States gear up as Covid surges: Big hospitals ready, smaller ones concerned

India reported 322 new cases of Covid-19 in a single day, according to data shared by the health ministry on Sunday. The number was lower than the 423 cases in a 24-hour span reported on Saturday, but the steady surge has prompted various states to step up preparedness as experts advise caution.

As of Sunday, Kerala reported one death and added 128 fresh cases to reach a total of 3,000, while Karnataka added 96 cases, taking the overall count to 271 cases in the state. Maharashtra reported 103 active cases, and Tamil Nadu 123. India’s active caseload increased to 3,742 on Sunday.

States have started issuing fresh guidelines as cases continue to rise.

In Tamil Nadu, T S Selvavinayagam, the state director of public health, has instructed authorities to conduct surveillance of influenza-like illness and severe acute respiratory infections through the Integrated Health Information Platform, ensure functional RT-PCR facilities, test symptomatic patients and keep all public and private hospitals ready in case of a surge.

Earlier this month, Union Health secretary Sudhansh Pant advised all hospitals to conduct drills between December 13 and 17 and asked states and Union Territories to prepare for possible public health emergencies. In a review meeting on Wednesday, Union Health Minister Mansukh Mandaviya also asked hospitals to conduct mock drills once every three months following the detection of the new JN.1 sub-variant.

In response, Selvavinayagam has asked officials to follow up with public and private hospitals in Tamil Nadu. They have been told to check the functioning of all ventilators, pressure swing adsorption (PSA) oxygen generating plants, liquid medical oxygen tanks, medical gas pipeline systems and oxygen concentrators, besides stocking up essential drugs. Karnataka had decided to conduct mock drills even before the Centre directed the states to do so.

A Maharashtra government official said the state was now focusing more on RT-PCR testing. Of the 1,791 overall in the last 24 hours (data updated till Saturday), around 658 were RT-PCR tests, and 1,133 rapid antigen tests. As of December 22, Maharashtra has five hospital admissions including two patients in intensive care units (ICU). Sixty-three patients were in home isolation as of Friday.

Larger hospitals are not worried about a spike in cases, as they are now accustomed to converting ICUs and general wards into negative pressure zones or isolation rooms. For smaller hospitals, the task is tedious.

The owner of a 100-bed nursing home in Mumbai pointed to the question of viability. “Converting a ward into a Covid-19 ward or creating beds is not a problem for bigger hospitals. But for us, this is not viable as most patients now don’t need hospitalisation. It would mean acquiring more PPE kits, and other consumables for staff. This is okay during a wave, when there is a patient flow, but now it would be a financial stress for us,” said the owner, requesting anonymity.

While hospitals with a bed capacity of 300 and more have a separate oxygen plant to cater to patients, mock drills and similar drives leave smaller hospitals at a loss.

An official with a smaller hospital in New Delhi said that while bigger facilities had installed PSA plants for oxygen, those with a capacity of 100-150 beds may have to source oxygen cylinders during a crisis.

An official at Delhi’s CK Birla Hospital said preparedness drives included stress on Covid-appropriate behaviour, protocols and staff training.

Bishnu Panigrahi, group head, medical strategy and operations, Fortis Healthcare, said that while the uptick in cases was primarily seen in the South, other regions need to be cautious as well.

Panigrahi said that the current stock is inadequate because that old stock has expired. “If there is a greater surge in Covid cases, the government may ask for re-vaccination since most of us would have got vaccinated more than a couple of years ago.”

He added that the last advice from the health ministry on JN.1 was that vaccines were already effective to combat the new strain. “The message is, there is nothing to panic but be cautious and wear a mask whenever possible,” Panigrahi said.

According to N K Arora, who heads the India SARS-CoV-2 Genomics Consortium, there is no need to administer additional vaccine doses. He said that precaution is necessary for those aged above 60 years, having co-morbidities or on drugs that suppress immunity (like cancer patients). “In case these people have not yet taken their third dose, they are advised to take precaution,” he said.

Rising numbers

·         India reported 322 new cases on Sunday

·         India’s active caseload: 3,742

·         Kerala reported 1 death and added 128 cases to touch 3,000 overall

·         Karnataka added 96 cases; overall count in the state: 271

·         Active cases in Maharashtra: 103; Tamil Nadu: 123