Maharashtra preps to turn the next Covid-19 tide

Caught unawares during the second wave of Covid-19, leading to shortage of beds, oxygen and drugs, the state has started implementing a plan in anticipation of the third wave in August-September – augmentation of health infrastructure, reserving beds for children, launching Mission oxygen and vaccinating 60 million people in three months

Caught unawares during the second wave of Covid-19, leading to shortage of beds, oxygen and drugs, the state has started implementing a plan in anticipation of the third wave in August-September – augmentation of health infrastructure, reserving beds for children, launching Mission oxygen and vaccinating 60 million people in three months.

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As Covid cases started to rise in Amravati in Vidarbha early February, the administration failed to see it as a sign of a second wave and take quick steps. It resulted in daily caseload shooting up to more than 60,000 in April, from less than 3,000 in January. The sudden surge resulted in shortage of beds, acute shortfall of oxygen as well as anti-viral drugs. Although the situation did not worsen much, the health infrastructure was stretched beyond limit. On April 22, the number of active patients was highest at 699,858 which resulted in patients outnumbering the available beds in Mumbai, Pune and Nagpur. The oxygen demand, too, went up rapidly, along with shortage of anti-viral drug Remdesivir, leading to panic.

The state learnt its lessons and is now using them to prepare for a potential third wave, say officials.

HEALTH INFRA

The total number of beds in the state has now gone up to 495,190 as of June 10, against around 80,000 in March 2020. A majority of them are in make-shift jumbo Covid centres. “We were struggling to accommodate patients in areas outside Mumbai as the health facilities did not have enough beds. Taking a cue from jumbo Covid centres in Mumbai, we have asked local authorities to set up temporary hospitals in case of a surge,” said another health department official.

The other problem, as pointed out by chief minister Uddhav Thackeray at the beginning of the second wave, was shortage of trained medical staff to handle facilities. “We can increase beds overnight, but how can we get doctors in a short span of time,” Thackeray had remarked while stressing the need for a lockdown to control the spread.

The administration now plans to recruit 16,000 medical staff, including doctors, paramedics and supporting staff. Public health minister Rajesh Tope said on Tuesday the recruitment process will be completed on an urgent basis. Orders were issued early this week to begin the process to recruit first batch of 2,226.

Medical education minister Amit Deshmukh said the government has also approved six more medical colleges in different districts in addition to medical colleges in 18 districts to strengthen public infrastructure. State-owned medical colleges come with public hospitals. “We are also planning public-private policy,” he added.

MISSION OXYGEN

Although the state did not witness tragic incidents, it barely managed to tide over the demand for oxygen with help from the Centre and private sector. “Against the daily production of 1,250 metric tons (MT), the demand had gone up to more than 1,600 MT at one point in May. The administration was put on high alert. Mantralaya war room saw heightened activity, as officials struggled to meet the demand. A special task force was constituted to look after oxygen supply. We did not want to lose any life due to shortage of the oxygen. The situation was taken seriously by the political leadership and a plan was chalked out to increase the production and take it to 3000 MT daily under Mission Oxygen,” said a top official from state’s public health department.

The government has now begun implementing Mission Oxygen drive to generate 3,000 metric tonnes of oxygen over the next two years, from the current generation of around 1,300 MT. Besides the targeted generation of 517.9 MT from the 487 PSA (Pressure Swing Absorption) oxygen generation plants at district levels, 56 have already been installed and the generation of 69.37MT has already started. The daily oxygen generation capacity of these plants varies from 0.5 to 5MT and cost ₹20 lakh and above.

Similarly, the state is planning Air Separation Units (ASUs), which take some time for installation. It is also eyeing to utilise the existing capacity of 600MT of generation plants in gaseous form, by providing compression and bottling facilities to them. This would help the government to take the generation to 2,300 MT in six months, said an official.

The state has announced sops for the private industries to materialise the Mission Oxygen Swavalamban which is expected to cost ₹1,100 crore. Private players investing in oxygen generation plants or the existing manufacturers going for expansion of the existing ones will get a waiver on duties and taxes including GST, stamp duty, electricity among others.

PAEDIATRIC COVID MANAGEMENT

Experts have expressed the fear that children may be the worst-hit during the third wave. Maharashtra was among the first few states to constitute a paediatric task force of expert doctors under Dr Suhas Prabhu. Chief minister Uddhav Thackeray has had a couple of meetings. The task force has submitted its draft action plan for the third wave.

The state has directed all district hospitals to reserve 10% of the beds for kids. They have also been asked to identify hospitals equipped to treat multisystem inflammatory syndrome in children and ensure adequate number of beds at all dedicated Covid hospitals. “The task force has submitted a draft of the action plan. The districts have been asked to prepare bed infrastructure to take up the patients equal to the highest number of active cases in tehsil or district during the second wave. At least 25% of the beds in Covid Care Centers need to be equipped with oxygen supply, while every dedicated Covid health centre needs 10% of their beds equipped with ventilator. Training doctors and paramedics will be undertaken with special focus on paediatric management,” said an official from the health department.

“The districts have been directed to conduct ‘My Kids, My Responsibility’ campaign for awareness among parents and teachers. Besides, training physicians and public health care staff in paediatric management, we have told the authorities to train teachers in schools to screen children for early warning signs,” another official said.

“We have prepared for the new wave with focus on paediatric health services,” Tope said.

Vaccination

With more than 25 million doses administered, Maharashtra tops in the country in inoculation. State officials said they have set up 9,000 vaccination centres and ramped up the capacity to vaccinate 1 million a day. “If we get adequate supply of vaccine, we would be able to vaccinate 60 million people in three months which will effectively help us contain the spread of the epidemic,” said another official. The state has been complaining continuously about the short supply of doses. The state has received 22 million doses from the Centre, while it procured 2.5 million on its own.

THE CHALLENGES

“Plasma therapy worked in first wave, while Remdesivir was buzzword in the second wave, both appear to be outdated now. We never expected the emergence of black fungus which has proven very dangerous in the second wave. Nobody knows what is there in store during the next wave,” the official said.

He said they have decided to continue with aggressive testing for at least three months, using newer methods such as portable testing kits. “The monitoring of suspected patients through initiatives like ‘My Family, My Responsibility’ will be relaunched. Also, initiatives like ‘Covid-19 Free Village’ will be encouraged,” he said.

“Maharashtra has shown the way not only for the country but for the world. We are all ready to take up the challenge. The number of beds has been increased by 500% over the past 15 months,” Deshmukh said.

Dr Avinash Bhondve, Maharashtra president of the Indian Medical Association, said, “The state has been talking about preparation for the wave, but everything is on paper. The PSA plants are not feasible in small and medium hospitals due to space constraint. The government has not been able to install large size oxygen plants or increase the number of beds in expected numbers,” he said.

Dr Lancelot Pinto, an epidemiologist from Hinduja Hospital, said, “Besides preparations, people and healthcare machinery should not lower their guard.”