CM says health system would choke; hospitals could run out of capacity in few days if precautions are not taken
Geetanjali Minhas | April 3, 2021 | Mumbai
As Maharashtra continues to report an increasing number of Covid-19 cases, chief minister Uddhav Thackeray has said he is not ruling the possibility of a total lockdown and he will take the decision in a couple of days.
“Today, I am warning about a complete lockdown but not announcing it. A decision will have to be taken against one’s will. I will speak to experts and political leaders in the next two days. If there is no other option to a lockdown we will have to accept it.” Thackeray said in his address to the state Friday night.
Maharashtra on Friday recorded 47,827 new cases, including 8,884 in Mumbai – the highest number since the pandemic outbreak last year. The state now has a total of 29.4 lakh so far, out of which 3.89 lakh are active cases. At least 202 patients died on Friday. The case fatality ratio in the state is 1.91 percent. Mumbai now has a caseload to 4.32 lakh out of which 57,687 are active cases.
Stating that the state government was on a strong footing and will ensure there is no lack of health facilities, Thackeray cautioned that the number of fast increasing cases will still choke the state’s health systems and hospitals could be full in next 15-20 days (if precautions are not taken).
“Even if health infrastructure is expanded there will be a shortage of medical personnel. I have given orders to upgrade health infrastructure wherever required. We will be able to increase the number of beds, ventilators and others. But how can we increase the number of doctors, nurses and health workers,” he asked.
He urged political opponents and critics speaking against a lockdown to instead help the administration upgrade health infrastructure and avoid a lockdown. “They should help doctors, support families who have lost their breadwinners, serve the infected and help the administration that is fighting against the virus. They should make arrangements for 50 doctors and nurses daily,” he said.
“I urge all political leaders not to play politics with the lives of the people. The government is taking initiatives for the safety of the people, to restart economic activities and save jobs. But at the same time we need to save lives,” he said while seeking cooperation from political leaders and also leaders of religious communities.
Thackeray said at present the state has 2.2 lakh isolation beds of which 62% are full; 20,519 ICU beds of which 48% are occupied; 62,000 oxygen beds of which 25% are full and of the 9,347 ventilators, 25% are in use. He also said, “Yesterday we vaccinated three lakh people and till Thursday, 65 lakh people have been vaccinated. We have the capacity to vaccinate 6 lakh to 7 lakh people daily. It will be done when the supply of vaccine is increased. Our target is to conduct 2.5 lakh RT-PCR tests every day in the next few days.” He also added that the vaccine is like an umbrella that protects you from rain. But as is the case, this is not rain; this is a storm.”
He said crowds at weddings, agitations and similar gatherings led to a spread of infection and festival celebrations will have to be restricted. “Some strict restrictions will have to be imposed in the coming days. In cities, we will need to avoid unnecessary crowding. In Mumbai there is crowding during peak and non-peak hours in trains. There is crowding in restaurants and in other places as well.”
The chief minister also said that his government was not hiding data and even if the situation in Maharashtra is shocking, it is putting the truth before people. “Some people tell me to look at other states… elections were held in Bihar and are going on in West Bengal but there is no rise in cases. I don’t want to talk about it. I love my Maharashtra and its people,” he said as he added that for their safety he is ready to be labelled a ‘villain’.
Review meeting in Delhi
In Delhi, cabinet secretary Rajiv Gauba chaired a review meeting to discuss Covid management and response strategy. The meeting was held with the chief secretaries, DG police and health secretaries and health professionals of all states and UTs with focus on 11 states/UTs that have been reporting a very high rise in daily Covid-19 cases and daily mortality in the last two weeks. The member (health) of NITI Aayog, the union home secretary, the union health secretary, the union secretary (I&B), the DG ICMR, and the NCDC director were also part of the meeting.
Taking note of the present situation and continuous deterioration of Covid scenario over the fortnight, the cabinet secretary pointed out that the current case growth rate of 6.8% in March 2021 has surpassed the previous record of 5.5% in June 2020. The country also reported 5.5% growth rate in daily Covid deaths in this period. While the country was reporting about 97,000 daily new Covid cases at the peak of the pandemic in September 2020, the country has now reached the critical figure 81,000 daily new cases.
The union health secretary highlighted the current trajectory of Covid in the states/UTs, while the union I&B secretary showcased ways of effective behavioural change communication to instill Covid-appropriate behaviour among the population. Dr VK Paul emphasized the need for states to follow a protocol for sharing clinical and epidemiological data for more detailed study of mutant strain of virus for genome sequencing. Union home secretary pointed out that the 11 states/UTs that are showing a surge in daily Covid cases have not shown commensurate increase in enforcement of containment activities. He urged the chief secretaries and DGs (police) of the states/UTs to take appropriate strict action in this regard.
These 11 states/UTs were categorised as the “states of grave concern” on account of their high and rising daily case and higher daily deaths. The states have contributed 90% of Covid cases and 90.5% of deaths in the 14 days to March 31, and crossed/or close to crossing their early reported peaks during last year. It was pointed out that the situation was particularly worrying in Maharashtra. They were advised to take up immediate and effective measures to ensure containment of active cases and daily deaths through adherence of the standard clinical management protocol shared earlier with all states and UTs.
Another worrisome aspect pointed out was that tier-2 and tier-3 cities along with peri-urban areas have recorded the recent high rise in Covid cases and the spread of infection from these areas to the rural areas with weak health infrastructure and overwhelm the local administration.
The cabinet secretary reiterated the necessity of meticulous and hard work regarding stringent enforcement of containment and surveillance measures along with ramping up vaccination and strict enforcement of Covid appropriate behaviour. The states were specifically asked to:
1. Increase testing continuously to ensure that positivity comes down to 5% or less than 5%
2. Focus on ensuring RT-PCR tests comprise 70% of total tests
3. Reduce waiting time of test results with regular review with testing labs
4. Use Rapid Antigen Tests (RAT) as screening test in densely populated areas and where fresh clusters are emerging.
5. All symptomatic RAT negatives to be mandatorily subjected to RT-PCR tests.
6. Ensure effective and prompt isolation of those infected in institutional facilities (Covid care centres). Ensure that patients isolated at home are to be monitored daily. Isolated infected persons to be transferred immediately to health facilities, if required.
7. Ensure that 25 to 30 such close contacts to be traced for each infected person. Tracing of close contacts and their isolation to be done in 72 hours. Subsequent testing and follow up of all close contacts to be carried out.
8. Set up containment zones/ micro containment zones to break the chain of transmission.
States were also asked to examine case fatality rate hospital-wise, devise appropriate strategy and mitigate concerns regarding late admission in hospitals and non-adherence to national clinical management protocol. The need to formulate district action plans with a focus on mapping of cases, reviewing of ward/block wise indicators, 24x7 emergency operations center, incident command system, area specific rapid response team and timely sharing of information was stressed upon.
In order to minimize the daily fatalities, the states were advised on strengthening of public and private healthcare resources. They were specifically asked to:
1. Increase the number of isolation beds, oxygen beds, ventilators/ICU beds as per requirement.
2. Plan for adequate oxygen supply.
3. Strengthen ambulance service and reduce response time and refusal rate with regular monitoring by local administration.
4. Ensure adequate number of contractual staff and optimum rostering of duties.
5. Plan regular tele-consultation of ICU doctors at the districts with AIIMS, New Delhi core team or state core team. Tele-consultation is being conducted by AIIMS, New Delhi twice a week on Tuesdays and Fridays.
6. Strict enforcement of covid appropriate behaviour (CAB) was reiterated. The following was underscored for immediate compliance by States/UTs:
a) use of Police Act, Disaster Management Act and other legal/administrative provisions for imposing penalties on defaulters.
b) use of local officials, political, cultural, sports, religious influencers to disseminate information proper wearing of masks and maintaining physical distance.
c) focus on markets, fair/melas, social and religious congregation that could become super spreader events.
d)awareness to be enhanced that CAB is equally important as vaccination, and this needs to be followed even after vaccination.
e) the message of ‘Dawai Bhi, Kadai Bhi’ to be effectively and profusely spread through multi-media and multilateral platforms.
In order to saturate vaccination for priority age groups in districting reporting surge in daily Covid cases states and UTs were advised for the following:
a) time-bound plan of 100% vaccination of eligible health care workers, front line workers and eligible age groups, to be made.
b) coordination with union health ministry to ensure adequate vaccine doses. It was stressed that there is no shortage of vaccines with States and UTs; the Centre will continually replenish the requirement by the States and UTs.
c) daily review of consumption from each cold chain point at the state level for required re-appropriation.
The cabinet secretary pressed upon the chief secretaries to galvanize the state administration and to use all resources at their disposal to tackle the surge. The need to expand the efforts to departments other than the health department through a “Whole of Government” approach that the centre must continue to provide all resources and support to all states and UTs for public health measures and clinical management for fighting covid-19 was reemphasised and reiterated.
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