Lesson learnt hard, states in preparation mode for possible 3rd Covid wave

Building capacity with oxygen plants and concentrators, beds, ventilators, paediatric facilities, nurses, doctors

As India prepares for a possible third wave of the Covid-19 pandemic, states are working on a war footing to augment and upgrade health infrastructure. This time, the primary focus is on ensuring self-sufficiency in oxygen, besides creating a buffer stock of essential medicines and increasing the number of beds, especially paediatric beds.

State health officials admit that the second wave had caught India unawares, and it is time to act on the valuable lessons learnt from it the hard way.

So, Rajasthan plans to take oxygen supply to the village level through a two-pronged approach. One, by setting up over 430 new oxygen plants in government facilities, including select community health centres (CHCs). Two, by deploying oxygen concentrator machines.

The state placed orders for 34,000 oxygen concentrators and also received some from the Centre and as donation. “We now have over 40,000 oxygen concentrators: five in every primary health centre (PHC), 10 in every CHC, and the rest in governm­ent hospitals,” says Rajasthan Health Sec­retary Siddharth Mahajan. Rajasthan has around 700 CHCs and over 2,100 PHCs.

Oxygen concentrator banks are also being created in every district, he adds. People can get oxygen concentrators from the state government against a prescription on paying small caution money. This would help to treat people at home and reduce the load on hospitals. Private hospitals, too, have been asked to ramp up oxygen infrastructure.

“All private hospitals with 60 beds and more will need to have their own oxygen generation plants. The others will need to have oxygen concentrators for at least 30 per cent of their bed capacity,” Mahajan says. Uttar Pradesh, too, has mandated private hospitals to have emergency oxygen backup, and those with 50-plus beds to set up oxygen generation plants for captive use.

Tamil Nadu, where oxygen requirement had gone up to 470 tonnes during the peak of the second wave, has increased its storage tank capacity to 1,100 tonnes. “We will increase it further to 2,500 tonnes,” says Tamil Nadu Health Secretary J Radhakrishnan.

Kerala, Gujarat and West Bengal, too, are ramping up capacity. Kerala is increasing its liquid medical oxygen capacity from 149 tonnes to 300 tonnes per day; UP is adding 542 new oxygen generation plants across 75 districts; West Bengal is adding 10 pressure swing absorption (PSA) oxygen plants; and Gujarat plans to install 300 PSA oxygen plants. Maharashtra, too, intends to more than double its oxygen production from 1,200 tonnes to 3,000 tonnes by the end of July.

Most states are targeting to have these plants up and running by next month.

Focus on children

Enhancing paediatric Covid-19 infrastructure is also a key area of attention. This will include ramping up paediatric wards and intensive care units, besides procuring paediatric medicines.

For the safety of children, West Bengal has decided to vaccinate women with children under 12 years on priority.

Tamil Nadu is lining up 175,000 more beds, with a minimum of 100 beds in every district. Of these, 50 per cent will be for paediatric use. During the second, only around 4 per cent of those infected in Tamil Nadu were children. Kerala, too, is scaling up paediatric facilities and training paediatricians.

West Bengal and UP are increasing capacity in the paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). PICU is for children over one-month-old, while NICU attends to children below one month. So far, 3,500 PICUs and 1,800 isolation beds have been set up in UP, while more than 2,900 isolation beds have been prepared in private hospitals for severely infected children.

Gujarat, meanwhile, has an ambitious plan of adding 600 new Covid-19 facilities to the existing 1,800. State health officials say oxygen and ICU beds are being doubled from 61,000 to 110,000 and 15,000 to 30,000, respectively. The number of ventilators is also being increased from 7,000 to 15,000, according to health dep­art­ment sources. Gujarat estimates a daily case count of 25,000 and over 250,000 active cases during the third wave — which is much higher than the 1,400 daily maximum cases (150,000 active cases) it saw during the second wave.

In Delhi, the Aam Aadmi Party plans to increase the Covid beds from 28,000 to 37,000. “We are preparing more this time. For oxygen, many oxygen PSA and storage plants have been set up,” Delhi Health Minister Satyendra Jain said.

Medicines and nurses

Keeping a buffer stock of basic medicines is also critical. Mahajan says Rajasthan distributed 1.8 million medicine packets (with basic drugs such as paracetamol, antibiotics and vitamins) in a door-to-door campaign during the second wave. The state has issued orders to procure more medicines and create a buffer stock. “While remdesivir and tocilizumab are highlighted, the demand for common medicines like paracetamol and antibiotics is much more,” Mahajan says.

The state has also almost finished rec­ruiting 26,000 temporary nurses for Covid care who would be deployed for outreach campaigns and in PHCs that have staff shortage. Around 1,000 doctors, too, are being recruited for short-term service.

Besides creating infrastructure, recruiting and training manpower, all states have one common focus: to increase vaccination coverage. Fully vaccinated people are less likely to fall severely ill and end up in hospital.

Meanwhile, Delhi has opened a genome sequencing facility at the Institute of Liver and Biliary Services and a similar laboratory in its biggest Covid hospital – Lok Nayak Jai Prakash Narayan (LNJP) Hospital. The Delhi government hopes to reduce its dependency on the National Centre for Disease Control and other central government agencies for genome sequencing for identifying variants.

With inputs from Sohini Das, Shine Jacob, Vinay Umarji, Ruchika Chitravanshi, Virendra Singh Rawat and Ishita Ayan Dutt