are talking to family, messaging them what to do at home when they're down with COVID. And if they worsen, then where do they need to go? So actually, the situation has reached such a point that many of our staff are scared that even if their loved one becomes seriously ill with COVID, will they find a bed in our own hospital or any other hospital for that matter?

On how India misjudged the pandemic and what led to vaccine hesitancy

We celebrated too early, too much chest-thumping, saying that we had vanquished the virus. I think all of us underestimated the virus. But how we were proved wrong, we are paying for it. ... There was a vaccine hesitancy, the reasons being that there was some degree of data intransparency, if I may say, about the vaccines that were being used in India ... . So the hesitancy was partly expected, could have been done better in terms of giving more transparent data.

On the ER being far over capacity

Our ER is beyond [capacity]. It had 30 beds and we have at any point of time about 100-odd patients and there are patients sitting in chairs who are being given oxygen because we are not refusing. It's nearly impossible to walk sometimes in the ER. ... sometimes we have to keep the patient in the ER for hours, for a day or two, because we don't have a bed in the wards or in the ICU.

On the collapse of India's health care system

We have collapsed in a sense. I mean, individual hospitals are standing up and doing the best they could. But as a system in different parts of the country, we have collapsed. I mean, what would you say if people start dying in ambulances because they can't get in a hospital bed, if people die at home, if people die in the ER because there is no bed in the wards or in the ICU. So that is a collapse of the system. There's so many more deaths that could have been prevented.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

STEVE INSKEEP, HOST:

We have a glimpse now inside a hospital in India. The country has been setting daily records for positive coronavirus tests, more than 350,000 people day after day. Some who need a hospital go to Holy Family Hospital in Delhi, which is already at 140% capacity. Dr. Sumit Ray is on call around the clock, and his pager went off as we spoke of the hospital.

SUMIT RAY: Many of the public areas, some corridors, et cetera, have been cordoned off. Right next to my office behind a wall, there is about 30 patients in a common area, which used to be the outpatient department. We have used those rooms also and put beds there, monitors there, oxygen cylinders there.

INSKEEP: I want to note the obvious, that increasing the number of beds and finding space for the beds is just the beginning for a hospital. You also need equipment. You also need staff. Do you have what you need?

RAY: So that's the difficult part. So what has happened is, yes, our staff is stretched. They're working more hours, working harder, longer. We built up capacity in terms of bringing in more ventilators, and we have extended the services on to areas which did not have central oxygen supplies. So we have these large cylinders between two beds to provide. Those monitors we have bought. But we need more ventilators because as the timeline of COVID is such that once the peak of number of cases happens, about two to three weeks down the line, those - a certain percentage of those patients become sicker and end up in the ICU. And that's what exactly we are seeing now. And the number of deaths are increasing now. And what we are now having a problem with is that we have many patients who need ICU beds, but we do not have ICU beds for them. So we are managing them in high-dependency units, on wards, et cetera.

Obviously, the quality of care is not the same because the level of monitoring, et cetera, cannot be matched as it is needed in the ICU. So these are the problems which we face now. We kind of predicted this a few weeks back because we know the timeline how COVID behaves. And we had tried to tell the government that there has to be a surge capacity building so that patients who will need this may have to be shifted. And that cannot be organized by an individual hospital. It has to be built by the government. It's starting to happen, but it's not come through yet.

INSKEEP: Our correspondent in India indicates that everyone in India seems to know people who are sick. Everyone in India seems to know people who are dying. And I guess that must be true of your staff, even of you. Are you going back and forth to work while you're aware that people at home are sick, people at home are in trouble?

RAY: Yes, that's a constant battle which the medical staff is facing, that people at home are sick. And we are constantly on the phone on the other end. I mean, while taking care of patients in the hospital, we are talking to family, messaging them what to do at home when they're down with COVID. And if they worsen, then where do they need to go? So actually, the situation has reached such a point that many of our staff are scared that even if their loved one becomes, you know, seriously ill with COVID, will they find a bed in our own hospital or any other hospital for that matter?

INSKEEP: Have you had moments of just wondering what on Earth went wrong here, given that India seemed to have beaten the disease a few months ago and India is the world's largest manufacturer of vaccines?

(SOUNDBITE OF PAGER VIBRATING)

RAY: So two things. One is I think we celebrated too early, too much chest-thumping, saying that we had vanquished the virus. I think all of us underestimated the virus. But how we were proved wrong. We are paying for it. Second is about the vaccination. Yes, we are one of the biggest vaccine producers. We are - but we are a lot of people here. And also there was a vaccine hesitancy, the reasons being that there was some degree of data intransparency, if I may say, about the vaccines that were being used in India - both the vaccines that were being used in India. So there was - the hesitancy was partly expected, could have been done better in terms of giving more transparent data. So yeah.

INSKEEP: Are you turning away patients?

RAY: We are turning away, yes, to a certain extent, I would say, those patients in ambulances, good ambulances who can reach some other place. But those coming in their own vehicles or in ambulances we know do not have the facilities to maintain the patient for a long period of time, we are taking them all. Our ER is beyond - I mean, it had 30 beds, and we have at any point of time about 100-odd patients. And there are patients sitting on chairs who are being given oxygen because we are not refusing. It's nearly impossible to walk sometimes in the ER. And what is happening is sometimes we have to keep the patients in the ER for hours, for a day or two, because we don't have a bed in the wards or in the ICU.

INSKEEP: During the worst surges in the United States, people feared that the health care system might collapse. Generally speaking, that did not happen. Do you have that fear where you are, though, that the system could in some way collapse?

RAY: We have collapsed in a sense. I mean, individual hospitals are standing up and doing the best they could. But as a system in parts of - different parts of the country, we have collapsed. I mean, what would you say is if people start dying in ambulances because they can't get in a hospital bed, if people die at home, if people die in the ER because there is no bed in the wards or in the ICU? So that is a collapse of the system. There are so many more deaths that could have been prevented.

INSKEEP: Dr. Sumit Ray in Delhi, thank you very much.

RAY: Thank you. Transcript provided by NPR, Copyright NPR.