‘Need better containment strategy, ramping up of infrastructure’

After the first wave of the Covid-19 pandemic, par as hospitals founder DHARMINDER NAGAR was sticking to his plan of setting up hospitals across India when the second “tsunami” hit. In the first wave, the group’s hospitals with a total of 1,000-plus beds treated 2,327 patients and witnessed 280 deaths over 10 months. In the second wave, the group converted 559 beds, treated 2,459 and lost 363 patients in a month and a half. Nagar tells Anjuli Bhargava about lessons from the pandemic experience. Edited excerpts:

How was the second wave different from the first?

First, the sheer volume of cases. My phone rang day and night and cases were arriving every few minutes. Second, many patients now were coming in needing oxygen and in a serious condition.

This wave hit us like a ton of bricks and there was no breathing room. One day you were planning surgeries and doing oncology and the next day, you converted half the hospital into a Covid facility. A majority of our cases were Delhi residents. This may be reflective of a slightly more aware, educated and risk-averse population living in Gurugram.

What worked to our advantage was that the doctors, nurses and staff were not scared like last year and they led from the front. They were on top of the virus, familiar with protocols and how to deal with patients while keeping themselves safe.

This wave has travelled from the west to the east. Our first hospital to get hit was in Udaipur. We got an indication there. Then it struck the National Capital Region (NCR) and it was like an avalanche. Patients were sicker, needing oxygen and ventilators. Further, we had many more female patients — almost 30 per cent unlike in the first wave when they may have been barely 5 per cent.

Also, this time we lost many patients in the mid-30s to early 40s age group as there is a propensity for them to have many undiagnosed comorbidities.

Do you think the Kumbh Mela worsened matters, since many may travel through Delhi and Mumbai to reach Uttarakhand?

It may have made things worse in Uttarakhand but it doesn’t answer the question. As we saw it, the wave originated in the west, travelled from Udaipur to the east, hit NCR and Panchkula, and then reached our facilities in Patna and Bihar almost two weeks later. South Mumbai residents or rich and upper middle income people from Delhi, for instance, didn’t travel to Haridwar for the mela but they were hit hard.

Do you think we went wrong somewhere with the vaccination drive?

I do think we should have handled this differently. In its bid to appear fair and as concerned about rural India, vaccine distribution has been botched up. In rural India, hesitancy was high, too. Even in semi-urban areas, a majority was reluctant to get vaccinated.

I don’t think a clear assessment of where it was needed and where it wasn’t was done. The vaccination drive should have focussed on large metros, then the bigger cities and moved to remote parts. Perceptions instead of reality seem to have guided decision-making. Moreover, the private vaccine manufacturers could have been given whatever financial support they needed to ramp up production dramatically.

What problems did you face in dealing with authorities?

In Gurugram, we had almost 320 beds dedicated to Covid (at any point, maybe 20-odd beds were for other patients). ICU capacity was 80 beds. This time, 95 per cent patients needed oxygen. We had not ramped up our oxygen capacity as we did not anticipate this. Also, our Faridabad supplier was told to supply to Delhi first, due to the high court order. You can’t say that a patient’s life in Gurugram is worth less than one in Delhi! We had to use strong arm tactics to augment supply of oxygen from our regular supplier. In Bihar and other hospitals, we didn’t see the same severity. There was a need and a bit of panic but we were not overwhelmed. Also, Jharkhand supplied oxygen to our hospitals there.

What changes would you like to see so that private hospitals can contribute if there are future waves?

Less knee-jerk reactions would help, as would a better containment strategy and ramping up of facilities and personnel.

We have all been asked to invest in oxygen generators instead of the authorities managing the supply chain better. This doesn’t make much sense. What happens to these generators when we no longer have such a pressing need for oxygen? The money can be invested to ramp up infrastructure like adding ventilators or hiring nurses and staff. There are unused ventilators in public hospitals, which could have been utilised if there were better partnership.