Kathmandu homes and hotels turn into hospitals

As government and private hospitals in Kathmandu fill up with Covid-19 patients, some of them are offering rented hotel rooms or home care to meet the surge of the seriously sick.

Even then, these extensions of the hospitals can only cater to patients with milder symptoms, and there is no room in the ICUs if their condition gets worse.

On Monday, the Ministry of Health announced that all remaining government hospitals in Kathmandu Valley would be converted to Covid-19 centres, and all ICU beds and ventilators would be consolidated.

It has also officially now allowed hospitals to start moving patients with mild symptoms to hotels in Kathmandu, but their rooms would not be allowed to have non-coronavirus guests. The Ministry also announced that hospitals would be allowed to perform only emergency surgeries for now,

After it got filled up with SARS-CoV-2 patients, Star Hospital in Lalitpur came up with the ‘Housepital’ service under which it sends people with mild symptoms to self-isolate at home, provide regular tele-consultation three times a day vitals monitoring, blood tests and dietary and psychiatric consultations.

The basic care package costs Rs12,500, while a more advanced treatment that includes essential medical kits and hands-on care is Rs30,000 for 14 days of isolation.

“There has been a steady increase in people coming for our Housepital service, we now get about three patients a day,” says Pratikchya Dhakal of Star Hospital, adding that in case of complication, individuals are admitted to the hospital if a bed is available.

This puts expensive ICU treatment and even Housepitals beyond the spending capacity of most Nepalis. But proper care can be provided also at homes for those self-isolating (still the majority of Covid-19 cases in Kathmandu Valley).

Ideally, asymptomatic or mildly symptomatic people self-isolating at homes should have a separate room and a bathroom. The patient should confine themselves in their room, wash their own utensils, wear mask while going to the toilet and sanitise it after use and wipe door and other handles.

Individuals need to keep track of their temperature and symptoms, measure oxygen saturation level if possible, take paracetamol for body ache and fever and make sure to eat nutritious food. One must be aware of danger signs: oxygen level below 93, chest pain, difficulty in breathing and blue tint to lips and limbs.

“None of what is happening now is unexpected, and we did have quite a while to prepare but it was not well planned. Now it is extremely difficult for all of us,” says Rakshya Pande of Pulmonary and Critical Care at HAMS hospital in Kathmandu. “None-the-less, if asymptomatic and mild symptomatic people follow safe home isolation, it will help break the chain of transmission.”

Some asymptomatic people who have tested positive but live in crowded joint family homes have now started moving to hotels for self-isolation. The Hotel Association Nepal has designated 80 of its properties in Kathmandu as quarantine hotels at Rs5,000 per night, and at Rs7,000 if two people share a room. Occupants get meals four times a day, with no tax or service charge.

Some hospitals that had filled up to capacity had already also started renting rooms in nearby hotels for their mildly symptomatic patients. Others are offering home isolation with consultation by visiting nurses and doctors.

For all intents and purposes, Kathmandu has now reached a saturation point for Covid-19 patients, and with Dasain and winter approaching, the dangers will multiply. Even the government seems to now have thrown up its hands, and left it up to citizens to take care of themselves.

“We are now in a situation where symptomatic patients are being sent home, and rationing hospital beds, oxygen and ventilators, that is like being caught between the devil and the deep blue sea,” says Buddha Basnyat, a physician  at the Patan Academy of Health Sciences.

The winter flu season and increased pollution will add to the respiratory complications due to Covid-19 and there might be another explosive surge., Warns Basnyat, “For now, because therapies and vaccines are not yet available, prevention is the best medicine.”

On Friday evening, digital healthcare platform Danfe reached out to all major hospitals in Kathmandu and the health ministry to admit a 33-year-old Covid-19 patient whose lips had turned blue indicating severe oxygen deprivation. There were no beds.

On Monday, friends and relatives were unable to find even general ward bed for a 59-year-old Covid-19 patient in Lalitpur with oxygen saturation level dangerously low at 85, fever and cough.

Both these patients are from upper middle class Kathmandu families. There are many more who are suffering silently in rented rooms in the capital, not able to afford even the basic medicines and treatment.

On Monday, there were a total of 4,047 new cases in Nepal with 2,283 in Kathmandu Valley alone. There were nine additional deaths, bringing the total fatalities all over the country so far to 645. Actives cases also climbed to 33,880. Nepal’s recovery rate is about 70%, and fatality rate 0.6%.

Globally, some 20% of Covid-19 patients need hospitalisation and 5% need ICU treatment. Moreover, a patient is serious enough to require critical care needs to be in ICU for at least 10 days, adding to the wait for patients.

But even as the critically ill fill up Covid-19 wards in hospitals, ICU and isolation beds seem to be magically available for ministers and top government officials.

A medical doctor working in a major hospital in Kathmandu admitted that there is so much pressure from politicians to admit constituents and relatives that they have to keep some ICU beds free just in case.

“We have to hoard ICU beds because you never know when you will get a call from a VIP or a minister who wants someone admitted,” says one doctor who didn’t want to be named for this article. Another doctor told Nepali Times there is a thriving “black market” for ICU beds.

Indeed, some of this shortage could be artificial. Kathmandu Valley’s government and private hospitals have 195 ICU beds and 88 ventilators, of which 154 are presently occupied and 50 ventilators are being used by patients with Covid-19 or other chronic ailments.

There are an estimated 2,600 ICU beds in private and government hospitals nationwide, and only 490 ventilators of the 900 are in working order. As of this weekend, there were 243 patients treated in ICUs and 39 of them were on ventilator support. Bagmati province alone had 130 patients in ICU and 28 on ventilators.

Kathmandu is lagging far behind rest of the country, particularly Tarai cities and municipalities in far western Nepal, that have better managed control coronavirus crisis. Kathmandu Valley’s population density and greater movement of people has ensured that the virus spread like wildfire.

Foreign Minister and government spokesperson Pradeep Kumar Gyawali admitted on Sunday that the state had failed: “Kathmandu leads the country in all other sectors and indicators but has been unsuccessful in controlling Covid-19. The decision for another lockdown will depend on how well the public follows safety measures.”

For some doctors, the problem is not so much a shortage of ICU beds and ventilators, but the fact that they are either too expensive for most patients, or they are not where they are needed he most. They say ventilators are important, but less than 3% of seriously ill Covid-19 patients in Nepal who need ventilator support make it.

Says Buddha Basnyat: “Our focus should now be on strengthening nursing care and supplying adequate oxygen, which are more important than ventilators, and for patients that need oxygen to be administered the cheap but effective drug dexamethasone.”