With nearly 40,000 of the over 105,000 infected cases found in Sindh alone, the worst fears of healthcare providers in Karachi are becoming real. The news comes as Pakistan has further relaxed the lockdown despite serious criticism from medical professionals.

With the rise in infections, Karachi has seen a spike in hospitalisation of patients. This was inevitable, says Dr Shobha Luxmi, an infectious diseases specialist heading the Covid-19 isolation centre at Dow University of Health Sciences' (DUHS) Ojha Hospital.

Terming the current situation a "national disaster", Dr Luxmi says: "From day one we have been begging people to stay home and take on some responsibility as the already collapsed health system will be unable to take on the burden, but even now despite the rise in death toll, no one seems duly perturbed."

Recently addressing the public in a television appearance, the prime minister also appealed to the people to seriously follow the standard operating procedures (SOPs) so the pace of infection can be reduced and healthcare facilities are not burdened.

But Dr Luxmi says people were stubbornly refusing to wear masks or observing physical distancing. "On my way to the hospital, every day, I get stuck in traffic jams because people are out in huge numbers in complete disregard to the government's SOPs," she says.

With rising number of infections, the Sindh Health Department is also trying to address the situation. According to the latest data shared by the Sindh Health Department, there are a total of 22 private and public hospitals treating Covid-19 patients in Karachi. In all, there are 224 beds with ventilators, out of which 69 are occupied. There are 545 beds in the High Dependency Units, out of which 258 are filled and 287 are vacant; there are 266 beds in the different isolation centres, of which 170 are filled and 96 vacant.

These neat figures are often updated as are the ones on the National Command and Operations Centre's (NCOC) app Pak Nigheban with over a 1,000 hospitals already associated with it. The app aims to help "navigate the patient in emergency to the nearest hospitals which have beds and vents available".

Experiences of Karachiites

However, the ground reality is quite different as are the experiences of Karachiites. There are several reports of people with Covid-19 or with suspicion of the infection of being turned away from hospitals.

"We had a hard time finding an ICU bed with a vent for our 73-year-old grandmother after she tested positive and her health started deteriorating," says 27-year-old BA*, a resident of Karachi, narrating the "nightmare" and the various roadblocks they faced.

"From getting a bed to finding an ambulance, to our apartment residents' refusal to help or allow the chowkidars to help us bring her down to the ambulance, everything was an ordeal," says the young woman.

"My uncle was already Covid-19 positive and running a fever. When my grandmother's condition deteriorated, we first started calling up various major city hospitals, to ask if they had a bed in the ICU available. All refused admission."

Using influence, they were finally given assurance that they would get a bed at a hospital in Clifton. When they reached there, they were told they would have to wait 24 hours. "With my grandmother in the ambulance and my uncle following in his car, they went about town for three hours checking at hospitals only to be turned away."

Finally they decided to bring the grandmother back home as her sugar level was dropping; she being a diabetic. And just when they had almost given up, they were able to secure a bed at Liaquat National Hospital and quickly took her there. The septuagenarian is recovering slowly with some drugs and plasma therapy (donated by those already recovered) and did not have to be put on the ventilator.

Karachi-based gynecologist, Dr Azra Ahsan, had an even worse tale to tell of a relative who scrambled to six different hospitals looking for an ICU bed for his mother.

"He was referred from South City Hospital's (SCH) emergency room with suspected Covid-19 infection to Ziauddin Hospital, in Clifton. From there referred to Indus Hospital, which referred him to Ojha Hospital. He also tried Aga Khan Hospital as well as Liaquat National Hospital. Admission was denied at all of these facilities," says Dr Ahsan.

"Thankfully, the mother remained at the SCH all night while the son went about town in search of a bed," Dr Ahsan says, adding that she tried to use her contacts and called up the Sindh Institute of Urology and Transplantation only to be told to take the patient first to a physician at Ruth Pfau/Civil Hospital Karachi's physician so a doctor could determine if she needed admission.

"I told them she was not maintaining her oxygen saturation and definitely needed admission and that we would not want to move her until I was assured of a bed," she says, adding that Dr Furqanul Haq's case was still fresh on her mind.

Still, she called CHK where she said she spoke to someone at the medical superintendent's office who "did not know if there was a bed vacant" but connected her to the COVID-19 ward. "No one picked up the extension," says Dr Ahsan.

Finally, they were able to get the mother admitted at the Jinnah Post Graduate Medical Centre. "It is not hard to imagine what the public is going through," says Dr Ahsan.

Many have also shared their own harrowing experiences on social media.

Aside from that, there are also cases where patients are reportedly being refused simply because they are suspected of being infected.

Dr Ahsan relates one. "I arranged a hospital bed for a friends' employee’s wife who was to give birth through a Cesarean section, at a charitable hospital. To my utter shock, the patient was refused admission when they reached the facility. Upon inquiry, the resident doctor said the family members were wearing N-95 masks so the hospital administration suspected the pregnant woman had Covid-19. They forced the couple to leave the premises without arranging a bed for her in another hospital."

Finally, the pregnant woman had to be taken to a private hospital where she was admitted and was also tested for Covid-19. "She tested negative," says Dr Ahsan adding: "Imagine the trial she and her family went through because of the fear of healthcare providers."

Karachi needs more ICU beds with oxygen

The news of patients being transported from one health facility to another seems to have been noticed by the federal government. Of the 1,000 additional beds with oxygen facilities it will provide across the country, Karachi's share will be 200.

Dr Luxmi remains unimpressed. "Even if the government provides us with more beds and vents, where will we get the manpower to run them?" she says. "A lot of the healthcare providers are testing positive. I don't know how long I can continue holding the fort as I cannot take on the burden of treating so many patients on my watch single-handedly," adds the stressed out doctor.

Dr Samrina Hashmi, former president of the Sindh chapter of the Pakistan Medical Association, says that while "everyone's talking about need for ventilators; we don’t need ventilators, we simply need ICU beds with oxygen".

"Only 5% patients are very ill who will need ventilators. What we need are isolation/ICU beds with oxygen," she explains.

She says the Sindh government should have established more isolation centres during the lockdown period.

"Instead of wasting money on private hospitals, they should have utilised their existing district general hospitals like the ones in Lyari, Liaquatabad, New Karachi, Korangi , Dumba Goth. In fact, there is a 400-bed hospital in Lyari. Even Abbasi Shaheed Hospital has a big medical unit and a medical faculty which remains underutilised. The government should have called newly retired professors to work in those units, who in turn, would have trained junior doctors as well, like in other countries," she points out.

"Many countries established isolation centres away from their main hospitals during lockdown and prepared for the second wave; we could have done the same," says Dr Hashmi lamenting the wasted resources at Karachi's Expo Centre.

"Even if they convert a portion of that area into an ICU, it would help a great deal in overcoming the burden at other facilities," says Dr Hashmi. "If there is political will, there is still time to utilise the spaces we already have as we ride the second wave," she says.

*. Name changed to protect identity