Oxygen, ventilators, testing: Central teams flag gaps in key surge states

India’s active Covid-19 caseload reached 11,08,087 on Sunday, the highest ever. “The five states of Maharashtra, Chhattisgarh, Karnataka, Uttar Pradesh, and Kerala cumulatively account for 70.82% of India’s total active cases. Maharashtra alone accounts for 48.57% of the total active caseload of the country,” the Health Ministry said.

Daily deaths continue to show an upward trend: 839 deaths were reported in the last 24 hours; 309 of them in Maharashtra; followed by 123 in Chhattisgarh and 58 in Punjab.

Besides these three states, the surge in Uttar Pradesh was now a “cause of worry”, and testing numbers in Gujarat were a “big issue”, top government sources told The Indian Express. Over the last 24 hours, UP has reported 12,748 new cases and 46 deaths; Gujarat has reported 5,011 cases and 49 deaths.

“There is a trend in Uttar Pradesh, which is cause for worry. In the video-conferencing, we have told them that although more than 70 per cent of their testing is RT PCR, the (testing) numbers have fallen. They are expected to quickly ramp up testing; last year (during the surge), the state had recorded big testing numbers like Delhi,” a source said.

Three teams are in Surat in Gujarat, examining the gaps in response and assisting health authorities over the worsening situation, the sources said. “This (Surat) was the area of most concern for us. Last year too, they could not ramp up testing. Also, the RT PCR percentage is fairly low. These teams will also go to Rajkot, Baroda, and Ahmedabad,” they said.

Health Secretary Rajesh Bhushan has written separate letters to the health secretaries of Maharashtra, Punjab, and Chhattisgarh, asking them to urgently address the concerns raised by the central teams, including hiring contractual health workers, and ramping up hospital infrastructure. He has flagged specific concerns with these three states.

Maharashtra

1. Occupancy rates of available hospital bed capacity are very high in Ahmednagar, Aurangabad, Nagpur and Nandurbar.
2. Team to Aurangabad reported dependency of the district on neighbouring districts for management of critical patients.
3. Medical oxygen supply was an issue in Bhandara, Palghar, Osmanabad, and Pune; malfunctioning ventilators have been reported by teams in Satara and Latur districts.
4. Acute shortage of healthcare workforce has been reported in Aurangabad, Nandurbar, Yawatmal, Satara, Palghar, Jalgaon, Jalna districts.
5. Testing capacity in Satara, Bhandara, Palghar, Amrawati, Jalna and Latur districts is already overwhelmed, resulting in delay in reporting of test results; delayed reporting by patients to definitive treatment centres in Satara district is leading to a large number of deaths within the first 72 hours of hospital admission.
6. Containment operations were sub-optimal in Satara, Sangli and Aurangabad, with less than satisfactory perimeter control, lack of active surveillance for ILI cases; surveillance and contact-tracing were sub-optimal in Buldhana, Satara, Aurangabad and Nanded, mostly due to limited manpower.

Punjab

1. There is no dedicated Covid hospital in SAS Nagar and Rupnagar districts, and patients are being referred to neighbouring districts or Chandigarh. The team has reported lack of any Covid Care Center/Dedicated Covid Hospital in Rupnagar district; hospital bed occupancy rates in SAS Nagar, Jalandhar and Ludhiana are on the higher side.
2. Teams have reported issues with the procurement of ventilators for proper case management in SBS Nagar. In Rupnagar, ventilators are not being optimally utilised due to shortage of healthcare workforce, particularly doctors and nurses.
3. Shortage of healthcare workers has been reported from Patiala, SAS Nagar, and Rupnagar.
4. There is need to enhance focus on contact tracing in Patiala and Ludhiana. Contact tracing and surveillance efforts in SAS Nagar are being hampered due to the shortage of manpower.
5. Low rates of testing have been reported from Patiala. There is no RT-PCR testing laboratory in Rupnagar.

Chhattisgarh

1. Hospital bed occupancy rates are high in Balod, Raipur, Durg, and Mahasamund districts. The district administration needs to ramp up hospital infrastructure and other logistic requirement. Shortage of remdesivir, low molecular weight heparin needs urgent attention in Korba district.
2. Limited oxygen availability and oxygen wastage have been reported by the team from Raipur; district-level and hospital-level oxygen planning must start in all districts.
3. Health workforce shortage was reported in Durg, Jashpur, Rajnandgaon districts.
4. Patient referral in Durg district is being hampered by unavailability of adequate number of ambulances. Ambulance services need to be strengthened without any delay.
5. The team from Raipur, Jashpur has reported lack of perimeter control in containment zones. There appears to be no restriction on movement of people inside containment zones too. Containment zones, including micro containment zones need to be strictly implemented.
6. Contact tracing efforts need to be reinforced in Korba. Resistance (even attacks on healthcare workers) to containment activities and testing was reported by the team from Dhaneli village, Raipur. This needs to be addressed on an urgent basis.