Action Plan for Handling the Covid-19 Threat-Second and Subsequent Waves

Vivekananda International Foundation conducted a webinar on 01 May 2021 on the challenges arising from the second phase of the Covid-19 pandemic. Leading specialists from various fields participated in the webinar and included Members of the National Defence Management Authority (NDMA), senior medical personalities, healthcare professionals, representatives of CII and experts from the field of logistics management.

The recommendations for the optimum management of the current crisis, based upon the intensive discussions at the webinar, are given below.

Intensity and Duration. There was general consensus that the second wave is yet to peak and the intensity will continue to rise for some more time. Therefore, the shortage of medical resources is only likely to intensify unless everything is done on a war footing.

Human Resource Requirements in the Medical Domain. If an estimated average 84000 patients needing ICU attention are to be added to the daily numbers, the resources in terms of ICU beds will be woefully short. The medical infrastructure is being expanded but the human resources required for manning the ICUs and other facilities in hospitals need similar expansion. Nurses and doctors are required in large numbers. We may take immediate action to harness the services of 200,000 nursing trainees awaiting final examinations which must be cancelled for now. They must be paid well with a minimum stipend for the period of hiring. Similarly, many MBBS students who are awaiting NEET (PG) may be called up to contribute to the overall medical effort with promise of some credit points for the qualifying examination they will later write for specialization. They too need to be well compensated. A method of quick sign up and deployment with minimum paperwork has to be developed without delay.

Additional issues related to medical manpower:-

• An exponential increase in the medical teams that would support hospitals and makeshift health facilities would relieve the existing health personnel who are overstretched and fatigued.
• The medical students and nurses can join their nearest district for the services they can provide; no extensive travel would then be necessary.
• A pool of such resources could also be created for rural areas.
• Retired health personnel from the Armed Forces and public sector hospitals must join the health services. Many of them are already employed in the sector. Their deployment could be decided by the state and district health services.
• Graduate students with degrees in biology and public health may also be called up by SDMAs and Indian Red Cross.
• Pharmacists may also be utilized in emergency.

Call for National Mobilization. A national mobilization of resources would involve the large-scale deployment of Armed Forces and Central Police Forces and their resources in dealing with the impact of the disease. Similarly, the public sector enterprises and academic institutions could also be asked to support this effort. There is no doubt that contributions from many of these institutions have already been phenomenal but this being a long haul their contribution to the maintenance of national stamina is critical. More makeshift hospitals could be set up, with large number of beds equipped with oxygen. This would provide immediate help to the administration in dealing with the surge of Covid-19 infection.

There are reported cases of hoarding and black marketing of essential medicines and oxygen. The necessary steps to strengthen its powers to tackle law and order and social malaise must be taken by the Central Government without hesitation.

National Pandemic Response Plan for Villages/Rural India. As the pandemic extends to the rural areas and perhaps the next phase may be intense in that sector, it is essential to evolve a plan to strengthen the medical infrastructure to cater to this threat.

• Community based initiatives is the key to this.
• Use of Panchayati Raj institutions.
• Partnership with NGOs who can substantially boost capability at the district and tehsil level.
• Psycho social care in the rural areas is a virtually non-existent domain as there is a stigma attached to it. This will have to be promoted in a big way and obstacles imposed by customs and social norms will need to be removed.
• Vaccination hesitancy and misnomers are both abounding in the rural areas and this needs a special communication effort to neutralize.

Crisis Management Teams. These must be set up at national, state and district level with 24 x 7 functioning. Six Empowered Groups (EGs) set up by the Central Government are functioning at present. These should be supported by a Crisis Management Team (CMT) headed by a Secretary and consisting of very senior officials drawn from the Civil Services, Armed Forces, and Health sector, which should function from the Cabinet Secretariat. The CMT must coordinate the work of the EGs and take all fresh suggestions and progress cum advisories on a daily basis.
A Data Management Group should be drawn from the Government and the leading management consultancy companies such as TISS. The Data Management Group can support all the Empowered Groups as well as the Crisis Management team. Most dashboards should be centrally maintained through a system of ‘information pull’
Central Teams for Assisting States. One Central Team per state be set up consisting of senior officers from the Civil Services, Armed Forces, and the public and private sector, with a Team Leader. The designated team should interact with the State Government on all pharmaceutical and non-pharmaceutical issues and connect with the Empowered Groups and the Crisis Management Team for necessary support.
Emergency Operation Centres (EOCs) and Helplines. All EOCs at different levels, including those of individual ministries, must be strengthened and helplines on different aspects be opened.

• Additional helpline numbers must be established. The national emergency helplines may be insufficient in the face of the enormity and the nationwide impact of the virus.
• SDMAs and DDMAs in particular must strengthen the working of their EOCs and play a proactive role. They must be manned by senior officers to make basic decisions.
• All helplines must take calls for medical emergencies and also provide basic information on immediate care.
• DDMAs must maintain an updated dashboard of availability of medical facilities including ambulances to enable assistance.
• Ambulances in particular must be brought under central control of DCs as these are being grossly misused for exploitation of the public.

Oxygen Supply.

• Every effort must be made to augment oxygen supplies by setting up a special Oxygen Management Group in each state.
• A national level Oxygen Authority needs to be established at the earliest under a senior Civil Services officer.
• Availability and resupply needs be known at all times.
• A reserve will have to be built as we progress beyond; this will be useful perhaps for the next waves.
• Monitoring must include private and government hospitals including hospitals of the Armed Forces, CAPFs and Public Sector Undertakings.

Coordination of External Support. Substantial external aid is arriving now that India has changed its policy on accepting this. The coordination of its arrival, storage and distribution needs a dedicated organization. It is important that only the direly needed items are identified and flown directly to the concerned states instead of centralized routing through Delhi. Customs procedures need waiver with requisite control such that there is minimum delay involved due to paperwork. In most disasters this is a particular challenge when substantial foreign aid fetches in and there is no system of distribution.

Aggressive and Persuasive Vaccination Drive. Subject to early availability of vaccines in sufficient quantities this needs to be ramped up with a very strong audio visual IEC campaign particularly in rural areas. We should shed all hesitation about the usage of private electronic platforms. More vaccines, which have been developed abroad, need to be approved and added to increase the supply of vaccines. Many of India’s outstanding management institutions could be tasked to develop distribution models for vaccines. The employment of a few teams of the Armed Forces and the CAPFs to administer vaccines in rural areas may be considered.

Community and Local Support. Combatting Covid-19 will best be done at the community level where credibility of messaging and ability to respond quickly exists, provided there is coordination and sufficient resources. Both the Ministry of Panchayati Raj and the Ministry of Housing & Urban Development should lead the effort of involving the local government in the Covid-19 campaign. Local government institutions need to be asked to commit their facilities and staff across the departments to the Covid-19 campaign. Services of human resources such as midwives, usually available in the rural areas, may be utilized by giving a bit of additional training.

Employment and Coordination of NGOs. There are almost 92,000 registered NGOs in India and are extremely keen to contribute. They need empowerment, cooperation and encouragement. SDMAs must coordinate NGO activities in their states to enable a uniform footprint of their effort. Their assistance in the Psycho Social domain is particularly important.

Cooperation and Coordination with the Private Sector. The partnership could be leveraged to increase the supplies of essential medical components and improve logistics. The most important component of this partnership is working with the pharmaceutical sector to expand the production and supply of essential drugs at reasonable prices.

Prefab Hospitals. DRDO, the Armed Forces and ITBP have set up additional medical facilities for citizens which have been fully utilized. Prefab construction material and medical utilities may be identified and kept ready for surge beyond handling capacity of the current resources.

Waiting Areas of Hospitals. Due to the large numbers involved there are many patients waiting for admission outside hospitals, some of them in critical state of health. The management of these waiting areas is equally crucial to save lives and must not remain a medical responsibility. It should be taken over by the local administration to ensure some tentage, shamianas, beds, oxygen, water and food is available there. A system of prioritization should be established with a medical officer making a round every few hours to determine criticality of any patients.

Crematoriums and Burial Grounds. Besides being swamped by the number of fatalities the administrative responsibility to ensure that there is no large-scale overcharging for any services has to be established. The local administration cannot watch while ambulance or hearse prices go up to Rupees 14000 for a 6 kilometer journey. These corrupt practices can stop if a few examples are set of prosecution by the law order machinery and the judiciary in quick collaboration.

Psycho-Social Support through Counselling Using Helplines. This particular aspect is one of the most significant fall outs of the pandemic. Due to the deaths and the contagious nature of the disease isolation is being experienced by many. Large-scale deaths in ICUs are leaving survivors traumatised. Orphaned children are not finding relatives coming to their rescue. NIMHANS has already commenced several helplines for this in different languages but this is yet insufficient due to the severe trauma that has afflicted many parts of society. More NGOs need to take on this responsibility and it is also something RWAs of societies can assist in organizing.

IT Platforms. A number of IT platforms have been created to assist with data management, decision making and general information. To maintain uniformity the government must have one official platform on which all this should be mounted so as to maintain uniformity. A number of Covid-19 related protocols are on social media. These need to be medically verified especially those for home treatment.
The above suggestions and recommendations by former government officials and private organizations have emerged from a discussion. More such discussions on specific issues will be conducted in the near future so as to extend support to the government in this hour of severe challenge for our nation.

(The paper is the author’s individual scholastic articulation. The author certifies that the article/paper is original in content, unpublished and it has not been submitted for publication/web upload elsewhere, and that the facts and figures quoted are duly referenced, as needed, and are believed to be correct). (The paper does not necessarily represent the organisational stance... More >>