Forecasting that the COVID-19 pandemic is only going to get worse, noted surgeon Dr Devi Prasad Shetty has said India will need an extra 5 lakh ICU beds, 2 lakh nurses and 1.5 lakh doctors in the next few weeks, and also suggested radical solutions to meet the mountainous challenge.
At present, India has only 75,000 to 90,000 ICU beds and almost all are already occupied - when the second wave of the pandemic hasn't even reached its peak yet, he said. India is reporting about 3.5 lakh cases a day, and some experts say the number could go up to 5 lakh cases daily at its peak.
While most of the newspaper headlines and prime time television coverage have been over the lack of oxygen for the patients in ICUs, "I am having sleepless nights for the next headline, which is going to be that patients are dying in ICUs because there are no nurses and doctors to take care of the patients," he said.
"And this is going to happen. I do not doubt it now," said Dr Shetty, the chairman and founder of Narayana Health, a chain of 21 medical centres in India, in his online address at the Symbiosis Golden Jubilee Lecture Series in Pune recently.
He pointed out that for every patient who is tested positive, there are 5 to 10 people who are positive but not tested. That means more than 15 to 20 lakh people are getting infected every day in India even now. Statistically, five per cent of the positive patients need an ICU bed, irrespective of their age. On an average, a patient in ICU spends at least 10 days there.
"So you can just imagine what the scenario is. Know what we need to do? We need to create at least five lakh additional ICU beds in the next few weeks," he said.
"Unfortunately, beds do not treat patients. We need nurses, doctors and paramedics in that order," he said, pointing out that managing COVID patients successfully in ICUs depends mostly on nurses, not doctors.
Even before the start of the pandemic, government hospitals across the country had a shortage of 78 per cent of medical specialists.
"Now, we need to produce at least two lakh nurses and at least one and a half lakh doctors in the next few weeks who are dedicated to managing COVID for the next one year. Because the current pandemic is likely to last for about 4 to 5 months. And then we should be prepared for the third wave," he said.
Dr Shetty then proceeded to provide out-of-the-box solutions for meeting that need. He said India has about 2.20 lakh nursing students who have finished their three-year GNM (General Nursing and Midwifery) or four-year B Sc courses in various nursing schools and colleges across the country who are preparing for their exam scheduled to take place in the next few weeks.
He suggested that the Ministry of Health, along with the Indian Nursing Council, should consider these students as graduates and deploy them to work in COVID ICU wards for one year, after which they will be given graduation certificates. They could also be given preference over others in government jobs, he said.
"Take the approach of drafting for the armed forces when there is an impending war with the enemy country ... This is not peacetime. It is wartime.
"If that is done, I am convinced most of these girls and boys will join the fight against COVID. The battle cannot be won by doctors of my age. No war can be bought by fought by people of my age. You need young people. Most of them are vaccinated and they are naturally in a better position to fight COVID in case they get it.
He said there are also 1.30 lakh young doctors today, working not in COVID ICUs but preparing for NEET exams to get into post-graduate courses where only 35,000 positions are available. An online test for NEET should be conducted immediately and results declared in a few days.
After allowing the 35,000 seats, there will be still one lakh young doctors who are left out, who didn't get the PG seats. They should be offered a chance during the next year's PG selection if they work in the COVID ICU for one year, he said.
Additionally, there are about 25,000 doctors who have finished their postgraduate training and haven't yet appeared for the exam. This batch of medical specialists should be told that they can skip the exam and get the degree provided they work in the COVID ICUs for one year, he suggested.
Also, there are between 90,000 to one lakh doctors who graduated from overseas universities who haven't been able to pass a national entrance exam. "Identify 20,000 brightest of these kids and ask them to work in COVID ICU for one year for getting a permanent registration," he said.
"If we can do this successfully in the next few weeks, believe me, we would have conquered the COVID battle. Otherwise, the consequences can be very very very serious, mainly because just admitting a patient in a COVID ICU and giving him some oxygen is not going to save their life," he concluded.
"When the oxygen drops, they need proning. And somebody has to monitor their blood gases. All this is done by nurses and junior doctors.
"The current doctors and nurses who are taking care of COVID patients across the country have done a fantastic job during the first wave. Now they are tired. They are fed up. They are burnt out. A number of them are getting infected.
"Unless we create a parallel workforce for COVID ICUs, believe me, there can be a problem," he said.
He acknowledged that all his speculation about the number of COVID patients and the estimate of ICU beds needed may be wrong.
"But what if I am right and it is too late?"