ISLAMABAD/RAWALPINDI: Hospitals in the capital can no longer accommodate the number of Covid-19 patients coming from within and outside the city, while the Punjab government is increasing the number of allocated beds for patients in Rawalpindi for a fourth time due to the surge in cases.

An employee of the Pakistan Institute of Medical Sciences (Pims) revealed in a video available with Dawn that after he was diagnosed with Covid-19, he did not find an available bed in the hospital.

He said he tested positive for the disease a few days ago and began having difficulty breathing.

He contacted friends in the hospital and then went to the hospital himself, but had to wait half an hour to be seen by a doctor. When he was finally examined, the doctor said he was suffering from an oxygen deficiency and suggested he be admitted to the hospital, he said in the video.

However, he was then told there was no bed available, and he insisted that the doctor state this in writing. He was then told to keep an oxygen cylinder at home.

Rawalpindi doctors sound the alarm on hospitals’ capacity in the face of Covid-19 surge

“Despite talking to the isolation ward in-charge Dr Naseem, the bed was not provided so I went home and arranged an oxygen cylinder for myself,” he said, adding there was no arrangement for sanitiser in the hospital.

“One should understand that if Pims employees are not getting facilities, what would the situation be for the public,” he said.

Dr Asfandyar Khan, the chairman of the Young Consultants Association of Pakistan, told Dawn that the situation was even worse than people were speculating it to be.

“Our hospitals have already run out of capacity, but the number of cases is increasing continuously. The situation in hospitals seems a little better, as outpatient departments are closed and elective surgeries have been postponed. If OPDs are opened and elective surgeries start, the situation will be miserable,” he said.

Even doctors have died across the country because of the shortage of beds and ventilators, he said.

“A few days ago, a friend of mine asked for a bed for a Covid-19 patient. The first preference was Peshawar, so I contacted hospitals in Peshawar but there were no vacant beds. I then checked public and private sectors hospitals in Islamabad but could not get a bed,” he said.

Another person contacted him to ask if he could place a ventilator that he was willing to purchase himself in Pims for his critically in wife, who died before the plan could be enacted.

There should be a quota for beds and ventilators for doctors in hospitals so they can recover quickly, Dr Khan said.

A Pims doctor who asked not to be named said the isolation ward in-charge at Pims, Dr Naseem, is a junior doctor.

“The head of the department Prof Rauf Niazi and medical specialist Dr Shajee Siddiqui were ignored when giving the charge. There are two professors, two associate professors and three assistant professors who are senior to the isolation ward in-charge. Because of such da discrepancy, transparency cannot be ensured and the patient can never be satisfied,” he said.

Pims Executive Director Dr Ansar Maxood admitted that Covid-19 cases had increased to the point where the hospital was running out of capacity.

“We have 26 ventilators and 75 beds, but all of them have been filled. We have now started considering whether to establish an isolation ward in another ward. The consumption of oxygen has also increased manifold,” he said.

To a question, Dr Maxood said not only is the community spread of the coronavirus increasing, but there are also more critical patients being received in the hospital.

“A hospital dedicated to Covid-19 [patients] is being established in Chak Shahzad, but it seems it may take a few more days to begin functioning. After that, we will start referring patients to Chak Shahzad,” he said.

Polyclinic ran out of capacity almost 10 days ago, the hospital’s media coordinator Dr Imtiaz Ahmed said.

“We have 12 beds and five ventilators. We are hearing that the National Disaster Management Authority has allocated five more ventilators for the hospital, but we have not received them yet,” he said.

However, Special Assistant to the Prime Minister on National Health Services Dr Zafar Mirza told Dawn the situation with ventilators is under control.

“Overall, 50pc of ventilators are not engaged, but the situation is bad in some big hospitals. Resources need to be evenly distributed, which is why we have introduced a resource management system (RMS) so patients are aware of where they should go and which hospital has vacant beds,” he said.

Dr Mirza said that the RMS was the only solution and will allow hospitals to be aware of where to refer patients.

He claimed that the situation is projected to be worse than it is on social media and that it is under control.

Pressure on hospitals

The sustained rise in Covid-19 cases in Rawalpindi has put tremendous pressure on its four government-run hospitals, forcing the government to increase the number of beds to 765 and recruit another 42 doctors.

According to official figures, there are 160 patients on oxygen, 30 on ventilators and 171 in the critical ward. As many as 1,004 are isolated in their homes.

“The Benazir Bhutto Hospital (BBH) outpatient department has closed and been declared a coronavirus management centre. Now, the 600-bed hospital can only accommodate [Covid-19] patients,” Commissioner retired Capt Mohammad Mehmood told Dawn.

Mr Mehmood said three expansion plans were exhausted between March 16 and June 9.

“From March 16, 164 beds were allocated for [Covid-19] patients, but they ran short by April 1. The government expanded the beds to 264 in four hospitals, but they were exhausted by May 1, and we expanded further to 450 beds in hospitals and 120 in the Red Crescent Hospital by those were also exhausted by June 1, and then we increased the beds to 545,” he said.

The government asked the district administrations to coordinate with the health department and provide the utmost facilities to patients, but the number of patients is increased with each passing day.

The Punjab government first declared the Rawalpindi Institute of Urology (RIU) a coronavirus management centre, which had the capacity to treat around 300 patients. There were also 75 beds in Holy Family Hospital, 120 in BBH and 50 in the District Headquarters Hospital.

But with the spread of the coronavirus in the last two and half months, another 600 beds have been allocated for patients at BBH.

Doctors said that the situation changed after the lockdown was lifted.

BBH medical superintendent Dr Mohammad Raffique told Dawn that the number of patients who are critically ill has increased in Rawalpindi hospitals, with most patients coming in with breathing problems in dire need of oxygen.

“The situation during the lockdown was normal, but things changed during Ramadan as people did not take precautions and contracted Covid-29 with serious health issues,” he said.

He said most of the patients coming to hospitals were older adults, who required oxygen because they had other conditions including diabetes and blood pressure and heart issues, which need more attention.

“The shortage of staff therefore worsened, but the government has started recruiting doctors and [Rawalpindi Medical University] Vice Chancellor Dr Mohammad Umer conducted walk-in interviews and recruited 42 more doctors for the four hospitals,” he said.

Dr Raffique said there are 95 Covid-19 patients on oxygen and seven on ventilators.

There has also been a substantial increase in the necessary medicines, lifesaving drugs and personal protective equipment since the surge in cases, he said. The government is providing these items, but the work of doctors and paramedical staff has increased.

He said BBH and other hospitals do not refuse patients, while Pimsalsosends Rawalpindi residents back to government-run hospitals.

“We accommodate patients from Gilgit-Baltistan, Kashmir and adjoining districts as well, as they do not have the space to accommodate critical patients,” he said.

Dr Raffique said people need to be informed of the importance of safety measures.

“If people do not understand the problem, the number of patients will multiply in the coming days and we will not have the space to accommodate them,” he said.

The number of beds in HFH will be increased to 100 in the coming days, but the number of critical patients is rapidly increasing, HFH medical superintendent Dr Shahzad Ahmed told Dawn.

There are 21 patients in the hospital currently on oxygen and eight have been placed on ventilators. Dr Ahmed too said people need to take precautions, as Covid-19 will put pressure on health facilities.

Dr Ahmed said that while there is no shortage of doctors and nurses in the hospital at present, there will be a problem if patients continue to arrive at the same rate.

Published in Dawn, June 10th, 2020