Goa struggles due to missteps in Covid control

The arrangement made to tackle the surge have been found wanting. Goa’s health care infrastructure is struggling to cope as there is a shortage of doctors, nurses, and other health care staff. The supply of medical oxygen, a key intervention among Covid-19 patients many of whom suffer respiratory distress, has run low at the premier state-run Goa Medical College and Hospital (GMCH) for four straight nights, according to health minister Vishwajit Rane, and has been costing lives.

Twenty-six patients being treated for Covid-19 at the hospital died between 2am and 6am on Tuesday, Rane said. He added they were facing a shortage of oxygen. “Yesterday [Monday] we required 1,200 cylinders of oxygen but we got only 400. Because of interrupted oxygen supply, I think somewhere between the hours 2am to 6am, there are a lot of deaths happening. Even today between 2 am to 6 am, there were around 26 deaths.”

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The Bombay high court at Goa on Wednesday said the material placed before it establishes that patients were indeed suffering and even in some cases succumbing for want of oxygen.

On May 2, the Goa Association of Resident Doctors highlighted the inadequate oxygen supply at various Covid wards. “The central oxygen flow delivers very low flow oxygen at times and that is inadequate to keep NIVS (Non-Invasive Ventilation) and ventilators working effectively. Also, the oxygen cylinders being used for patients get over in the middle of the night and it takes at least 2-3 hours for replacement cylinders to come and sometimes more than that and for this time period, the patients are kept without oxygen with saturations dropping to less than 60%,” the Association said in a letter to GMCH’s dean Shivanand Bandekar.

The letter prompted the high court to intervene and forced the government to admit to a shortage of oxygen and logistics to make it available.

Ashley Delaney, whose father-in-law is battling Covid-19 at GMCH, said every night the oxygen levels have been dropping. “It is patients relying on cylinders who suffer first as there is no one to swap the empty cylinders, especially during the late hours. The nurses and doctors are way too burdened to be able to do this.”

Delaney said he has been raising the issue, but little action has followed, and many people have died. He added the experience has been numbing. Delaney said he has seen first-hand people dying as oxygen levels dropped. “Eight wards are dedicated to Covid-19 patients, and each has a capacity of 28 beds. Instead, they are dealing with as many as 70-80 patients in each ward,” Delaney said. “There are only six nurses and one or two doctors to handle 80 patients. If patients are crashing, they require at least six people. The other night, two patients were crashing at the same time and four were attending to one patient and the other had only two. Only one of them was able to make it,” he said.

Rane set the alarm bells ringing when he said a high number of deaths were taking place between 2am and 6am, the hours when the oxygen levels also dip.

His comments came even as the government had been in denial about the shortage of oxygen.

“There is no shortage of oxygen. Instead, we have a shortage of manpower and people to carry the cylinders to ensure that patients have full cylinders at all times. If the cylinders are not in the place...we might as well say there is no oxygen,” Sawant said.

A person aware of the matter said the hospital’s general ward does not have a fixed oxygen pipeline. “...that means someone (a technical person) has to keep monitoring the oxygen cylinder gauges etc. Flowmeters have to be adjusted by doctors/nurses depending on the saturation levels. The hospital is supposed to understand the consumption and keep at two times buffer stock, so whenever they get empty, the stock is replenished and this has to go on,” the person said, requesting anonymity.

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Rane acknowledged the GMCH is overburdened. “The consumption (of oxygen) is unprecedented. We are also facing a shortage,” said Rane, countering Sawant’s claim that there was no shortage.

Bandekar conceded before the high court that there indeed was a shortage. “We have faced many interruptions in the supply of central oxygen on a daily basis, leading to near-critical fall in the oxygen saturation of patients in the intensive care units. The supply of cylinder oxygen that is used for mild/moderate patients has also been deficient, and erratic, leading to the needy patients not getting it continuously,” Bandekar told the court on Wednesday.

“The death following such hypoxemia (low levels of oxygen in the blood) and organ hypoxia may be immediate, or most of the time after some period of time. Adequate and uninterrupted supply of oxygen is of vital importance in managing (Covid-related pneumonia).”

The court ordered the government to ensure an adequate supply of oxygen, which had run low for four nights, “at least for tonight (Wednesday)”.

But the oxygen again ran low once and prompted late-night SOS calls on Wednesday night.

A police team was be called and constables lugged cylinders up and down the floors to ensure that the empty ones were replaced.

Ruling Bharatiya Janata Party lawmaker Atanasio Monserrate has been among those who have hit out at the government over its Covid mismanagement.

“The other day, a patient, who had a bed, was taken down and the bed was given to someone else just because that person hailed from Valpoi (Rane’s constituency). You have to be inhuman to be doing something like this. He is the health minister of the whole of Goa, not just of Valpoi,” he said.

Rane refused to comment on Monserrate’s allegations.

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Private hospitals have also been facing the oxygen crunch. “Ours is a private hospital, when I call the supplier, he says the collector has said not to give (oxygen) to private hospitals. We have to keep begging and somehow we manage to get sufficient quantity,” said a manager at a private hospital, requesting anonymity.

Experts said Goa ignored the warning signs as the positivity rate began rising in early April when it crossed 10% for the first time in over six months. The government did not increase testing or initiate any kind of trace and track mechanism to ensure that the virus does not spread further.

“The government has been caught completely clueless in handling the pandemic. Rather than have the politicians take decisions, they should have set up a committee of experts to chalk out a strategy. Everyone knew that the second wave was coming and that it would be more lethal than the first,” said Dr Jorson Fernandes. “Instead, the government did nothing. There was no move to increase the capacity of the beds to ensure that there are at least 50% more beds than were required during the first wave, no move to set up isolation centres to ensure that people do not transmit the disease among their families. Now there are instances where entire families are positive.”

Fernandes said the first thing that the government should have done was to make Covid negative certificates mandatory on arrival in the state. “The state has had to go for a full lockdown, which could have been avoided if it had closely monitored the cases and imposed specific restrictions on certain activities well in advance to ensure that you break the chain even without a lockdown.”

Goa now has the highest positivity rate in the country. It had a weekly average positivity rate of close to 50% in early May.

Another doctor said the biggest mistake the government made was to take the issue of vaccination very casually. “As soon as there were signs that the second wave was impending, they should have speeded up the vaccination to ensure that everyone is vaccinated in a very quick time,” said the doctor, who did not wish to be named. He said the government was to be blamed, but people too should not be absolved.

Experts pointed out the other mistake was keeping Goa open to tourists until two weeks back. Even as the number of tourists arriving in the state fell drastically as Covid-19 cases surged across the country, there were no restrictions on entry into the state.

The Travel and Tourism Association of Goa, which opposed any kind of restrictions and on March 19 said making testing mandatory for tourists was not a solution, relented only on May 7 and asked the government to impose a lockdown.

State minister Michael Lobo on March 31 said restrictions on tourists would kill the industry. As the cases surged, Lobo was among those who called for a state-wide lockdown.

And it took a high court order for the government to make testing for those entering the state mandatory.