How Capital is preparing for probable Covid 3rd wave

Addressing a digital press conference on Saturday, Chief Minister Arvind Kejriwal said that the Delhi government has made several preparations well in advance for a possible third wave of Covid-19 in Delhi. The CM chaired two meetings on Friday with the Expert and the Preparations Committees, and made several decisions to mitigate the impact of the third wave.

Kejriwal said, “Experts are saying that a third wave is bound to emerge, but nobody has any information on when such a wave will arrive and how dangerous it could be. It is our duty to be prepared so that if a third wave does arrive and turns out to be extremely dangerous, the government should be prepared. The preparations for this are under full swing in the Delhi government and yesterday (on Friday), I chaired two different meetings with experts as well as officers who were working during the coronavirus situation. We have formulated two committees and carried out detailed discussions with them.”

He said, “This time, the coronavirus peak saw a maximum of 28,000 cases in a single day, which was around April 22 or 23. Based on this figure, we estimated how high the next peak might be. After our discussions, it was concluded that we should prepare for a peak of 37,000 cases per day. This however, does not mean that if the peak goes beyond this figure, we will not be prepared. We are ready for even that, but if you are prepared on a base of 37,000 Corona cases, then even if we cross the limit, we will be prepared for it. Thus, all calculations are being made as to how many beds will be needed, how many ICU beds will be needed, how many will be needed for children, how much oxygen will be needed, how many medicines will be required.”

He added, “A separate pediatric task force has been created, which will decide how many oxygen beds will have to be reserved for children and how many ICU beds are to be reserved for them. For children, different types of equipment will be required, different masks, different oxygen masks. The pediatric task force formed yesterday (on Friday) will give its recommendations separately.”

The CM said, “This time there was a huge shortage of oxygen due to which we did not get oxygen beds. Ultimately after the intervention of the Supreme Court and with the support of the central government, we did get oxygen. We don’t want to face such a situation should another wave arrive. Therefore, preparations have been made – a storage capacity of 420 tons of oxygen is being readied. We’ve had talks with Indraprastha Gas Limited and they have been asked to prepare a 1.5 tonne oxygen production plant, for which they have said that it will take 18 months.”

He added, “We also faced a shortage of oxygen tankers. Since Delhi is not an industrial state, we don’t have oxygen tanks. Therefore, 25 oxygen tankers are being bought so that if we face a problem then we have our oxygen tankers. Sixty four small oxygen plants are being installed, and we hope this will be completed in another 1-2 months.”

He said, “Now that we have decided 37,000 as the peak, then the number of oxygen beds, ICU beds will be decided accordingly and based on that it will be decided as to how many oxygen cylinders will be needed. For example, we imported 6,000 cylinders from China recently so how many more oxygen cylinders and oxygen concentrators will be needed will be decided. In the next 1-2 months,  the Delhi government is going to buy a lot of oxygen concentrators.”

He also said, “Two important decisions have been taken with regard to medicines. Firstly, it was seen that a lot of medicines were being prescribed on WhatsApp and once these medicines were being circulated as being effective then it became chaos across. So, a team of doctors and experts will be set up. If there is a demand for a particular medicine, then the doctors will examine and inform whether a particular medicine will be beneficial in treating coronavirus or not. If the doctors approve, the government will try to commission that medicine and if the doctors say that the medicine is not necessary and that the people should stop running after that medicine then the public will be made aware of it.”

The CM said, “A list has been prepared for all important medicines, and a buffer stock will be created for those medicines. Keeping in mind the expiry date of medicines, a buffer stock is being created, and even private hospitals have been directed to do so, so that if the pandemic returns, then we are prepared for it. Apart from this, genome sequencing labs are being created in LNJP hospital and ILBS so that we also know about the variant that comes to Delhi – whether it is an old one or a new variant has emerged and then we can ask experts as to what precautions we need to take. I want to assure you that your government is working 24 hours to mitigate the situation. I hope that the third wave does not come, and we will try to vaccinate our people before that, but if the third wave does emerge, then the people should not face any difficulty."

Decisions with regards to human resource & beds escalation

1. During the last few months, the Delhi government has made consistent efforts to increase Delhi’s bed capacity by increasing ICU beds in GNCTD Hospitals from 1,830 (in April 2021) to 3,100 (June 2021) and Covid beds from 5,221 to 7,978. It has also created new CHCs in partnership with several non-government organisations (NGOs).
2. The Delhi government has increased the manpower in its hospitals by about 20% in recent months by engaging 610 doctors, 628 nurses, and 162 paramedics.
3. While the positivity rate and overall active cases have substantially declined, the government will continue its pursuit. While this wave had a surge of 28,400 daily new cases, a capacity in Delhi will be created to deal with an even higher wave. The aim is to create 36,900 Covid beds in hospitals and CHCs. These will be apart from those at CCCs.
4. During the earlier waves, the Delhi government hospitals provided hospital care to about 20% of the total patients. To manage the third wave of Covid-19, the mitigation capacity will be doubled by adding about 12,000 beds. The focus will be on oxygen and ICU beds. The Delhi government will seek partnerships with the central government, private sector, faith organisations, and NGOs in this regard.
5. The government will start preparations in advance by improving the civil infrastructure and creating oxygen pipelines, LMO tanks, and O2 points. Vendors will be impaneled for the same.
6. For nurses and doctors, the Delhi government is extending their contract engagements by 6 months, i.e., up to December 31, 2021. To take care of staff shortage in hospitals, the government will strengthen sanctioned strength in these hospitals, and link these hospitals with our teaching hospitals (LNJP, GTB, etc.) for providing teaching experience and creating adjunct faculty.
7. To improve the availability of doctors in all hospitals, the Delhi government will introduce an internship of one year for graduating PG students in Delhi hospitals so that they can immediately start working as SRs and also gain useful functional experience.
8. The Delhi government will undertake capacity building programs in a huge way. The government will aim to train all their non-ICU medical personnel in oxygen therapy, ICU management, paediatrics healthcare, Covid care activities, etc., by developing about 500 master trainers in these critical areas and implement customised training programs for over 3,000 non-ICU doctors, nurses and paramedics. MBBS and BDS students will be oriented for tele-consultation and non-clinical activities.
9. A graded Escalation Plan has been formulated for increasing the mitigation capacity of Covid-19. Based on these, activation/ repurposing of (1) beds, wards, other infrastructure, (2) supply of consumables/equipment, (3) stopping optional surgeries, and (4) diverting resources of/to other departments will be undertaken.
10. The Delhi government will also review the PPE kit design to make it more comfortable and lighter while ensuring full security.
11. Keeping in mind the mutating virus, a genome sequencing lab will be made functional in Lok Nayak hospital in 2-3 months’ time.

Oxygen augmentation

1. Top Delhi government officials have been engaging with Professor Sanjay Dhir from IIT-Delhi who had submitted his report pertaining to oxygen management in Delhi in three varied scenarios. Prof Maninder Agarwal from IIT-Kanpur who came up with the Sutra Model, which provides mathematical projection for covid spread in the country has also been a regular guest member in the expert committee meetings.
2. The buffer LMO storage capacity will be enhanced by 421 MT, and the LMO storage of Delhi will be increased to have at least one day buffer of the peak oxygen demand of Delhi.
3. The Delhi government will also issue an order to ensure mandatory LMO storage in all hospitals linked with bed capacity benchmarks. Every storage tank will be fixed with telemetry equipment to track the oxygen levels on a real-time basis.
4. Around 25 tankers of 350 MT will be procured by the health department to ensure timely picking up of LMO from the manufacturing sources and for inter-city distribution.
5. The Delhi government will also ensure the generation of 150 MT of oxygen and refilling of 2,000 cylinders. An adequate number of cylinders should be procured to ensure that sufficient quantity is available in case of crisis and bed escalation.
6. To prevent hoarding, cylinders will be live-tracked with the help of QR Code tracking

Decisions on Covid-19 treatment-related drugs

1. It was decided to create a reasonable buffer stock of required medicine for Covid-19 treatment in all government hospitals to handle the Covid-19 surge, if any, efficiently.
2. An advisory will be issued to all private hospitals to make necessary arrangements for a seamless supply of all required medicine to treat Covid-19 patients.
3. A team of senior doctors/specialists under DGHS to be created for effective IEC and multi-modal awareness campaign to educate the public about judicious use of drugs, and pros and cons of new drugs like Remdesivir, Tocilizumab, Monoclonal Antibody, etc., to prevent indiscriminate use, over-prescription, etc.
4. A detailed SOP will be prepared for Covid drug administration and IEC material indicating advantages and disadvantages and usage guidelines for any special drugs such as Remdesivir, tocilizumab, etc.
5. The Delhi government will request the IMA, DMA and the medical fraternity to educate the general public regarding the use of drugs and advisories to the doctors while prescribing any medicine and avoiding panic buying through electronic media/social media.
6. Some standard guidelines and general instructions shall be followed by all hospitals in line with ICMR guidelines and circulated to the hospitals, and advertised among the public for their knowledge and understanding. The Delhi government will speak to DGHS in this regard.
7. Procurement will be done after assessing the required quantity for both adult and pediatric patients by the government hospitals so that there is no shortage of medicine for both hospitalised cases as well as home isolation cases.
8. It has also been decided to create stock in hospitals and a buffer considering the expected period of the next wave of Covid-19 cases keeping in mind that Delhi government hospitals have to cater to about 25-35% of the total Corona cases in Delhi.

Vaccination campaign

In a focused approach to ensure universal vaccination of citizens of Delhi in the 45 and above age segment, the state will adopt a polling booth wise approach. The field level team, composed of BLOs and CDVs would go from house to house booth wise and find out the vaccination status of those eligible for vaccination. The leftover eligible beneficiaries willing to get vaccinated will be registered on the Co-WIN portal and told about the vaccination facility being made available in their polling booth near their home. Those who are hesitant or not eligible at the moment for vaccination shall be counseled.

The Delhi government will also make arrangements in the form of Near To Home Covid Vaccination Centers (NHCVC) in the polling booths. This is to ensure that all beneficiaries above 45 years of age are reached and vaccination made accessible to them near their home. All assembly constituencies shall be covered in a phased manner in the next few weeks.