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PART 1 – WHO MISMANAGED COVID-19 MANAGEMENT?

This is the first part of our series of articles that track various steps taken by the Government of India to manage the COVID-19 crisis. Second part is here .

India has been leading the fight against COVID-19 from the front, investing in resources, research and remedy. As the second COVID-19 wave tests the country’s preparedness, response and agility of policies, it would be unfair and far from truth to say that India had squandered the gains it made during the first wave. Right from enforcing COVID-19 appropriate protocols to increasing surveillance in micro containment zones to ramping up capacity in case a subsequent wave was to hit, the leadership along with experts have made continual efforts at the Centre and State level.

Ensuring oxygen supplies to States

One of the commonly spotted SOS calls on social media is related to oxygen cylinders. While shortage of oxygen cannot be denied, it would be incorrect to assume or conclude that the Government was not adequately prepared to meet the demand.

Some of the critical steps which suggest that the challenge was more to do with last-mile delivery than availability of liquid medical oxygen include:

  • 1,02,400 oxygen cylinders were procured in April and May of 2020 and distributed to states to enable easier access of medical oxygen to end users.
  • Further orders for additional 1,27,000 cylinders (54,000 jumbo D type and 73,000 regular cylinders B type) was placed in April and deliveries of the same have already started.
  • Pressure Swing Adsorption (PSA) plants enable hospitals to become self-sufficient in generation of oxygen for their needs. In this line, Union Health Ministry is in the process of commissioning of 162 PSA plants (154 MT capacity) across the country.
  • Further, 500 more PSA plants are to be installed in the hospitals in district headquarters to enhance oxygen generation in smaller cities and towns.
  • Indigenous technology for PSA plants developed by DRDO (individual plant capacity of 1000 litre/min) and CSIR (individual plant capacity of 500 litre/min) is being explored to ramp-up PSA plant availability.
  • Short-term tender for import 50,000 MT of medical oxygen, to be supplied in a span of 90 days, has already been floated.
  • To ensure equitable supply, an allocation plan for the high burden states has been prepared by DPIIT. The same is periodically reviewed.
  • Total demand for medical oxygen as assessed on April 23 was 7,281 MT; of this a total of 7,409 MT has been allocated to 21 States.
  • Apart from the steel manufacturers, other manufacturers such as RIL and Linde have also enhanced the production of medical oxygen in their plants; the total capacity has been increased from about 7,200 MT to beyond 8,200 MT
  • India has 1,224 oxygen tankers (16,732 MT capacity). Efforts are being made to increase availability of oxygen tankers to more than 2,000 through conversion of 50% of existing Nitrogen & Argon tankers (~ 600 tankers) to transport Oxygen as well as through import of 138 cryogenic tankers for oxygen. Besides, IOCL is also manufacturing 50 tankers in IOCL Cryogenics Plant, Nashik.
  • Railways is being used for long distance transport of tankers through Roll on – Roll Off (RORO) service.
  • Defence Ministry is coordinating with oxygen suppliers for air-lifting of tankers to reduce the turnaround time. The Indian Air Force (IAF) is also shipping ISO tankers from Singapore.
  • Ministry of Home Affairs on 22 April 2021 issued instructions that no restriction should be imposed on the movement of Medical Oxygen between States.
  • National Pharmaceutical Pricing Authority (NPPA) on 26th September 2020 fixed the price of Liquid Medical Oxygen, while prices were already fixed for gaseous Medical Oxygen.
  • An order dated April 7, 2020 to allows industrial gas manufacturers the license for manufacturing medical oxygen within 24 hours from receiving the application for the same.
  • Union Health Ministry vide order dated April 18, ‘21 has restricted industrial use of oxygen. These restrictions on industrial use of oxygen have resulted in 1,000 MT of additional oxygen availability.
  • All the States have been advised rational use of oxygen. States are also advised to undertake facility-wise/hospital-wise oxygen inventory mapping and advance planning for timely replenishment so that there is no stock out.
  • Ministry of Health and Family Welfare is closely monitoring the availability and supply of Medical Oxygen and necessary infrastructure available at respective States/UTs.
  • MoHFW with Empowered Group -2 (EG-2) looking after essential medical supplies has conducted various review meetings on medical Oxygen supply with States/UTs including High Priority States and North Eastern States. Regular Video Conferences have been organized by Union Health Ministry & DPIIT with State Nodal Officers for Oxygen and Petroleum and Explosives Safety Organization (PESO) nodal officers.
COVID-19 Vaccination

With 2 indigenous vaccines to boast of, India is conducting the world’s largest vaccination program. The meticulous planning and resource allocation on the back of technology has ensured India’s vaccination program leads the world in terms of number of citizens inoculated within a specific period of time. To put the scale in perspective, on 5th April, India administered 34% of the total doses administered on that day across the world (43.19 lakh doses).

Task Force on Focused Research on Corona Vaccine and other Science and Technology Issues was constituted as early as 14th April 2020 for guidance on R&D of vaccine, & other regulatory issues. National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) was established on 7th August 2020 for guidance on all aspects of vaccine introduction.

  • December 2020: Operational guidelines for COVID-19 vaccination and COVID-19 vaccine communication strategy were issued and widely disseminated. Requirement of other paraphernalia such as stock of syringes was assessed, and orders were placed to meet the additional demand.
  • Capacity building of entire human resource has been conducted in a cascaded manner, from training of trainers at national level to the vaccination teams working at the ground level.
  • More than 7,600 participants were trained at state level; around 61,500 trained at district level; more than 2 lakh vaccinators and 3.9 lakh other vaccination team members have been trained on the process to be followed at the vaccination sites.
  • January 2021: Permission for restricted emergency use of vaccine was issued on 2nd January 2021 for two vaccines (Covishield and Covaxin) by Drug Controller General of India after detailed examination of the results of clinical trials. Nationwide Mock Drill on the COVID-19 vaccination was successfully held in January 2021. Successful roll-out of COVID-19 vaccination drive across country was taken up on 16th January 2021.
  • Co-WIN, a digital vaccine management platform was made and launched nationwide to support the vaccination delivery, helping the programme managers in registration and tracking of every beneficiary for COVID-19 vaccination along with real time information on the available stocks of vaccine, their storage temperature, actual vaccination process, generation of digital certificates etc.
  • April 2021: On 20th April, 2021, India rolled out a revised strategy of COVID-19 vaccination, opening up the vaccination drive for all age-groups above 18 years of age.
  • In addition to above mentioned 2 vaccines, Sputnik-V has also been granted Emergency Use Approval. 6 other vaccines are in clinical trials while 12 additional vaccines are in pre-clinical stages of development.
Augmenting Capacity & Infrastructure

Efforts in multiple aspects and directions have been made at district, State and Central level to ensure surplus resources are available in the event of any exigency.

COVID-19 Related Medical Equipment

  • Since 1st October 2020, 73.715 lakh N95 masks; 31.30 lakh PPE coveralls & 8,754 additional ventilators were delivered to states. HLL, the central procuring agency of Ministry presently also maintains a stock of 17 lakh PPE kits & 24 lakh N95 masks.
  • Government of India coordinated with number of manufacturers of related sectors who were encouraged to repurpose and establish/setup for manufacturing of these products. A large number of textile units started manufacturing PPEs and N95 masks as guided by the Ministry of Textiles in this regard.
  • From no suppliers, currently 70 suppliers (BIS) are providing PPEs; from 2 suppliers for N-95 masks, currently 220 suppliers (BIS) are providing N95 masks.
  • Union Health Ministry continues to request the States for projecting their demand/requirement enabling the central supplies to be made accordingly. Since April 1, 9,808 ventilators have been allocated to the states of which 3,835 have already been dispatched.

District Level Review & Monitoring of Infrastructure

  • Union Health Ministry identified high focus districts, conducted specific reviews asked for District Action Plan for COVID-19 management in these districts.
  • 46 districts from multiple States were reviewed on March 27, ’21 followed by 52 Districts (Madhya Pradesh) on 15th April, 2021, 75 Districts (Uttar Pradesh) and 27 Districts (Chhattisgarh) on 16th April, 2021.
  • All States and districts were also provided with detailed Toolkit on Containment besides template for preparation of District Action Plan.
  • The COVID-19 India portal provides a logistic requirement assessment tool based on trajectory of case growth rates, for all States and UTs to forecast and plan their requirements since April 2020.
  • From 1 laboratory for COVID-19 testing in January 2020, testing infrastructure has been upgraded to 2,477 laboratories at present (1,610 in Sep, ‘20); current testing capacity is 20 lakhs tests per day.
  • Detailed guidelines were issued for creation of COVID-19 dedicated health infrastructure. Availability of isolation beds, oxygen supported beds, ICUs and Ventilators were continuously ramped up.
  • Isolation beds (with/without oxygen) were increased to around 15.7 lakhs as compared to 10,180 before lockdown in the first wave; ICU beds were increased to more than 85,000 as compared to just 2,168, specifically for management of COVID-19 cases.

Slew of steps and sustained efforts to prepare for a possible second-wave have been undertaken by the Government of India under the aegis of PM Narendra Modi, right from the time the pandemic first made appearance in 2020. Even experts have mentioned that it is the sheer scale of the second-wave which challenged the existing system, and not lack of preparation or resource availability.

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