The West Bengal government on July 6 advised all COVID-19 hospitals in the state to issue death certificates according to the guidelines set by the Indian Council of Medical Research (ICMR).

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The department also advised the hospitals that "before putting hypoxic patients on ventilators, high flow nasal oxygen therapy should be tried as per the guideline". Earlier, it had advised all COVID-19 hospitals to opt for "prone awake ventilation" as and when possible before putting a patient on conventional mechanical ventilation. The move would cut down on the use of mechanical ventilators amid the surge in coronavirus cases, a senior official of the health department said.

Prone positioning ventilation also called as prone awake ventilation (lying flat on the belly to improve oxygenation), which is mostly used in intensive care units (ICUs) for those having acute respiratory distress syndrome (ARDS), should also be attempted on COVID-19 patients, according to an advisory issued by the department. If that does not help, patients should be put on conventional ventilators, the official said. "With the number of COVID-19 cases soaring every day, we have to have ICUs and ventilators ready for patients at all times. But the number of ventilators the state has at the moment is not enough to support them all," he said.

West Bengal currently has 395 ventilators and 948 ICU beds in its COVID-19 hospitals, according to state health department data. "In cases, where the doctors suspect that the patient has a 'secondary bacterial infection', the (blood) culture should be sent for examination and he or she should be put under mechanical ventilation," the advisory stated. The department also said that "super-speciality teams should be available for appropriate advice in relevant cases". It has also warned against "indiscriminate use" of antibiotics for bacterial infections. "Since COVID-19 is a viral infection, justification for prescribing antibiotics must be documented. We need to avoid indiscriminate and prolonged (use of antibiotics) as experience shows that it may cause harm in many cases," the advisory said.