FIRST DOSE-SEEKERS HELPED DRIVE RECORD VACCINATION

Crisis management: Oxygen plants at hospitals, doctors & nurses on standby, ICU beds, buffer stock

“We have recruited medical staff and kept them on standby for Covid duty if the need arises,” says Joy Chakraborty, chief operating officer of Hinduja Hospital in south Mumbai. While the hospital now has 78-80 operational Covid-19 beds (21 are currently occupied), it plans to double the number if the third wave hits. And to avoid last-minute manpower crisis, Hinduja has recruited additional doctors and nurses. “Even after Covid, we feel we can always use their services to treat non-covid patients,” Chakraborty says.

As India braces for a possible third wave, the health system is trying to ensure that it isn’t caught by surprise — the way it was last time. So, hectic preparations are on. From hospitals and civic bodies to chemists and drug firms, everyone is readying a contingency plan in case there is a sudden surge in Covid cases.

Shuchin Bajaj, founder director, Ujala Cygnus Group of Hospitals, tells Business Standard: “The directive from the authorities to us is to activate the temporary Covid-19 beds (at jumbo facilities etc) the moment the positivity rate in Delhi-ncr (National Capital Region) crosses 1 per cent.” The Covid-19 positivity rate in Delhi is currently around 0.06 per cent.

Bajaj’s group was managing a 1,000-bed jumbo Covid-19 facility in Burari, North Delhi, during the second wave. Now, another 308 intensive care unit (ICU) beds have been added to the facility, which Bajaj claims will be the largest temporary Covid19 ICU facility in the country.

Such a huge centre also requires sufficient manpower. “Right now, around 50 beds are operational at the facility for which we have deployed nine doctors and 20 nurses,” says Bajaj. “We have the contact details of all the medical staff that worked with us last time. There is a graded action plan. The moment cases start going up, we will activate the entire facility even if it’s not required.” Bajaj says while there was a shortage of medicines, oxygen and consumables, not once did any doctor or nurse step back from the line of duty.

“Not a single one of our doctors took leave during the second wave, despite battling the disease themselves or even losing close family members,” he says.

Private hospitals are expecting that with better planning, the shortage of consumables and medical oxygen would not become an issue if a third wave hits. Dilip Jose, MD and CEO of Bengaluru-headquartered Manipal Hospitals, says the state government has asked them to be prepared, and if needed, they can activate Covid care centres outside the hospital, too.

Most states have mandated that any hospital with 50-plus beds must have an oxygen generation plant. However, these orders came in only around July-august, and many private hospitals are now working on getting these plants. Not many are yet activated though, says a senior official of a Mumbaibased hospital. “For a 100-bed hospital, it would cost ~70 lakh to ~1 crore for a full oxygen generation plant. So for smaller hospitals, this may not be viable,” adds the executive.

Some hospitals like Fortis have set up internal oxygen audit committees. Rahul Pandit, director, critical care, Fortis Hospital Mulund, Mumbai, who is also a member of the Maharashtra Covid-19 task force, says that for hospitalised patients an oxygen saturation level of 90-92 per cent is usually fine. The audit committee would thus monitor the oxygen requirement versus supplies for each of the hospitalised patients at Fortis. The hospital is planning to set up an internal oxygen generation plant.

The government is also asking other stakeholders in the healthcare ecosystem to get into serious preparation mode. For instance, the Drugs Control Department of Delhi has written to the Drug Manufacturers’ Association as well as chemists to maintain buffer stocks of essential Covid-19 medicines, especially those that are used to treat mucormycosis (black fungus) and Multisystem Inflammatory Syndrome in Children (MIS-C).

The Centre, too, has been buying critical drugs like remdesivir from pharma manufacturers and is trying to maintain a 30-day buffer inventory.

A report by the National Institute of Disaster Management (NIDM) says that in the worst case scenario, India may have peak daily of 600,000 cases — almost 50 per cent more than the second wave.

Mumbai’s civic body, however, has a contrarian view. Suresh Kakani, additional commissioner, Brihanmumbai Municipal Corporation (BMC), said last week that the third wave would not be as big as the second one, when the number of active cases in the city had crossed 90,000 around April. Kakani’s confidence comes from the high rate of vaccination in the city. “Around 73 per cent of Mumbai’s eligible population has got at least the first dose, and around 25 per cent are fully vaccinated,” Kakani said. Before the third wave hits (if it does), BMC wants to increase the single dose coverage to at least 80 per cent.

This aligns with what the NIDM report highlighted: “According to a recent study done by professors and alumni from Pandit Deendayal Energy University in collaboration with Nirma University, the vaccination rate of India is currently 3.2 per cent, which if does not improve, India can witness 600,000 cases per day in the next (third) wave.” Currently, around 7.6 per cent of India’s population is fully vaccinated, it said.

Confidence aside, Mumbai’s civic body is not taking any chances. Temporary Covid hospitals have not been shut down. Four out of the seven jumbo Covid facilities remain operational, even though they now have few patients. For instance, the 1,500bed jumbo centre at Mulund has less than five patients. And of the 30,000 beds available across these centres, a little over 500 are currently occupied.

BMC has said it can activate the remaining centres quickly, if required. It is also in talks with private hospitals for a cumulative 100,000 beds in the city for Covid-19. A civic body official says they are training their staff in the ward war rooms to handle the crises related to children, who could be hit during the third wave since this is an unvaccinated population.

The state governments, too, have worked to improve oxygen supplies at village level. Kerala is on its way to double its liquid oxygen capacity to 300 tonnes per day, while Uttar Pradesh is adding 542 new oxygen generation plants. And, Rajasthan has placed orders for 34,000 oxygen concentrators.

The Centre, too, has been buying critical drugs like remdesivir from pharma manufacturers and is trying to maintain a 30-day buffer inventory