Earlier this week, the Telangana government discharged 393 asymptomatic COVID-19 patients below the age of 50 from the Gandhi Hospital in Hyderabad and sent them to quarantine.
The move came as a surprise as the state government had never missed a chance earlier to point out that they had enough beds to treat COVID-19 patients and was taking care of them in the hospital, though the Centre's guidelines allowed them to be sent home.
Even while sending the patients home, the state government insisted that it had many empty beds and urged citizens not to believe 'fake news' being spread by a section of the media about a shortage of beds at the hospital.
So, what made the government take such a step? The decision was taken as the state has been seeing a steady increase in the number of people testing positive for the coronavirus each day.
On Tuesday, Telangana recorded 178 cases, out of which 143 were from the Greater Hyderabad Municipal Corporation (GHMC) area. On Monday, the state recorded 92 new COVID-19 cases and five deaths. And while the Telangana Health Department does not provide any information on what the active case count in Hyderabad is, the state has 2030 active COVID-19 cases presently.
"The state government is expecting an influx of COVID-19 patients as lockdown has eased. This is why it has asked those with mild or no symptoms in Gandhi Hospital to be discharged and put under quarantine. It hopes that with this move, it should be able to manage the new cases that come in," a senior resident doctor who wished to remain anonymous said.
So does the Telangana government have enough beds to tackle the coronavirus pandemic? On paper, yes.
On June 2, the Director of Public Health and Family Welfare, in a report submitted to the Telangana High Court, said that the state had 17,081 beds to deal with the COVID-19 crisis, out of which 15,465 were isolation beds, while 1,616 were ICU beds.
Experts like T Sundararaman, retired Director of the National Health Systems Resource Centre and Global Coordinator of the People's Health Movement, say that around one ICU bed per 30,000 people is a good number of beds for a state to have.
As per the 2011 Census, Telangana's population is 3,50,03,674, which means that the state needs to have at least 1166 ICU beds to meet the criteria. With 1,616 ICU beds, Telangana meets this requirement, on paper.
"But that's only one part of the issue to ensure availability of beds," says Sundararaman.
A re-shuffle of beds for COVID-19
Observers say that many states in India have been emptying out beds that are being used for other illnesses and earmarking them for COVID-19.
"It is just prioritising COVID-19 over other healthcare. At some point, it may affect healthcare for other illnesses," Sundararaman points out.
On May 13, Director of Medical Education Ramesh Reddy in a report to the High Court said that there were 5,168 beds for Hyderabad and 1,307 in the districts to deal with COVID-19 -- a total of 6,475. This was after the 14-floor 1,500-bed Telangana Institute of Medical Sciences and Research (TIMS) was inaugurated as a COVID-19 hospital. However, in the submission made to the HC on June 2, the state said that it had over 17,000 beds in the state to deal with the virus. This meant that within a month, the number of beds available for COVID-19 in the state rose by over 10,000.
The only possible explanation is the shuffling of beds marked for other diseases, being allocated to tackle the coronavirus.
"From a policy perspective, we have to plan for other diseases as well. With monsoon coming in, cases of dengue, malaria, chikungunya etc come in or there might be another outbreak which needs to be addressed. You can't assume that most hospital beds can be kept for COVID-19 as other problems will not disappear," says Dr Anant Bhan, Researcher, Global Health, Bioethics and Health Policy.
Most beds in Hyderabad
The other part of the issue is the distribution of the beds, as most of them are situated in Hyderabad.
While 5,168 out of the total 6,475 beds were in Hyderabad as of May, the Telangana government's report submitted in June gives no district-wise breakdown on the number of beds available.
"If there isn't adequate preparation in the districts and there is more spread of infection in rural areas as we're seeing in many parts of the country, it will pose a challenge. We can't keep ferrying patients to Hyderabad all the time," Dr Anant says.
"In many cases, the condition deteriorates rapidly. It's better to have care available in the district areas, where faster referral can be done. You would also need to ensure that adequate transport like ambulances are available," he adds.
Is Telangana's justification valid?
The Telangana government has been dismissive of critics and repeatedly insistent that it can handle the pandemic, without the health system getting overwhelmed.
"Every individual should be cautious and should not worry unnecessarily about coronavirus. The government is taking all measures to contain the virus. Even if coronavirus cases are large in number, the government is ready to offer treatment," Chief Minister K Chandrasekhar Rao said earlier this week
In its report filed in June with the High Court, the Telangana government justified its preparedness.
"Various studies and also Telangana's experience with COVID-19 till date shows that about 80% of COVID-19 positive patients are either asymptomatic or would have very mild symptoms which go unnoticed. 15% would have moderate symptoms and would only need rest and good nutritious food along with immune boosters. Only 5% of positive cases would have severe symptoms requiring hospitalisation," it said.
Suggesting that 80% of positive patients could be treated with home isolation, the report said, "Hospital Preparedness Plan for government hospitals is drafted with an assumption that at the peak of the pandemic, about 60,000 active cases are anticipated in the state."
Out of this, the Telangana government estimates that 5%, or 3,000 cases, would require hospitalisation and intensive care.
"The total beds available for hospitalisation are 17,081 and the estimated projected cases at the peak of the pandemic are around 12,000. Hence it is submitted that the state is well equipped," it said.
Experts feel that there is still cause for concern.
"You can use estimates and contextualise that and calculate how many beds you would need. However, we have to be careful because estimates are useful but they aren't perfect. It is better to be over prepared for every eventuality," Anant Bhan says.
"It's one thing to have infrastructure, but the other question is if there is enough manpower to run this around the clock. Additional beds are available but they will also need trained professionals who can operate them as it requires a specialisation," he adds.