Districts ramp up critical care facilities

MUMBAI: Though Maharashtra’s daily caseload is a quarter of what it was a month ago, 50% of the daily numbers have emerged from six districts over the past five days: Sangli, Satara, Ratnagiri, Sindhudurg, Pune and Kolhapur. Experts attribute this to a delay in the introduction of the virus and said that the administrative decision to allow activities and ramp up infrastructure for new waves of the pandemic must be taken at a district-level.

Satara, which added 848 new infections to the state’s tally of 12,207 cases on Thursday, is in the process of adding three 100bed jumbo Covid care facilities in the interiors of the district. Currently, the district has 19 Dedicated Covid Hospitals (DCH) and 89 Dedicated Covid Health Centres (DCHC) – mostly concentrated in urban areas. According to Subhash Chavan, the district’s civil surgeon, three more facilities will come up in semi-urban areas like Karad and Phaltan and the more rural area of Mhaswad. “We are focusing on creating facilities at the taluka level so that people don’t have to travel far,” said Chavan.

Critical care facilities are also in the process of being ramped up. The district currently has 4,880 beds for Covid-19 patients, including 894 regular beds, 3346 oxygen beds, 256 ventilator beds, and 384 beds with BIPAP and CPAP machines. Of these 55% are currently being used. At the height of the second wave pandemic, in April and May, the district had 100% occupancy of oxygen and ventilator beds.

Officials said that 700 beds, at least half of them with oxygen support, will come up in the existing facilities as well as in the new jumbo centres by the end of next month. Satara’s civil hospital is preparing a 20-bed Intensive Care Unit (ICU) for paediatric patients. An under-construction women’s hospital in the premises of the civil hospital is also being equipped with a 50-bed ICU and a 50-bed paediatric ward.

Given the oxygen shortage that gripped the state in April, 19 oxygen generation plants have also been commissioned in rural hospitals, civil hospital as well as jumbo facilities in the district. “We aim to get the plants ready by July end,” said Chavan adding that the setup of the oxygen plants known as Pressure Swing Adsorption (PSA) units have been ordered from a company in Bengaluru. “We have started the civil work meanwhile,” he said. Currently, the district’s oxygen supply comes from four Liquid Medical Oxygen (LMO) tanks of 20 kilolitres each and jumbo cylinders. In addition to the oxygen plants, the district is also in the process of constructing four new LMO tanks with a capacity of 13 kilolitres each.

In Sangli district, which saw 1044 cases on Thursday, district health authorities have formed teams to visit the 210-odd paediatric hospitals to set up linkages with the government. What this means is that if the government facilities fall short, patients could be shifted to these facilities. The details of these joint ventures are being worked out and it is as yet unknown if the treatment would be free or subsidised. With concerns over the possible plight of children in upcoming waves, Sangli has also formed its own district paediatric task force for guidance. “If the paediatric cases do surge in the third wave, we will have tie-ups with the major paediatric hospitals where patients can be admitted,” said Dr Sanjay Salunkhe, civil surgeon of Sangli.

“We are also procuring a few paediatric ventilators and stock of Intravenous immunoglobulin (IVIG) drug that may be required in paediatric treatment,” he added.

During the first wave in September 2020, Sangli’s highest single-day surge was 1,174 cases. In the second wave, the district’s highest single-day peak was 2,328 cases in May. “We are making preparations by estimating a 15% addition to the last peak,” said Salunkhe. Sangli is known to have a robust healthcare system with many private and charitable facilities in addition to the public hospitals. “Instead of increasing beds, we are focussing on avoiding oxygen and medicine shortfall and looking at expanding paediatric facilities,” said Salunkhe. The district has a total of 5,069 beds including 3,620 oxygen beds, 878 ICU beds, and 293 ventilator beds.

The district’s oxygen usage was about 41 metric tonnes (MT) in the first wave, and it went up to 53 MT during the second wave. As many as 12 oxygen generation plants have been commissioned in the district. At present, the district has seven LMO tanks with a capacity of six kilolitres each and nearly 300 jumbo cylinders.

Amravati in the Vidarbha region, which was one of the first districts to experience the rise in caseload during the second wave, will start a dedicated 60-bed paediatric hospital in the premises of an existing government-run super speciality hospital in the next two months.

“Overall, we will be adding 500 more hospital beds to the existing capacity of 2167 beds,” said civil surgeon Dr Shyamsunder Nikam. The 2167 beds include 675 ICU beds, 875 oxygen beds, and 139 ventilator beds. The district has ordered 100 BIPAP and 100 CPAP machines to equip normal beds with non-invasive ventilation support. In addition, construction work has begun to install oxygen generation plants at 13 locations.

“We are expecting a few [parts of the] plants to arrive this month,” said Nikam, adding that some of the plants are funded by philanthropic organisations and CSR initiatives.

While the thrust has been on creating paediatric facilities and decentralizing Covid-19 treatment -- taking it to taluka level -there is a lack of efforts in terms of creating permanent, longterm facilities. Experts also point out that setting up hospitals in tents, schools, and community halls -- makeshift facilities -- are necessary to fight the pandemic at the moment, the government has to develop a robust healthcare system. Districts that are predominantly rural are known to have weaker district hospitals. In most places, the urban population has access to private care along with public health facilities, but the rural areas remain poorly serviced. “The government’s attitude is of firefighting instead of looking for long-term solutions,” said Ravi Duggal, a health researcher and activist. “One of our oldest demands has been to convert all district hospitals into teaching hospitals so that these facilities automatically become tertiary care centres. But even today, only about four or five district hospitals in the state are teaching hospitals,” he said. Teaching hospitals require a minimum of about 500 beds, a certain number of teaching faculty, and infrastructure. “These efforts automatically create good, long-lasting tertiary care set-ups,” he said.