{"id":49113,"date":"2020-11-27T12:10:12","date_gmt":"2020-11-27T11:10:12","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49113"},"modified":"2020-11-27T12:10:12","modified_gmt":"2020-11-27T11:10:12","slug":"pressure-on-critical-care-facilities-in-covid-19-patients-in-india","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/11\/27\/pressure-on-critical-care-facilities-in-covid-19-patients-in-india\/","title":{"rendered":"Pressure on critical care facilities in covid-19 patients in India"},"content":{"rendered":"

The covid-19 pandemic has presented multiple challenges to healthcare systems around the world. We want to highlight the difficulties in Kerala, India, of providing palliative care for patients with pre-existing advanced disease who are infected with coronavirus.<\/span><\/p>\n

There are difficult ethical issues related to triage and care rationing when resources are limited and demand is high, alongside the logistical challenge of making such decisions. The pandemic has now laid bare issues about futile and inappropriate medical interventions in certain contexts.\u00a0<\/span><\/p>\n

As best practice in intensive care units (ICUs), palliative care has been recommended to be initiated as early as possible to allow focused interventions that anticipated or minimised unnecessary suffering.\u00a0<\/span><\/p>\n

In the current pandemic, this is relevant when people with severe, advanced diseases are admitted to critical care facilities because they have tested positive for covid-19. People with comorbidities have higher mortality if they are infected with covid-19. However, in at least some patients with pre-existing advanced diseases aggressive treatment may be inappropriate and cause needless suffering.\u00a0<\/span><\/p>\n

In the Indian context, where covid-19 cases are increasing exponentially, this is a pressing concern because of the existing low take up of end-of-life care principles and practice, as well as the huge socioeconomic impact of ineffective medical care (<\/span>Razvi 2020<\/span><\/a>).\u00a0<\/span><\/p>\n

At the time of writing there are <\/span>68,000 <\/span>covid-19 patients in Kerala. <\/span>Under 0.2% are currently <\/span>admitted to critical care units and current bed use is less than <\/span>half <\/span>of the designated critical care beds. There is a tendency to admit people with severe advanced comorbidities to critical care. More than a quarter of documented deaths in covid-19 ICUs in Kerala are patients who died in hospital of severe comorbidities (<\/span>Government of Kerala 2020<\/span><\/a>).<\/span><\/p>\n

There are multiple reasons for this.\u00a0<\/span><\/p>\n