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Second wave: With fewer beds and more demand, discharge from hospitals is faster

However, it is slower in government hospitals as they focus on critical cases

With the COVID-19 pandemic spinning out of control and availability of beds becoming a challenge during this second wave, doctors in private hospitals are discharging patients on the fourth or fifth day if they develop clinical stability.

This is different from last year when there were specific norms on when a patient should be discharged.

V. Ravi, member of the State’s Technical Advisory Committee (TAC) and nodal officer for genomic confirmation of SARS-CoV-2 in Karnataka, said discharging patients soon after they develop clinical stability is essential so that beds are released for others who are in dire need of hospitalisation.

“This is only if the patient’s condition stabilises and oxygen saturation starts improving. If they are weaned off high flow nasal cannula (hfnc) and show clinical improvement, they can be transferred to a nearby stepdown hospital set up by private hospitals in collaboration with hotels or COVID-19 Care Centres,” he said.

C.N. Manjunath, nodal officer for labs and testing in the State’s COVID-19 task force, said most patients are considered stable and on road to recovery if there is no exertional desaturation by more than 4% (on a six-minute walk test) and biomarkers are within reasonable limits.

Monitoring vital

However, it is important that patients who are discharged within a short period should be monitored via telephone at least for the next seven days by hospitals.

S. Sachidananda, Vice-Chancellor of Rajiv Gandhi University of Health Sciences (RGUHS), said the expert committee at RGUHS has framed guidelines on transfer of patients from hospitals to stepdown centres once their condition improves. “We submitted this to the State government on Thursday. The guidelines are aimed at preventing patients from occupying hospital beds for long if their condition improves. The stepdown centres can be used for such patients under supervision of healthcare staff from the attached hospitals,” he said.

Longer stay

However, the scenario is different in government hospitals. Unlike private hospitals where even mild and moderate cases also get admitted, almost all those who are admitted in government facilities are critical cases. None are recovering before the 10th day, said doctors.

At Victoria hospital, the largest designated government COVID-19 facility, where over 700 patients are on oxygen support, the recoveries have reduced to around 20 a day. “While we are getting 115-120 admissions every day, our recoveries per day are hardly 20. As almost all of them come in a critical condition, they require oxygen for a longer period,” said Smitha Segu, COVID-19 nodal officer in Victoria hospital.

Manoj Kumar H.V., dean, director and Medical Superintendent at Bowring and Lady Curzon Medical College Hospital, said the average recovery time is 12 days. “Even if we have patients in general beds, they turn critical and require oxygenated beds. All our beds in Bowring and Charaka hospitals are occupied. We had to convert two normal beds into ICU beds on Friday to accommodate more patients, and our ICU was full,” he added.

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