5-point plan to tackle worst case
16.5 million PPE and drafting medical students part of government’s worst-case plan
NEW DELHI: India has ordered 107 million tablets of hydroxychloroquine, 16.6 million units of personal protective equipment (PPE), and 48,000 ventilators, and hopes to have everything in place by May 31 — the deadline for scaling up health infrastructure to fight Covid-19, which has infected 5,305 people in the country, and killed 160.
The plan also includes enhanced testing — peaking at 100,000 a day — and drafting final year students of medicine and nursing. Some parts of this plan were already known, but HT spoke to health ministry and other officials to capture granular details of what the government thinks India needs. They described this as a plan that prepares for the worst case scenario, which India may not actually face.
There’s a caveat, especially on the equipment front. A country can count international orders in its stockpile only when it gets them in hand in these times, said a consultant with a multinational consulting firm. And while “some of the ventilators being turned out are very good, at least some are being made by companies that do not have much experience in this”, he added. Still, even internationally, companies such as Ford Motor and GM that have no experience are working on a war footing to produce ventilators.
The health ministry’s plan has five components.
PEOPLE
India has about 70,000 students in the final year of their MBBS course; about 250,000 final year nursing students; 30,000 in final year dentistry, about 1.8 million registered Ayush (ayurveda, siddha, naturopathy, unani, and homeopathy — all alternative systems of medicine) practitioners and allied health professionals such as paramedics, technicians and helpers, and an estimated 10,000 physiotherapists. The idea is to involve all of them.
The fight against Covid-19 also requires feet on the ground to screen people, and monitor others in quarantine. The field surveillance will be done Ayush students, volunteers from National Service Scheme, Nehru Yuva Kendra Sangathan, Indian Red Cross Society, National Cadet Corps, workers of state-owned firms, ambulance drivers, gram panchayats, urban local bodies and rozgar sevaks (workers under MGNREGA in villages), according to the plan, parts of which were reviewed by HT.
“People with medical knowledge can be used for screening , while others can be used for surveillance, which is the mainstay of our Covid-19 management strategy,” a senior health ministry official said on condition of anonymity. The states will be involving this workforce as per their requirement.
“It’s an excellent idea to list out possible volunteers beforehand because you don’t know which way this pandemic will go,” said K Sujatha Rao, former health secretary.
The plan is to also use medical interns and final year MBBS and nursing students, alongside doctors and other medical staff drawn from the defence forces, the paramilitary and the railways at isolation facilities (hospitals). “If the numbers rise, every single medical professional and student will count,” the official added.
“Any knowledge workforce is useful in a situation like this, so involving medical students will definitely help. There is a section of doctors trained in intensive care, and post graduate students of fields like anesthesia who can come in handy at this time,” said Dr Devi Prasad Shetty, senior cardiac surgeon, and chairman and founder, Narayana Health.
Meanwhile, retired doctors, as well as health care staff above the age of 60 or with known medical conditions will be used to treat non-Covid patients.
TESTING
Since January 24, government and private laboratories approved by the Indian Council of Medical Research (ICMR) have tested only around 109,536 samples for Covid-19. The plan is to take this up to 100,000 a day (the current daily total is 9,000-11,000).
“One lakh tests a day is the worst case scenario; it may or may not be required, but we should be able to perform these many tests, if it’s required, and which is what our labs are staying prepared for.” said an ICMR spokesperson.
ICMR has approved at least 200 labs (both public and private) for testing through RT-PCR machines and is in the process of identifying other government and private labs, research institutions and medical colleges that have the capability and infrastructure to undertake testing for inclusion into the Covid-19 testing network.
The plan also envisages the laboratories working 24x7 and re-deploying automated and manual RT-PCR machines already in the country, and optimising in-lab processes.
ICMR is also procuring 500,000 rapid testing (blood test) kits for mass testing, to be deployed in the worst-affected states. The first lot of these kits, which test for antibodies, is expected this week. However, it is not yet open for everyone, and has been allowed only in large clusters, evacuation centres and migrant worker camps. Experts say a more widespread use of the antibody test will help scale up testing. “The currently used test – PCR tells us who are currently sick. We are seeing only the tip of the iceberg. The antibody detection blood test will identify even those with mild or no symptoms. It will help us to know how many have been able to fight off the infection and have become what is called ‘corona-blocker’,” says Dr Lalit Kant, a senior infectious disease expert.
HOSPITALS
The Centre Monday released close to ₹3,000 crore under its National Health Mission (NHM) to be distributed among states and UTs. Earlier, about ₹1,100 crore was released for the purpose of Covid-19 management. All states and Union territories have been asked to earmark at least one hospital dedicated to Covid-19 patients. The states have also been given a free hand to procure ventilators, PPE, masks, gloves and other kits.
Some states have been temporarily taken over small private hospitals in badly affected districts to be used as dedicated isolation facilities. “All states have followed the directive, and have been creating dedicated Covid-19 facilities till district level. These hospitals will only be used to manage positive cases, and we are working with states to ensure all these hospitals are equipped to handle critical patients such as intensive care unit beds and beds with ventilators,” said Lav Agarwal, joint secretary, ministry of health.
DRUGS, PPE
The problem area in terms of medicines is the anti-malaria drug (hydroxychloroquine) that has shown promise in treatment of the disease. Hydroxychloroquine (HCQ) is currently being given to health care workers, and close contacts (family) of Covid-19 patients as part of a demonstration study by ICMR. And Covid-19 patients in ICUs are being given this medicine along with antibiotic erythromycin . There are about 1.5 million health care workers who have received around 7.5 million HCQ tablets.
To meet the shortage of supply, the government has restricted the drug’s export currently and also booked supplies from the two manufactures in India. “We have booked all their supplies- about 107 million tablets, and once they supply this to the government then they are free to export,” said a government official familiar with the matter. The health ministry has ordered 8 million PPEs from Singapore, and is expecting to receive at least one million per week. In all, it has ordered 16.5 million PPEs from global and local firms. The ministry has also placed an order for 48,000 ventilators and is likely to add more.
INNOVATIONS
The department of science and technology has set up a Centre for Augmenting WAR with Covid-19 health crisis (CAWACH) at a total cost of Rs 56 Cr to scout for, evaluate and support the innovations and start-ups. The Society for Innovation and Entrepreneurship (SINE), a technology business incubator at IIT Bombay supported by DST has been identified as the Implementing Agency of the CAWACH.
CAWACH aims to identify up to 50 innovations and start-ups that are in the area of novel, low cost, safe and effective ventilators, respiratory aids, protective gear, novel solutions for sanitizers, disinfectants, diagnostics, therapeutics, informatics and any effective interventions
“We have been having meetings every day and have come up with strategies to prioritise our research work,” says Dr Renu Swarup, secretary, department of biotechnology.