Second wave and steps to increase medical oxygen

Deadly second wave of Chinese coronavirus

India is facing dire consequences of the second wave of Chinese coronavirus pandemic. A fast-spreading mutation of the virus has lead to an immense surge in new cases. Huge crowds and lack of precautions had become the norm as people went about their normal lives. This was expected and also necessary for economic revival.

However, the spread and worsened state of affairs is aided no doubt by the gross negligence of opposition states like Maharashtra, Delhi, Chhattisgarh, Kerala and West Bengal, as these continue with policies of inadequate testing, lack of proper follow-up and lack of proper planning for treatment (eg hospital beds, care equipment, consumables spare capacity) and inadequate vaccinations. Lockdowns and inadequate support to migrant workers will create problems for neighbouring states. In hindsight, a second wave was long overdue and large urban centres should have prepared better for it.

Some states are taking a proactive approach whilst others are leaving it all to the Centre. This is putting the onus (and blame) on Centre to rescue situations from incompetent and corrupt opposition state leadership, particularly in Maharashtra and Delhi. For example, politicking by opposition includes non-cooperation, stopping shipments and illegal capture, hoarding & black marketing of essential items and vaccines. Besides, fake news from the usual sold-out journalists and media platforms is leading to a heightened sense of desperation. 

Live Law  

@LiveLawIndia

 

Mehra (Delhi Govt Advocate): My Lords, lives are at stake

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High Court: I don't understand for whom are you repeating this again and again? The court knows, you know, I know that lives are at stake. Central govt is doing what it can, I'm sorry to say it is your incompetent administration.

Preventing the potential public backlash or anger

Things have NOT yet gotten out of control. But as cases are rising, difficulties for the ordinary person will compound. Govt is providing solace in a few ways: 

1) Avoiding a blanket lockdown.

2) Free rations for the poor as many would become unemployed.

3) Multi-fold increase in production of essential treatments, oxygen and temporary hospital beds; improved logistics including green corridors & armoured escorts to shipments; and tighter controls on distribution to stop black marketing and hoarding.

 -  Remdesivir (anti-viral drug) production has been more than doubled from 4m doses/month to ~ 9m doses/pm. 25 new manufacturing units were started around 12/4, exports banned and imports arranged (eg from Russia).

 -  Temporary COVID hospital at Ahmedabad for 900-beds was inaugurated by 23/4, along with DRDO oxygen plants. As care equipment is at hand, it is done very quickly. Other COVID Hospitals to be installed in a few days are 450-beds (Lucknow), 750-beds (Varanasi), 500-beds (Chhatarpur, Delhi) and 500-beds (Bihar).

Dr Harsh Vardhan  

@drharshvardhan

Reviewed preparedness of the @ITBP_official Sardar Patel COVID Care Centre in Chhatarpur, Delhi.

This facility will initially reopen with 500 oxygenated beds which will be quickly ramped up to 2000. It will have 10 basic care life support ambulances, X-Ray, BI PAP machine Bi PHASIC Defibrillator, suction machine along with other medical equipment.

4) Vaccinations are opened to over-18s from 1st May (previously limited to over-45s) as vaccinations have worked, and young people need protection:

 -  Vaccines are available as per state policy and also from private sector. Most states including UP, MP, Bihar, Assam, Gujarat, Uttarakhand, [All BJP ruled states], etc. are promising it for free. Otherwise, SI's Covishield is priced at an affordable per dose rate of Rs 300 (govt hospitals) and Rs 600 (private hospitals). Covaxin is priced at Rs 400 (govt) and Rs 1200 (private). Price is set by each manufacturer, so foreign vaccines will surely cost more >> Rs 1200.

 -  Ramp up vaccine production for the 1st May opening up. This includes a 7-fold increase in Covaxin production (to 58m/pm), expansion of Serum Industries facilities (to 120-140m /pm), bring to use spare capacities in PSUs, and arrange imports and Make in India production (eg agreement with Dr Reddy for 250m total of Russian vaccine Sputnik V). Other Indian pharma are in pipeline to deliver higher capacities. 

-  Freedom to import all established vaccines including American, but not Chinese. New Indian vaccines are in trials (eg. Zydus Cadila's ZyCoV-D, Biological E, Gennova). Intranasal vaccine is game-changer for mass vaccinations as it is very effective, easy to take and can cheaply and rapidly be mass-produced. India's Bharat Biotech has one such intranasal vaccine that could enter trials quite soon!! Video

-  Emergency approval for Zydus Cadila's Virafin (oral anti-COVID drug for moderate hospitalised patients). It brings recovery over 7-10 days and reduces the extent of oxygen ventilation. Canada's SaNOtize nasal spray treatment is a breakthrough treatment for COVID. SaNOtize is in talks with many Indian manufacturers. 

Oxygen crisis

Second COVID wave has created an unprecedented demand for oxygen within a few short weeks. As India is equipped with oximeters and ventilators, most patients with low blood oxygen are detected early and can be placed on oxygen. 

Production of more oxygen

1) The medical oxygen supply has been increased by nearly 4 times from 1,273 MT/ day in the last week of February to 4,739 MT/ day on April 17th. This is set to increase further in coordination with national suppliers.

2) In the meantime, Govt has requisitioned all oxygen production from non-essential industries. 

3) Firms in essential industries are not only volunteering their spare capacity but processing industrial oxygen into medical grade oxygen.

4) Supreme Court is considering whether to reopen a significant copper plant in TN which promises to supply 1,000 MT/ day of oxygen.

5) 50,000 MT of liquid oxygen will be imported and IN will assist in bringing it quickly to India.

Distribution of oxygen

Centre is driving the effort to distribute oxygen to hospitals that have shortages.

1) Indian Railways will soon run 'Oxygen Express' trains (on non-stop, green corridors), each loaded with lorries containing liquid medical oxygen containers and oxygen cylinders. Indian Airforce will transport empty containers by air to speed up oxygen dispatches by rail.

2) 162 Pressure Swing Adsorption (PSA) oxygen plants are sanctioned for installation in hospitals. 100 more will be added at request of states. Due to slow pace from Jan 2021, only 33 were built by 18/4. They reckon 59 will be installed by April-end and 80 by May-end. Each plant will produce ~ 0.9 MT/day.

3) DRDO's innovative oxygen generation plants are being installed alongside COVID temporary hospitals. Each plant takes just 72 hours to build. Peak flow is 1 m3/min which is sufficient for ~20-25 ICU beds. UP has ordered such units for 5 health facilities. Besides, DRDO has transferred oxygen generation technology to the industry, which has now started providing oxygen plants to state governments and hospitals.

4) Large industrial firms like all major steelmakers (private and public) and Reliance Industries oil refiners have offered large volumes of medical-grade oxygen to nearby districts, states and across India. Tata is procuring cryogenic cylinders to fill acute shortage of specialist containers.