AMID PROJECTIONS of a second wave of novel coronavirus (COVID-19) cases once the lockdown is lifted, there is a proposal to roll out “train hospitals” in Tier II and Tier III cities as well as villages, where the existing health infrastructure may not be sufficient.
While 5,150 train coaches (non-AC) have already been converted into “isolation centres”, the NITI Aayog has proposed that some of these should be upgraded to hospitals, with oxygen, ICU and ventilator facilities.
This is in preparation for a likely surge in cases. According to NITI Aayog’s presentation shared with states last week, if the lockdown was lifted as scheduled on May 3, the number of cases was estimated to touch 65,000 by May 15, and 2.74 crore by August 15.
So far, about 20 per cent of the over 40,000 cases across the country have needed hospitalisation.
“This idea came from the Prime Minister. The conversion of some of these isolation facilities into hospitals (Level II and Level III COVID care centres) is a highly logical step. It gives us capacity with mobility, especially in places where medical infrastructure is lacking. They can reach anywhere in the country within 24 hours, they can be parked anywhere. So we are prepared for a surge at any place, any time the local infrastructure is not enough,” said Dr V K Paul, member (health), NITI Aayog, who chairs the empowered group on medical emergency management plan.
He said some of these “train hospitals” could be retained even after the pandemic, to be used during disasters. “Some of these could continue to be with the National Disaster Management Authority,” he said.
The staff, said Dr Paul, could be sourced either locally from wherever the train is stationed, or posted on a rotational basis.
“NITI Aayog has suggested to the empowered group to provide Level-II care, i.e. dedicated COVID health centres, in the railway coaches, with facilities for administering oxygen, IV fluids etc., to strengthen the support to districts, as and when needed. It has further been suggested that a small fraction of coaches should also be included as Level-III, i.e. dedicated COVID hospitals, if possible. However, the current protocol still stands for railway coaches – as Level-I facilities,” said Health Minister Dr Harsh Vardhan.
“As per consultations with the Health Ministry, we had prepared these coaches as Level-I centres. We have been given to understand that, if needed, these would be deployed in areas where isolation facility is not there. That is where the matter stands as of now,” said Arun Arora, Principal Chief Mechanical Engineer, Northern Railway.
There are currently three levels of COVID-19 facilities in the country: Level-I is for isolation of those who are positive but asymptomatic or have a history of contact with a confirmed patient; Level-II (dedicated COVID health centres) are hospitals with oxygen facilities that offer care for cases that have been clinically assigned as moderate; Level-III (dedicated COVID hospitals) are fully equipped hospitals with ventilators and ICUs to treat severe cases.
Following consultations between the Health and Railways ministries, 5,150 train coaches have been converted into Level-I isolation centres, but are yet to be used.
Dr Paul mooted the idea to upgrade these into Level-II and Level-III facilities at a meeting with the Railways’ top brass last month. It was underlined that these coaches would add more value to the COVID-19 containment infrastructure as hospitals on wheels rather than isolation facilities.
“It was pointed out that isolation of asymptomatic patients could happen anywhere, like stadiums, schools etc, whereas these coaches could be more useful as hospitals,” said a source.
However, some issues were raised, including the fact that since these are non-AC coaches, it would get very hot for the patients, and would not have the facilities needed for plugging in sophisticated machines for healthcare.
The example of the Railways’ Lifeline Express, a hospital on wheels, was cited. However, source said replicating a similar rake would take about six months. The coaches have already undergone considerable modifications for use as isolation centres —the middle berths have been removed, two toilets have been converted into bathrooms etc—at an estimated cost of Rs 2 lakh per coach. Each coach has been re-structured to accommodate 16 patients.
According to the Railways’ usage protocol, each coach has space for two oxygen cylinders; the roof of the coach would have to be insulated for cooling; each rake should be designated to be attached to a COVID-care hospital; and an emergency resuscitation centre should to be kept at the platform where a train with these coaches is parked.
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