“Patients are dying in ICU because there are no nurses and doctors” is going to be the headline news after we address the oxygen shortage. Based on data from the first Covid wave, positivity rate should remain at 25-30 per cent for the next 3-4 months. Every day over 3 lakh people are testing positive. Statistically, for every positive patient, there will be at least five more patients who are positive but not tested.
That means at least 15 lakh people are getting infected every day. Assuming that 5 per cent of them may need ICU care, we will be adding about 75,000 ICU patients every day, who need to stay in the ICU for about ten days. Unfortunately, we only have 75,000-95,000 ICU beds, which were full even before the pandemic reached the peak. Today, our own intensivists aren’t sure whether they will get a bed in the same ICU where they’re working if they get infected.
Unlike the first wave, ICUs today are getting filled with younger patients. So, most of the patients who die are going to be young breadwinners of the family, with devastating social implications.
We need to add 5 lakh new ICU beds in a few days to prevent this calamity. Any bed with central oxygen in a government or private hospital can be converted to an ICU bed with a few accessories, which can be procured easily.
Unfortunately, beds do not treat patients. Doctors, nurses and paramedics do. Well before Covid, shortage of medical specialists in government hospitals was 76 per cent. Most of the government hospitals’ ICUs are suboptimal and Covid patients end up in short-staffed private hospitals. Frontline workers who did a phenomenal job during the first wave are tired and exhausted. We need a few lakh young, skilled and vaccinated nurses, paramedics and doctors to win the battle.
India is the only country in the world that can produce a few lakh young Covid frontline workers in a few days, just by changing the regulations. The greatest bottleneck in expanding ICUs is the shortage of nurses. There are about 2.2 lakh nursing students who finished GNM or BSc training, just waiting for the exam. The nursing and ICU serving paramedical students should be exempted from appearing for the exam to graduate and given preference for future government jobs, provided they work in a Covid ICU for one year. Most students would love to take up this offer.
The second greatest hurdle is the availability of specialist doctors. Over 25,000 young doctors are about to finish training in various medical and surgical specialties. NBE or NMC should exempt them and the ones who failed in past exams and offer a degree if they work in Covid ICU for one year.
There are a few thousand medical specialists with diplomas in critical specialties like intensive care cardiology or emergency medicine who aren’t recognised by the Medical Council. If the NMC recognises these diplomas, we should get thousands of motivated and skilled medical specialists to manage Covid ICUs across the country.
Over 1.3 lakh young doctors are sitting at home memorising multiple choice questions to secure a PG seat through NEET exam. Since there are only 35,000 PG seats in clinical subjects, there will be over a lakh doctors who will be unsuccessful in securing a PG seat. They can be offered grace marks for the next NEET exam, provided they work in a Covid ICU for one year.
In addition, there are at least 20,000 doctors who graduated from overseas universities and are unable to pass the Indian entrance exam. They can practise as doctors in other countries except their country of birth. These doctors can be given medical council registration in exchange for working in a Covid ICU.
All the doctors who I am suggesting to be exempted from the final exam are already qualified doctors with the ability to practise medicine. In the United States, postgraduate resident doctors do not need to even appear for a final exam. They are recognised as board eligible and allowed to practise.
A Covid ICU is the worst place to work with PPE. We rarely encounter a situation wherein we need to be thinking about our lives first before saving the patient’s life. No monetary incentive can make one work in the Covid ICU for months together.
We need to give young nurses and doctors a lifechanging gift to face the battle. Let’s be practical and accept that whatever we are doing currently inside the hospital to increase ICU beds is not working. That’s the reason why today private hospitals are not providing ICU beds even for millionaires.
We belong to an amazing country that can solve life-threatening challenges in remarkable fashion. We started the war against Covid with virtually no PPEs and very few ventilators. In a few weeks we produced enough PPEs and ventilators to become a net exporter.
Today the entire country is gasping for breath due to lack of oxygen. Thanks to the generosity of the industries and the government’s interventions, the oxygen shortage will get solved shortly. We have a tiny window of opportunity to address the manpower crisis and prevent one of the greatest human tragedies.
We have no doubt that our government under the able leadership of PM Modi can convert any catastrophe into an opportunity to save precious lives.
The article by Dr Devi Shetty, Member, CII Healthcare Council & Chairman and Founder, Narayana Health, appeared in the April 2021 issue of CII Economy Matters. Click here to read the issue.