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'We are hoping for the best, but we are prepared for the worst'

By PRASANNA D ZORE
April 01, 2020 08:35 IST
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'As of this moment, we have 1,173 ventilators, 2,695 ICUs and about 10,408 plus isolation beds.'
'But this number keeps changing with every passing hour as we incorporate more private as well as government hospitals in our fight against the pandemic.'

IMAGE: Medics conduct door-to-door thermal screening of residents in Mumbai. Photograph: PTI Photo
 

As Maharashtra reported over 300 cases of coronavirus infected patients, Dr Pradip Awate, the state's disease surveillance officer, Integrated Disease Surveillance Programme, gives Prasanna D Zore/Rediff.com the details about the Maharashtra government's battle-preparedness as it emerges one of the major hotspots of coronavirus patients in India

Could you tell us about the measures that the Maharashtra government has taken so far to control the COVID-19 pandemic?

Actually, in the initial phase we started with the point of entry screening of passengers across all international airports and ports in the state from January 25.

The next stage was keeping those coming from coronavirus-affected countries under surveillance and quarantine them for 14 days under the Integrated Disease Surveillance Programme (IDSP) at government facilities and those who were quarantined at home were asked to self-report about their symptoms and condition.

Along with that we focussed on the development of more isolation facilities. Apart from the two hospitals at Kasturba in Mumbai and Naidu at Pune, we have now more hospitals where COVID-19 patients can be treated and hospitalised or quarantined.

The next important need is the diagnosis and testing labs for patients showing COVID-19 like symptoms.

Till the second week of January, we had just the National Institute of Virology, Pune. But step-by-step, we increased our lab capacity to 23, which includes ten government and 13 private labs, after the ICMR (indian Council of Medical Research) permitted the latter to join the government's efforts.

We are also planning to have these testing facilities at many of our district hospitals and government medical colleges so that in future if we need to conduct more tests for patients we are ready for that.

Are these 23 labs enough to take care of the testing requirements coming from the entire state?

At this stage, they are enough.

Apart from that capacity building and training of manpower is also needed. We have recently completed the training of trainers programme at block, district and state level.

The next important component in this fight is the requirement of N95 masks, personal protection equipment (PPE) and triple layered surgical masks.

We are ensuring that these are available at every institute that screens or tests or treats COVID-19 patients in adequate numbers.

We are using CSR funds too to procure these equipment. We are trying our level best to maintain adequate stocks for the fight against Coronavirus.

What is the requirement of all these equipment and what is the situation on the ground right now?

I can assure you that we do have sufficient number of PPEs, N95 masks and triple layered surgical masks.

We did undertake a mathematical modelling of this outbreak which projects the increase in the number of COVID-19 like patients in the month or two, and we are preparing to stock ourselves keeping that scenario in mind.

But even if one per cent of Maharashtra's population were to come under the COVID-19 outbreak it will be a huge number.

At that juncture we may fall short of supply, but we are trying our level best to prepare for that situation.

There is no shortage today, but in the future nobody knows.

What number has this mathematical modelling thrown at you?

There are different views coming out from different mathematical models. But assuming even if 0.5 per cent or one per cent of the state's population gets affected, even then it is a huge number, isn't it?

With almost 122 million (12 crore) people, it becomes a huge number.

Fortunately, from whatever trends that we saw in China and other countries, 80 to 85 per cent COVID-19 patients showed milder symptoms or were asymptomatic which could be handled at the OPD (outpatient department) level.

Only 15 to 20 per cent required hospitalisation with only 3 to 5 per cent requiring ventilators and ICU beds. We are planning accordingly.

Now that we have moved on from the district to block level our assessment of requirement of hospital beds, ventilators and other necessary equipment will help us to prepare for the future. We are planning to prepare 50-100 beds at even block levels.

IMAGE: Dr Pradip Awate.

What is the trend in Maharashtra like?

We are observing the same trend as one saw in China.

Though our tally is 302 (this number was at 153 on March 27), and this number keeps changing by the hour and is so very fluid, more than 80 per cent of these patients are either showing milder symptoms or are asymptomatic and they are recovering well even with minimum treatment support to them.

What about the number of ventilators, ICU beds available and manpower being prepared in Maharashtra to treat serious COVID-19 patients?

We have completed the entire training cascade from block level to the state level.

I can tell you that we have completed 62 'train the trainers' sessions that include doctors nurses and other hospital support staff and each session was joined by at least 50 participants.

We are also ensuring that most of these doctors are also epidemiologists.

As of this moment (this interview was conducted at 9.30 pm India time), March 31, we have almost 1,173 ventilators, 2,695 ICUs and about 10,408 plus isolation beds.

But this number too keeps changing with every passing hour as we incorporate more private as well as government hospitals in our fight against the pandemic.

What we are doing is we are hoping for the best, but we are also prepared for the worst.

As I told you before, even if one per cent of the population of Maharashtra gets affected, we are looking at a huge number.

But looking at global trends, 80 per cent patients show only milder symptoms and respond to monitoring and medicines at homes, and about 20 per cent will require some kind of hospital intervention.

And at least three to five per cent of them will require admission in the hospital in the ICU facility.

Accordingly, we are preparing for all situations and scenarios.

How many tests are we conducting now every day in Maharashtra?

Every day 500 plus tests are being conducted across Maharashtra at least since last week or so.

We have been able to ramp up the number of these tests because now we have expanded our lab network, which now includes government as well as private labs.

With every passing hour, every passing day we are ramping up our capacities of ICUs, isolation beds, trained personnel, protective gear, number of labs that can perform tests and number of tests that can be conducted at these labs.

What is the ratio out of COVID-19 positive patients to total tests done?

Maharashtra has reported 302 COVID-19 positive patients out of 6,331 tests done till now. That's like less than five in every 100 people tested are reportedly COVID-19 positive.

Are these efforts to tackle the COVID-19 pandemic in the state well-funded?

The state government has made it amply clear that there will be no financial restrictions or rules and regulations which apply in procurement of goods and services in normal times, will be applicable to procurement of goods and services to fight this pandemic.

Only the nodal officers will have to make whatever decisions need to be made. There will be no financial restrictions.

We have taken into account availability of all the ventilators and ICU beds at government hospitals, at municipal corporation hospitals and district hospitals, and along with medical colleges, both public and private.

We are also involving private hospitals at places like Mumbai, Pune, Pimpri-Chinchwad, Nagpur for the treatment of coronavirus patients. This has definitely boosted our medical infrastructure preparation.

Now that the Union government has asked for screening of 15 lakh travellers who were not scanned on their arrival from international destinations in India, how big is that a challenge for the state government?

Screening and scanning of international travellers arriving in India was vital at the initial phase of this outbreak. Now that phase is almost over and as of today, the international travel has been halted.

Maharashtra has already screened three lakh people since January 25 at Mumbai, Pune and Nagpur airport.

Even today, we have more than 23,900 people home quarantined, more than 1,400 in isolation quarantine at hospitals, almost 3,500 admissions in Maharashtra having COVID-19 symptoms and only 302 of these patients tested positive.

(As of April 1, 1.30 am, the number of dead in Maharashtra totalled 10, but the number keeps changing with time; for the country this number stands at 35 out of 1,397 COVID-19 positive cases; these figures could easily increase by the time you read this interview).

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PRASANNA D ZORE / Rediff.com
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The War Against Coronavirus

The War Against Coronavirus