Private hospitals, big and small, have been struggling to survive since the outbreak of Covid-19 as their business has been hit hard with sharp drop in footfalls and occupancy by 40 to 75% and a consequent fall in revenue.When announcing the lockdown, the government ordered all out-patient services and elective surgeries to be suspended. These are the biggest earners for the private health sector. “Close to 70% of the routine activities in hospitals have been stopped. It’s a tough time,” said Dr R Ravindra, president, Private Hospitals And Nursing Homes’ Association (PHANA), Karnataka Bigger hospitals and hospital chains remained open to offer emergency services as ordered by many state governments. However, even emergency cases shrank, as people stayed away from hospitals due to problems of transport during lockdown and because of fear as hospitals became hotspots for Covid-19 infection.Most small hospitals and clinics downed shutters as they could not afford to pay staff salaries with no revenue coming in. As they struggled to access safety gear, even emergency services in these hospitals were suspended citing lack of staff or infrastructure to deal with possible COVID-19 patients.Despite fall in revenue, there was no drop in expenditure, said many private hospitals. “We have to continue paying staff salaries and provide essential equipment like personal protective equipment for all the staff members. How are hospitals supposed to do everything? The way things are headed, many private hospitals will be left with no choice but to close down,” said a doctor who runs a 100-bed hospital in Pune.However, reports have come in from several states about private hospitals slashing salaries or even laying off staff. In Kerala, many of the hospitals are reported to have withheld, on an average, 30% to 50% of senior doctors’ salary last month. Some hospital managements have asked doctors and nurses to go on leave temporarily with no pay for the period on leave.According to Vidarbha Hospital Association convener and owner of a hospital Dr Sameer Paltewar, hospitals can survive for 19 days without any inflow of patients. “First phase of lockdown was somehow managed and we paid salaries of March to our employees. But, it’s not possible for April,” he said. A manager in Orchid Hospital, Ranchi, Santosh Kumar said that with acute shortage of patients they would “not be able to survive more than three to four months”.With partial lifting of lockdown in some areas, some hospitals have started offering out-patient consultations. Many, especially those in larger cities, are offering consultations using telemedicine, via video calls, social media apps or just phone consultations. Several doctors however expressed apprehension that telephonic consultation might lead to legal issues in case of any complication.Private hospitals in Andhra Pradesh welcomed the state government’s decision to include Covid-19 treatment under the state health insurance scheme that offers free treatment to patients in private hospitals. About 15 different Covid packages ranging from Rs 16,000 to Rs 2 lakh were announced. Meanwhile, hospitals across India have appealed to governments to clear pending bills for treatment given under various government schemes such as CGHS, ECHS and ESIS.Associations of private hospitals and health providers have also written to the state and central governments requesting interest-free loans to pay salaries, besides 50% waiver of electricity and water bills for at least three months.