After second wave, has India upgraded its health system for next the big challenge? Read to know

Releasing a white paper on the pandemic that warned about an impending third wave, Congress ex-president Rahul Gandhi claimed the second surge was a “misfortune foretold”.

An ICMR examine based mostly on mathematical modelling evaluation, is “foretelling” that the new variant is unlikely to trigger a brand new wave except it leads to an entire lack of immune safety from a earlier an infection.

But the crushing tenure of the second wave has created a dread.

SECOND WAVE — A TRAGEDY OR LESSON LEARNT?

The second surge arrived virtually 90 days in the past and India began gasping for some oxygen inside hospitals, on pavements outdoors medical amenities, in public transport automobiles and houses. Soon, India’s healthcare system was on its knees.

Oxygen cylinders have been stolen, oxygen tankers have been hijacked, oxygen concentrator sellers have been profiteering whilst hospitals and states did not have sufficient oxygen, ventilators or ambulances.

India’s April Covid hell introduced immense agony. Close to 20% of all official deaths reported in India due to Covid-19, occurred over the 4 weeks of April. May introduced dismay. While it’s a best-kept secret that the deaths weren’t being absolutely counted, the formally declared toll was 83,135.

Next, India ran in need of capability at crematoriums and burial grounds.

India’s “oxy-panic and distress made global headlines. The manic scramble for oxygen landed in courts, which told the central government “You can put your head in the sand like an ostrich, we will not.”

The distress created anger, which like a tsunami, dwarfed the Modi government’s popular mandate of 2019. Aware the second surge had eroded the governement’s political equity and a third could entail political calamity, the government prepared to battle the mutating pandemic and hostile opposition awaiting a political opportunity

CHALLENGES BROUGHT CHANGE

Did India change after the first two waves of the pandemic? Has adversity shaken off the seven decades of apathy towards building public health infrastructure?

Through a series of review meetings starting March, Prime Minister Narendra Modi started a status check of decisions taken on availability of oxygen, ventilators, oxygen plants and other essentials since March 2020.

PROOF OF APATHY

The last National Sample Survey (NSS) on health conducted in 2017-18 had highlighted that India’s public health matrix was poor, private health system was expensive, and good only in Metros and a large population in rural India depended on small, private and informal medical care providers.

The survey underlined that 45% of India’s rural population depended on Govt/public sector health facility, 51.9% on private facilities (hospitals, clinics and practitioners) and 2.4% on Ngos/charitable/informal health facilities.

SOURCE : NSSO

Experts said this public-private distribution changes in case of critical illness or medical emergencies like the one brought by the pandemic. Rural India has little option but to shift towards public sector health facilities due to the accessibility and affordability factors

Before the pandemic, the cost of treatment in a private health facility for rural India was 6 times higher than a government/public health facility and eight times higher in urban centres. This means the rural low-income segment can’t afford treatment in private hospitals in urban areas.

Source : NSSO

When the pandemic-hit India, many private clinics shut shop, many private facilities refused to accept Covid patients while others were too expensive for the poor, who then turned towards public hospitals

Soon the demand for oxygen, oxygen concentrators and life-saving ventilators far outstripped the availability.

Facilities at public health Centres || April 2020

For example in April 2020

India’s public health facilities run by the Centre or state govts had just 16,644 ventilators. While 16,325 were in state government-run facilities, there were only 319 in central government run centres.

Source : MoHFW

Experts feel, during the first and the second surge, nearly 65% Indians were dependent directly on public health facilities.

This figure roughly translates to nearly 87.75 crore people depending on 16,644 ventilators or simply there was an average 1 ventilator for every 52,000-odd people.

If one takes into account the entire population of the country with 16,644, India had one ventilator in public health facility for every 81,110 people

It’s important to note that the distribution of ventilators in public health system was extremely skewed.

For example Tamil Nadu’s public health system with 7 crore population had 3,495 ventilators, which translates to one ventilator every 20,000 people.

But Uttar Pradesh with over 24 crore population had only 723 ventilators in public health system. That works out to one ventilator for every 3.31 lakh people of the state in the public health system.

Worse, Bihar with 12 crore people and 380 ventilators, had one life saving machine per 3.15 lakh people.

Maharashtra, another state which has stayed at the top in terms of cases during both waves has 11.5 crore people, but in April 2020, it only had 1,456 ventilators in public hospitals. That means, one ventilator for 75,000 people.

Delhi, which witnessed perhaps one of the most visible tragic sequence of events in April-May, had only 55 ventilators in public health facilities for the state’s 2 crore population, which translates to one ventilator for 3.63 lakh people in public system.

That’s why, when the second surge crashed in and a large percentage of patients turned towards central and state-run health facilities, the system was virtually crushed.

ADVERSITY BROUGHT REMEDY

The centre had started planning, ramping up the infrastructure in March-April 2020. Shortage of medical equipment like ventilators and cylinders was identified. Three companies were short listed to manufacture India-specific ventilators.

Cut to 2021, the total number of ventilators is up to 57,557 from 16,644.

Bulk of funds for this came from the PMCares fund, criticised by the opposition.

Source: MoHFW

A large percentage of these had reached the states way back in October. However, the declining numbers of cases as the first wave created a sense of complacency. States like Punjab, Bihar and UP sat on hundreds of ventilators.

These states lacking trained personnel, facilities like piped oxygen and sheer administrative will, had to be sent reminders by union health secretary to install the equipment provided. This was happened as late as April 23 when the second surge was peaking.

But by May-end India’s ventilator availability map, as far as public sector health facilities are concerned, has improved.

If the earlier average in April 2020 was one ventilator for every 81,000 citizen, now it’s one ventilator for every 15,245 people.

Compared to 723 ventilators pre-April 2020, Uttar Pradesh now has 3,997 ventilators in public facilities, Bihar has 764 against 380 earlier and Maharashtra has 12,647 compared to 1456 in April 2020. Delhi now has 2,044 ventilators in public health system compared to 55 earlier.

While speaking to India Today TV, a senior health ministry official said: “This is bound to have an impact if there is a third wave. Since the public health system is critical, the attempt had been to beef up this infrastructure. India is now better prepared to handle critical Covid cases, which need ventilators for medical intervention.”

Kerala’s health care system has proved to be higher managed in contrast to most of the states. The Kerala expertise proves {that a} effectively outfitted public health system has potential to stand up to stress

Interestingly at the time when medical amenities in states like Delhi have been displaying “no ICU/oxygen or ventilator beds available”, Kerala’s superior main health system ensured much less stress.

That’s why kerala’s Covid First Line Treatment Centres recorded the highest occupancy price of 34% on May 8 when second surge had climbed to its highest peak throughout India. The Covid Second Line Treatment centres recorded 40% occupancy on May 8 and the peak of 41.9% on May 31.

Source: Kerala health dept

The ICU and ventilator occupancy price in public health amenities in prime 5 Kerala districts was approach greater than non-public.

For instance, in Trivandrum common ICU occupancy has been 48.59% at authorities amenities whereas it was a little bit over 15% at non-public amenities. The ventilators’ occupancy in the metropolis’s authorities amenities has been 28.57% in contrast to 16.66% in non-public sector.

Source : Kerala Health Department

Commenting on central provides of ventilators Dr. Mohammed Asheel, government director, Kerala Social safety mission, mentioned,” Kerala obtained round 500 ventilators from PMCares and sure they’ve been useful as they added to our stock of bettering our health system surge capability.”

Kerala health minister Veena George advised India Today TV, “The department of health has formulated and is implementing a surge plan as the third wave will affect children as well. Facilities in medical colleges, other government hospitals and private hospitals have been augmented. Pediatric facilities have been up and running since last Monday. Expert training has also started. In Paediatric ICU, the number of beds will also go up.”

Jaiprakash Shivhare, the health commissioner of gujarat, which now has 6,389 ventilators compared to 1,438 in April 2020 said,”The centre has labored onerous with a view to enhance the health infrastructure in the state. Numerous gear has are available in and extra is predicted.”

OXYGEN AVAILABILITY & PREPAREDNESS

The centre confronted flak from Opposition, courts and public as oxygen and machines that ship it for sick lungs, turned new gold. As cylinders want refilling and amenities that may produce giant quantities of Liquor Medical Oxygen have been situated in distant areas, the Centre eager to scale back the transportation time and improve availability, centered on creating native giant, medium and micro-oxygen era hubs.

OXYGEN GENERATION PLANTS

One of the key focus space for fast availability of oxygen in case of a disaster are PSA (Pressure Swing Adsorption) crops.

The crops are being established in hospitals to allow them to develop into self-sufficient in era of Oxygen. Under PM Cares, 162 PSA crops have been sanctioned in 2020, out of which 77 are up and working and the relaxation will probably be on stream by July ’21.

An extra 1,051 PSA Plants sanctioned beneath PM Cares Fund in March & April 21 are being procured by way of DRDO and CSIR and will probably be put in in the next three months in phases.

This means by September, there will probably be over 1,200 oxygen crops up and working with the public health amenities.

The second surge nudged states like UP, which undergo poor main health care system and a massively poor matrix of presidency hospitals, to improve its public health system by putting in extra oxygen era crops.

Source : UP Health Dept

Using funds from PMCares and different state departments, 528 oxygen crops have been cleared. Of these, in a really quick interval, 105 PSA crops have been put in and 423 crops are being arrange.

UP’s health ministry spokesperson mentioned, “Since May 5, 80,000 nigrani samitis ( surveillance committees) have carried out a door-to-door survey in the villages across the state besides the house-to-house surveillance in the urban and rural areas covering 18 crore people population. Based on the findings, UP now has 80,000 ICU and isolation beds.”

CRYOGENIC TANKERS

To future-proof the public health system in opposition to a feared third wave, the authorities went in for capability enhancement of Cryogenic tankers.

It has elevated by over 60% from 1,040 tankers (12,480 MT) in March 2020 to 1,681 tankers (23,056 MT) in May 2020.

Source https://dipp.gov.in/

Instead of stepping into for a shopping for spree, 408 present Nitrogen and Argon Tankers have been transformed into oxygen-carrying tankers to improve capability.

LIQUID MEDICAL OXYGEN AVAILABILITY

To ramp up oxygen provide for future manufacturing of Liquid Medical Oxygen (LMO), manufacturing was ramped up by greater than 10 instances from a paltry 900 MT/day in pre-Covid instances to 9,300+ MT/day (as on seventeenth May 2021). At the present price of manufacturing of 9,300 MT/day, India achieved the complete LMO manufacturing of 2019 over in May.

Prior to April 2021, majority of India’s oxygen crops situated in distant Eastern areas of India have been too far-off from the-worst hit states of west and north India.

The Railways and Indian Air Force transported Oxygen over lengthy distances and guarantee sufficient provide. Based on experiences of
April-May interval, an in depth blueprint for most oxygen transportation in minimal time is in place.

Railways have operated 245 sorties now and has a examined capability of 25 oxygen-special trains to transport 967 LMO tankers & 15,938 MT of LMO over lengthy distances by way of Roll on-roll off providers.

After conducting 557 sorties domestically, IAF has a possible to airlift 403 oxygen tankers of seven,596 MT.

In April-May, IAF additionally carried out 98 worldwide sorties by airlifting 95 cryogenic oxygen storage containers (1,693 MT); 1,252 empty 02 cylinders; 3 oxygen mills (1,331 MT); 360 oxygen concentrators. The Air Force is prepared to replicate this effort in case of a disaster linking the manufacturing hubs to consumption factors entails excessive value and transportation time. To reduce value and time, Jumbo Medical amenities are being arrange by Steel & PNG (Peteoleum and pure gasoline) sector.

Work is on to arrange 11,000 beds (8,200 by Steel firms, 2,800 by PNG firms). Numerous them have already develop into operational in crops in Gujarat, Maharashtra, & Andhra Pradesh.

To face the problem of an anticipated third wave, a matrix for diversion of business oxygen to medical oxygen, has been put in place. The use of oxygen has been restricted for medical use solely (besides for some exempted classes) & industrial producers have been receiving quick tracked permissions to produce LMO.

Ministry of Steel has dedicated the whole security inventory of 11,909MT from metal crops in case of an exigency.

To facilitate sooner motion of LMO, the Centre facilitated import of ISO tankers and conversion of LNG tankers from oil advertising and marketing firms like Indian Oil. Of the complete 418 ISO containers ordered, IOCL is arranging 208 ISO Containers.

Of these, 50 ISO Containers are being manufactured in India. Till final week 50-odd IOCL tankers/containers and 125 imported ISO containers have been deployed by non-public firms.

The tragedy that unfolded throughout India throughout April and May additionally made Centre and the state governments realise the want for dynamic mapping of oxygen provide and requirement.

Oxygen provide plan is now in place by mapping manufacturing throughout all the crops in the nation with demand based mostly on present and future instances. The centre has aligned oxygen allocation to the estimated demand for every state inline with the MoHFW components based mostly on the hospital infrastructure, together with ICU beds in every state

OXYGEN CONCENTRATORS

Compared to ventilators wanted to deal with severely impacted sufferers, oxygen concentrators have been recognized as gear that may present rapid aid to sufferers with barely aggravated signs.

The centre sanctioned procurement of 1 lakh oxygen concentrator items beneath PM Cares Fund.

India’s COVID vaccine diplomacy had generated international goodwill and 10,558 items have been obtained by India from international countires. These have been dispatched/delivered to all 36 states & UTs by 21 May.

The levies on concentrators has been lowered to deliver down the value to promote purchases by smaller health amenities and people.

OXYGEN CYLINDERS

The Covid-19 second surge additionally taught a painful lesson that India’s health care system was terribly depending on oxygen cylinders and tankers.

During April and May 2020, a whopping 1,02,400 oxygen cylinders have been procured and distributed to States to allow simpler entry of medical oxygen to finish customers. But April-May 2021 disaster underlined the inadequacy of cylinders in the nation. Orders have been positioned for extra 1,27,000 cylinders in the third week of April and deliveries of the similar will begin by the finish of April.

The procurement consists of 54,000 jumbo cylinders (D kind) in addition to 73,000 common cylinders (B kind). Of these, almost 24,000 have been distributed to States/UTs. In addition, 1.5 lakh SPO2 based mostly oxygen management system cylinders are being procured by DRDO.

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