India’s capital hunkers down as coronavirus cases surge and hospitals face staffing shortages

NEW DELHI — As the omicron variant blazed through the Indian capital this week, Naresh Gautam’s intensive care ward, inside one of India’s largest public hospitals, went from half empty Monday afternoon to almost full by Tuesday morning.

But the steady stream of new patients in his ward did not worry Gautam as much as who was missing: nearly half of his colleagues, who had tested positive for the coronavirus.

Eight months after a delta surge ravaged India, a shortage of medical staff is posing a looming problem as authorities seek to avoid a repeat of last spring, when the health-care system buckled, leading to hundreds of thousands of deaths. Although government officials and health care workers claim they know lessons , and are able to prepare far more hospitals beds and oxygen tanks in advance of this current surge, there is a shortage in staff at many hospitals as the authorities take a soft lockdown in order to reduce transmission speeds.

On Tuesday, New Delhi ordered private-sector offices and restaurants to close as India reported nearly 170,000 new cases. Others cities including Mumbai are also enforcing curfews, and keeping schools shut.

At Safdarjung Hospital in the heart of Delhi, Gautam said front-line workers treating covid-19 are having to work shifts of up to 16 hours as their colleagues test positive or stay at home with the onset of symptoms. Gautam’s hospital is converting more ICUs dedicated to covid patients — and possibly even its 100-bed overflow facility built last year on campus, though he doesn’t expect a shortage of beds.

“A lack of doctors, that’s what’s causing a real crisis,” said Gautam, an anesthesiologist.

While many countries, including the United States, have reported staffing difficulties, India’s problem has been exacerbated by a dispute between trainee doctors and the government, which has delayed roughly 45,000 recent medical graduates from joining the workforce.

The incoming batch of residents will register for placement at hospitals this week, government officials said Sunday after a Supreme Court ruling settled a conflict over quotas. Anuj Aggarwal (a Delhi-based radiologist who is secretary to a national association representing Indian medical residents) said that hospitals in India will not receive their new residents until February.

“It’s better than never, but it’s already too late,” said Aggarwal, who estimated that about a third of residents at Delhi hospitals are home sick.

In a memo Monday, Rajesh Bhushan, the Indian health secretary, ordered hospitals to “conserve” their staffs and summon retired health-care workers and students to assist in phone consultations. According to media reports, many hospitals have cut their elective procedures in order to send staff to the covid wards. This week, India began administering vaccine boosters to health-care workers and people over age 60 with comorbidities.

Despite omicron’s rapid spread, Indian officials say they are not worried yet about hospitals overflowing. Some hospitals in India’s major cities are experiencing a surge of patients. However, others aren’t. Officials from Delhi and Mumbai claim that there are plenty of vacant beds. Others have also reported having makeshift clinics that can be opened for patients if demand rises.

A team of Indian modeling experts at the Indian Institute of Technology in Kanpur, which advises the government, has projected that cases will continue to grow and peak at the end of January — and exceed the record numbers set in India during the second wave.

K. Srinath Reddy, president of the Public Health Foundation of India, said the government should have paused all political, social and religious events until April. He said that Omicron was like a fast-racing car and would spread quickly from large cities to smaller towns to the country.

“I’m concerned that as a society we aren’t taking note and protecting ourselves with appropriate behavior,” Reddy said. “We’re giving an opportunity to the virus to spread very fast.”

According to India’s genome-sequencing body, data from December showed that the delta variant of the coronavirus was responsible for 39 percent of infections. Many experts now believe that the current wave of infections is powered by the Omicron variant.

The rapid rate of cases doubling and the phenomenon of the virus infecting vaccinated people or those who had covid in the past suggest omicron is now the dominant variant in India, said Shashank Joshi, a member of the coronavirus task force for Maharashtra state, which includes Mumbai.

Joshi said the country was “not past” the point at which the situation was worrying, but he remained “cautiously optimistic” that omicron will not send an overwhelming flood of patients to hospitals in the coming weeks. He said that the government should include a clearly defined communication strategy and a policy of home isolation to ensure hospitals and workers don’t get too stressed. There also needs to be measures to concentrate treatment on vulnerable high-risk patients.

Still, one major reason for concern has been data showing a high proportion of tests returning positive in major cities, including Kolkata, where the rate is nearly 40 percent. Experts warn that infections could be more common than test results indicate and may rise further.

The positivity rate in the next 10 days will be a key signal to “how the infrastructure will take the pressure,” said Shiv Kumar Sarin, the vice chancellor of Delhi’s Institute of Liver and Biliary Sciences.

Many hospitals have already begun to enact contingency plans. Savrankar Datt, a radiology, stated that the All India Institute of Medical Science (Delhi) had announced two weeks ago a plan to rapidly vacate patients’ beds in response to rising cases. Two buildings were converted by the hospital, the burn and trauma centers to house only covid patients. He said that many departments had stopped elective procedures, funneled personnel to covid patients because it was impossible to maintain normal operations.

“It’s wrong to say this is not going to be a challenge for the health-care system,” he said. “The sheer numbers will be so high that even a small percentage of hospitalizations is going to test limits.”

But at the very least, he said, “we’re not going to allow bed shortages to occur.”

Anant Gupta contributed to this report.

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