Mission impossible: 163 Covid ambulances, 3,000 patients to transport
Data available with the government and comments by district-level officials showed the new protocol is virtually impossible to follow in the national capital, where roughly 3,000 new cases have been found every day since Friday.Updated: Jun 24, 2020 01:20 IST
The guidelines announced this week requiring each new Covid-19 patient to be brought at least once to a government facility to undergo assessment presents itself with a logistical challenge that health staff say is impossible to meet: each of the city’s 163 dedicated Covid ambulances will need to carry out an average of 18 trips in 24 hours to ferry these people to the facilities.
The challenge becomes tougher if the mandatory sanitization process – which takes roughly two hours after every trip – is taken into account, and the ambulances are also made to ferry at least some of these infected people back to their residence if they are assessed to be fit for home isolation.
Data available with the government and comments by district-level officials showed the new protocol is virtually impossible to follow in the national capital, where roughly 3,000 new cases have been found every day since Friday – the day authorities abandoned a procedure by which these assessments were done by teams that visited the patients at their homes.
Many local level officials say they simply are unable to put the new protocol into place.
“Currently, around 3,000 people on an average are testing Covid positive in Delhi per day through swab tests. If they have to be taken to CCCs, the government will have to arrange 3,000 trips of ambulances in addition to the distress calls that they are presently catering to. This seems impossible at this juncture. So, we have no alternatives but to continue with the old method for now until further orders are received,” said a district magistrate who asked not to be named.
Of the 11 districts, HT reached out officials from seven. At least two others confirmed that they too have not been able to switch to the new protocol, while the rest said that they had but were unsure of how long they will be able to.
As per government data, the state government through its Centralised Accident and Trauma Services (CATS) runs about 200 ambulances. Another 170 have been added through contracts with private companies and the Army. In all, 163 are ferrying patients from home to hospital, between hospitals, and take people who do not have personal vehicles to testing centres.
The government has asked the Delhi Police to provide PCR vans and has reached out to four private firms in its bid to augment its ambulance fleet to up to 1,000.
“On an average, each ambulance can attend a maximum seven distress calls a day. And currently, the CATS ambulances are operating almost at full capacity,” said a government official who asked not to be named.
The logistical challenge in moving these patients to a Covid Care Centre (CCC) is matched by a question of human resources at these facilities,
“Creating more Covid Care Centres is, in fact, easier than solving two other problems of manpower shortage and transportation. A 10,200 bed Covid Care Centre is currently being readied in south Delhi for this purpose. Other CCC are also being prepared. But, it is still unclear where the government can find staff to deploy there from,” said a senior official in North East district.
For patients with mild to moderate symptoms – those who are likely to be admitted to the makeshift CCCs – the government will need at least one doctor for every 10 to 12 beds and one nurse for every five to eight beds, in line with the staffing norms followed in the city’s Covid-19 hospitals.
“Now if we admit milder cases and also start getting asymptomatic patients, the requirement of medical staff will increase further. More screening counters will also have to be set up at every for clinical examination — which essentially includes checking the temperature, pulse, and oxygen levels apart from any visible symptoms. Besides, the need for support staff such as housekeeping, plumber, electrician and food will also go up,” the official said.
Deputy chief minister Manish Sisodia on Tuesday wrote to the L-G, seeking a rollback of the latest protocol.
“More than 3,000 patients are testing positive for Covid-19 every day and if they are made to stand in queues outside quarantine centres, they run the risk of infecting even more people around them. This (the new rule) has also added to the already overburdened ambulance services. Should the ambulance take critical Covid-19 patients to the hospital or should the ambulance take asymptomatic patients to the quarantine centres for a checkup?” Sisodia said at a press conference on Tuesday.
Jugal Kishore, head of the community medicine department in Safdarjung Hospital, said: “Taking large number of people to Covid care centres for assessment has its own problems. It increases the exposure risk for healthcare workers, attendants who accompany the patients in an ambulance and the ambulance driver among others. One case can multiply into three in no time. So, sending an equipped team to the residence of the patient is logistically better as an option.”