On Sunday, Union Home Minister Amit Shah, after a meeting with Delhi Chief Minister Arvind Kejriwal, declared that 500 Covid isolation coaches would be deployed in Delhi. So far, over 5,000 coaches have been converted into Covid isolation coaches across India.
What are these coaches?
In March, Railways was sounded out by the PMO and the government’s multi-ministerial outbreak-containment apparatus that train coaches could also be used as a last resort to keep isolated patients. Officials later claimed the idea first came from Prime Minister Narendra Modi.
So far, 5,321 non-AC sleeper class coaches of ICF variety (older design) have been converted by the 16 zonal railways through their workshops spread across India. These are developed as COVID Care Level 1 centres—as per the Health Ministry classification of COVID facilities—where suspected cases or those with mild symptoms are to be kept. Suspected and confirmed cases will be kept in separate coaches.
Besides the 500 being deployed in Delhi, Telangana has requested for 60 coaches in three locations, and UP has requested in 24 locations. Many states are said to be informally enquiring about the coaches in zones.
How were these coaches selected?
Early into the pandemic, health experts were of the view that air-conditioned environments might aid the spread of the virus. Well-ventilated, airy environments were thought to be safer. India’s decision to use non-AC coaches for islation has to be viewed in that context.
As per targets given to the 16 zonal railways, 5,000 older coaches, surplus to Railways’ operational needs, were marked for conversion. With each carrying 16 patients, this translates into 80,000 isolation/quarantine beds. Railways said it has set aside 20,000 coaches and if needed, more conversions can be done.
How were they converted?
Each sleeper coach is divided into eight bays or “cabins”. The idea was to remove the middle berths so that each bay carries two patients on the lower berths — a capacity of 16 per coach. Two of the four toilets were converted into bathrooms. The windows were covered with mosquito nets. Power plug sockets were installed for medical equipment in each bay. And plastic curtains were installed in every cabin. Each coach also has oxygen cylinders. Each coach has been converted at a cost around Rs 2 lakh. So the 5,321 coaches have been converted at over Rs 100 crore.
What were the challenges faced?
The summer heat in the coach was always a matter of discussion, not only in Railways but also in the Empowered Group of Secretaries based on whose inputs the coaches were converted.
Several ideas were discussed, including erecting shamianas over the coaches, or painting the roof with “solar reflective” paints. Finally, it was decided the roof would be insulated in a number of coaches. The technical solution was vetted by the Research Designs and Standards Organisation of Railways. A solution has been developed by IIT Mumbai which brings down the temperature in the coach by several degrees. Railways has attached an AC coach as well, for doctors and medical staff.
Another question was how to dispose of toilet waste if the coaches were in remote areas and whether such waste was potentially infectious. It was agreed that since chlorine tablets are placed in the chambers of the biotoilets, the risk was neutralised. In any case, bio-enzymes in the toilet tanks take care of the human waste.
Another question was placement. The batteries of the coaches need to be charged and the water needs to be replenished. Not all areas in India might have such facilities. After discussions with the Health Ministry, 215 stations were identified across India. The idea was that being mobile units, they could be dispatched to any part of the country to pick up patients and come back to their bases.
Of the 215 stations, Railways would provide their own healthcare professionals for patients in 85. In the other 130, states would have to arrange doctors and medical staff, as per a protocol issued by the Health Ministry. Each isolation train will be tied to the nearest hospital.
The Ministry of Environment and Forest and Climate Change has provided a one-time exemption from registration of train coaches for the purpose of generating hospital waste. The state is supposed to dispose waste. Railways will maintain the coaches, provide linen and may provide food also, depending on feasibility, if requested by states.
Will these be upgraded further?
NITI Aayog in early May proposed that instead of mere COVID Care Level 1 centres, some of these coaches should be upgraded to hospitals, with oxygen, ICU and ventilator facilities. It was also suggested that Railways could take help from private hospitals for the upgrade. In a meeting with Railways, NITI Member V K Paul, who is also the head of the relevant Empowered Committee, suggested that the coaches be upgraded to Level II and III COVID Care Centres. Railways discussed internally that such a task would require months. One rake of Lifeline Express, which is “hospital on wheels” with all medical facilities, takes months to roll out.
In Europe, governments have used trains to transport patients to other regions. In March, France used its TGV high speed trains to move patients out of Paris to other parts of the country where hospital capacity was yet unutilised. Spain also readied high-speed trains to carry patients to Madrid from other parts of the country where hospital facilities could be overwhelmed. Italy has now created similar hospitals on wheels as a defence against a second Covid wave.
This article first appeared in the print edition on June 17, 2020 under the title ‘The making of Covid isolation coaches’.
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