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Bed occupancy at ICU goes up by 10 percentage points

Since January 4, the Intensive Care Unit (ICU) bed occupancy has gone up nearly 10 percentage points and ventilator bed utilisation has increased by nearly 11 percentage points in Mumbai. The oxygen bed occupancy in the city has doubled in the same 10-day duration. However, the oxygen usage in the past week, senior civic official say, has only increased by an estimated 5% indicating that patients on oxygen beds seem to be recovering with mild oxygen therapy.

Data collated by the civic body shows that on January 4, there were 11,998 oxygen beds, 2,577 ICU beds and 1,368 ventilator beds. On that day, 1,374 oxygen beds, 507 ICU beds and 320 ventilator beds were occupied — 11.5%, 19.67% and 23.39%, respectively. On January 13, the city’s oxygen bed strength was 11,854, ICU beds were 3,053 and ventilator bed strength was 1,547, of which 2,806 (23.67%), 897 (29.38%) and 538 (34.77%) were occupied, respectively. What this indicates is that while there is still a large share of such beds available in the city, Covid-19 cases requiring critical care are on the rise.

To be sure, based on case curves seen in the earlier waves, oxygen, ICU and ventilator beds typically start filling up seven to 12 days from the onset of infection as an infected person would only start to display serious symptoms — which require critical care — only from the seventh day onwards.

What’s more, civic authorities said that city’s oxygen usage has not increased drastically despite an increase in the number of patients requiring oxygen therapy and intensive care.

“Currently, the city is using about 40-45 Metric Tonnes (MT) of oxygen every day,” additional municipal commissioner P Velrasu, who oversees Mumbai’s oxygen supply and distribution, said. “This is only 25% of what we required during the peak of the second wave. Even if the oxygen bed occupancy has doubled over the past few days, oxygen usage is likely to have increased by a marginal 5%. It would have been around 42 to 43 MT last week,” he said.

This includes oxygen usage in Covid ICU beds as well as for non-Covid related treatments. According to Velrasu, this is also an indication of how the disease is being manifested in the third wave of the Covid pandemic, where more patients seem to be improving with mild oxygen therapy compared to the previous wave.

Mumbai’s total oxygen capacity is 900MT with more than 40 Pressure Swing Adsorption (PSA) plants with a capacity of 300 MT and Liquid Medical Oxygen (LMO) storages tanks with varying capacities in hospital premises. “We have not yet started using the PSA plants, because the LMO capacity is sufficient at the moment,” said Velrasu. “Medical experts have predicted that we are already in the peak. So, it unlikely that our oxygen usage will go up further,” he added.

Dr V Ravishankhar, chief executive officer of the Lilavati Hospital in Bandra said that none of the 100 Covid-19 patients admitted in their wards is on oxygen support. “But we have 38 patients in our ICU, including four on ventilator support, who are requiring some amounts of oxygen,” he said.

According to Ravishankar, all patients in ICU and on oxygen support are with co-morbid conditions or are senior citizens with existing ailments. “We have a mix of people, some are breakthrough infections, some are partially vaccinated and some are unvaccinated,” he said adding that 90% of their ICU beds were full on Thursday.

The ongoing third wave has been driven by the Omicron variant, which is known to impact the upper respiratory area, thus causing symptoms like runny nose, scratchy throat and cough. But the Delta variant, that drove the second wave, is still in circulation in the city. Delta, doctors said, was a much deadly variant impacting lower respiratory areas, causing lung damage and serious disease. But not all samples are sent to genome sequencing to confirm the variant of the virus.

“We are seeing a faster turnaround from the ICU, with many patients coming out of the ICU within five days,” said Ravishankar.

Physician Dr Pratit Samdani, who consults at Breach Candy Hospital said doctors can only assume that a particular patient has the Omicron variant going by the clinical symptoms. “When the number of infections is this high, there will be some percentage of patients who will land up getting serious disease. Most of my admissions have been in the wards, but there are some patients with co-morbid conditions and age-related risk factors who are in the ICU and on oxygen support.”

Dr Prince Surana, chief executive of Mumbai’s Surana Group of Hospitals said that ward admissions were higher during the first week of January. “But now, we are seeing an uptick in the ICU admissions. A majority of these patients are in advanced age and have serious comorbid conditions,” he said. Of the 15-bed ICU facility in the Chembur branch of Surana Hospital, 14 were full on Thursday. Their eight-bed ICU facility in Navi Mumbai was full.

Thane has also seen an uptick in serious patients. On January 4, the oxygen bed occupancy was 1.4%, ICU occupancy was 5.2% and ventilator bed occupancy was 6%. On January 12, the oxygen bed occupancy had jumped to 6.3%, ICU bed occupancy had gone up to 15.9% and ventilator beds occupancy had increased to 12.8%. Hindustan Times

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