New Delhi: In keeping with the forecast made on June 10, Delhi appears to be headed towards having around 1 lakh cases of COVID-19 by the end of the month. On Wednesday, its tally reached 70,390 with 3,788 new cases added during the previous 24 hours.The surge has seen Delhi record more cases than any other state or union territory over the last week. It has also brought into focus the issue of oxygen supply, ICU beds and ventilators, since around 6% of all cases usually end up requiring these facilities.While as of now, Delhi has around 6,000 vacant beds, chief minister Arvind Kejriwal on Wednesday said that more would be added soon. However, medical experts believe mere addition of beds alone would not suffice if the exponential growth in cases continues.As per the estimates that were shared at the Delhi Disaster Management Authority meet chaired by the Lieutenant Governor on June 10, the cases are expected to surge to 2.5 lakh by July 15 and there would be a requirement for 33,000 beds. By July 31, the cases are expected to be at 5.5 lakh, when nearly 80,000 beds would be needed.Adequate oxygen supply, ventilators will be crucialA senior Delhi government doctor said that merely adding beds will not be of much use since only patients with moderate to serious symptoms are being admitted. “These patients require either the administration of oxygen or need to be kept in an ICU or on ventilators. The question is how the beds can be converted to provide these facilities and whether it would be possible to make a provision for these in all the new set-ups at such short notice,” the doctor said.Another doctor with a leading private hospital said the presence of senior doctors and trained nursing staff is another important facet to treat COVID-19. “If new facilities are being created, it needs to be seen how ICUs or ventilators can be made operational there. Along with them, you also need senior doctors and support staff.”Delhi CM Arvind Kejriwal during the inauguration of an emergency COVID-19 care centre at LNJP Hospital Annexe in New Delhi, June 24, 2020. Photo: PTI/Ravi ChoudharyMany existing hospital buildings do not have oxygen pipelinesA doctor posted with the GTB Hospital in North East Delhi said the problem is that much of the infrastructure that should have been in place was not provided earlier. “There is a new block in GTB Hospital which has provision for beds but the oxygen pipelines were not installed there. Otherwise, it would have been easier to convert it into a facility for serious patients,” he pointed out.The issue of staff and availability of oxygen and other infrastructure was recently deliberated at length in a meeting chaired by deputy chief minister Manish Sisodia. It was stated therein that ICU staff shortage was a major hurdle in expanding the health infrastructure quickly.It was then decided that the Delhi government would hire final-year students of post-graduate medical courses such as MD/MS and DNB, as well as final year undergraduate and postgraduate nursing students, for deployment at the new ICUs.As for augmenting oxygen support, Sisodia had stated that efforts were being made to supply oxygen along with all the hospital beds and to provide ICUs in all the big COVID-19 hospitals. Also, the Delhi government has purchased 2,000 oxygen concentrators to cater to patients showing moderate symptoms of the virus, that is known to kill by impacting the lungs severely.A rush for ventilatorsDelhi has so far witnessed 2,365 COVID deaths, with 65 being reported in the past 24 hours. With the rise in new cases, the sheer number of serious cases is also expected to go up. As per a thumb rule, while around 2% of all positive cases need ventilator support, another 4% require oxygen support or admission to ICU.As far as availability of ventilators goes, Delhi has 735 of which 167 are in state government hospitals, 181 in Central government hospitals and 387 in private ones. According to the Delhi Corona app, on Wednesday, nearly 500 of these were in use while around 245 were still available for patients.ITBP teams including medical and administration deployed at Radha Soami Beas COVID-19 care centre with 10,000 beds in New Delhi, June 24, 2020. Photo: PTIDelhi to get 600 new ventilatorsThe number of ventilators is also expected to rise, with the Centre claiming that it has provided Delhi 275 of the 1,340 ventilators that have been manufactured under the ‘Make in India’ initiative. In fact, apart from Delhi, Maharashtra has also been given the same number of machines.The Centre has claimed that 50,000 ventilators would be manufactured soon, of which 14,000 would be delivered across the country by the June-end. Delhi has received a total of 425 new ventilators, which will go up to around 600 in the beginning of July. That would take the total number of ventilators in the city to around 1,300.But when it comes to the actual availability of ventilators, people often find themselves struggling to locate them. Several people have reported that when they called up a hospital to check if ventilators are available, they get a reply in the negative. This issue has also been flagged by some support groups who provide people with real-time data on the availability of hospital beds in Delhi.On June 17, Delhi CM Arvind Kejriwal had also stressed the need for creating more Intensive Care Units with ventilators in Delhi.We may need more ICUs in the coming days. Discussed wid doctors of our Del govt hospitals on how to increase no of ICUs. https://t.co/oOsXn2hIku— Arvind Kejriwal (@ArvindKejriwal) June 17, 2020A day later, Kejriwal had also tweeted about the new 10,000-bed facility being developed at Radha Soami Satsang Beas grounds in Chhattarpur, saying provision for providing oxygen support with some of the beds would also be made there.ITBP, armed forces personnel to man new facilitiesWith the number of cases rising sharply, Kejriwal on Tuesday urged Union home minister Amit Shah to ensure that this facility was operationalised with the help of Indo Tibetan Border Police by June 26. Shah responded by saying that the facility would be ready in the next 10 days.He also tweeted that a 1,000-bed hospital with 250 ICU beds is also being developed with the help of DRDO and Tata Trust. The facility, he said, would be manned by personnel from armed forces.I would also like to inform the people of Delhi that a 1,000 bed full-fledged hospital with 250 ICU beds is being developed for Covid patients. DRDO and Tata Trust are building the facility. Armed forces personnel will man it. This Covid Care centre will be ready in next 10 days.— Amit Shah (@AmitShah) June 23, 2020Need to modify AC systems to curb virus spreadThe need for developing ICU facilities in existing hospitals and new hospitals was felt because it was realised that like oxygen supply, proper air-conditioning was also vital for their operation. In many government hospitals, like LNJP, it was revealed that the authorities had simply switched off the AC system to prevent the spread of the virus instead of making efforts to modify it.However, cutting off ACs is not the solution since COVID-19 patients need to be kept in an atmosphere in which they can breathe easy – especially in the oppressive summer heat.Some of the private hospitals, like Ganga Ram, had changed the air-conditioning for COVID-19 wards from positive, or one in which the air moved away from the patient area, to negative through reverse engineering. They had also installed viral filters in the input-output areas and change the pattern of airflow to curb the spread of the virus.