Oxygen protocol, Covid care centre in each village: Worst-hit Maharashtra gears for 3rd wave

To avoid devastation caused during second wave, Maharashtra has tightened overall lockdown measures across state and imposed budgetary cuts to meet Covid-related expenses.

File image of beds set up by the BMC for Covid-19 care in Mumbai | Photo: ANI

Mumbai: Maharashtra, one of the states worst hit by the pandemic, has been a bellwether for Covid-19 throughout, and is now preparing for a possible third wave on a war footing.

Learning from its experience in the second wave when the Delta variant of the virus caused a sudden spike in cases, the state has been taking quick containment measures to limit the impact of the new Delta Plus variant.

The state government has also tightened overall lockdown measures across the state, imposed budgetary cuts to make room for Covid-related expenses and is pulling up laggard districts every week based on fortnightly forecasts.

Moreover, the government also plans to make all 36 districts in Maharashtra self-reliant in terms of oxygen and will set up a Covid care centre in every village.

The state’s public health department has predicted that the active caseload during the third wave could reach a maximum of 8 lakh and Maharashtra could record 50 lakh new infections.

Dr Pradeep Awate, who heads the epidemiology cell of Maharashtra’s public health department, told ThePrint: “Nobody can predict the exact time and magnitude and figures of the third wave, but we require a tentative model to plan. In the second wave, the peak of active cases was 7 lakh. We are expecting a minimum 10 per cent increase in that. We are preparing for a worst-case scenario.”

So far, Maharashtra has recorded 60.26 lakh Covid positive cases, of which about 40 lakh infections were detected during the second wave that started in mid-February. It accounts for 20 per cent of India’s total cases recorded and as of Saturday, the state’s active caseload stands at 1.21 lakh. Maharashtra has also registered 1.2 lakh Covid deaths.

Lessons from the second wave

According to Awate, there have been two major takeaways from the second wave for the Maharashtra government — recognising new variants and being self-sufficient for oxygen.

“The state needs to focus more on genomic sequencing and take immediate measures of stringent containment wherever we get early cases of the new variant,” he said.

So far, 21 cases of the Delta Plus variant have been found in Maharashtra across five districts. Nine of these are from the Ratnagiri district, seven are from Jalgaon and the rest are scattered between Mumbai, Thane and Sindhudurg.

Many of these were asymptomatic and not vaccinated for Covid. One patient with the new variant died in Ratnagiri last week.

The Jalgaon district administration screened the entire village where the seven cases with the new variant were found and has sent more samples for sequencing. All the infections with the new variant were found from samples sent for genomic sequencing in May, District Collector Abhijit Raut told ThePrint.

Similarly, the Ratnagiri district administration has imposed containment measures in villages where cases of the Delta Plus variant have been found, a district official said.

While officials and experts in Maharashtra note that further research needs to be undertaken to understand the virulence, transmission rate and other characteristics of the new variant, the central government declared it as a ‘variant of concern’ Tuesday.

During the second wave, the Delta variant, first found in Amravati, was responsible for a majority of infections.

While the state public health officials knew about the variant as early as mid-February, immediate stringent action was not taken until much later, and by then the variant had spread across Maharashtra and to other states.

Awate noted that the other key takeaway from the second wave is that “all hospitals in Maharashtra need to be self-reliant in oxygen supply”.

“We have a plan by which we won’t need any oxygen from outside,” he said.

The state government has decided to equip every public hospital in Maharashtra with Pressure Swing Adsorption (PSA) oxygen plants.

Accordingly, the government has proposed to build 487 oxygen tanks with a capacity of 517.9 metric tonne. So far, 56 with a capacity of 69.37 metric tonne have been competed, according to the state health department.

The state task force is also developing a detailed oxygen protocol to audit oxygen use and avoid wastage.

Stricter restrictions, pulling up laggard districts

Using a fortnightly forecasting system that has been in place since the first wave, the state government has been identifying districts seeing a spike in cases, high positivity rate or mortality rate, and advising the district administration on the measures to be taken.

A state health department official said: “Often the CM himself holds meetings with the administration of these districts.”

In preparation for a third wave, the Maharashtra government has rolled back relaxations granted to restaurants, cinema halls and private offices in various cities and districts for a more cautious unlock plan.

The state government had five levels of relaxations for different districts to follow depending on their weekly positivity rate and oxygen bed occupancy. It has done away with two of these levels, under which there were maximum relaxations. The weekly positivity rate will also now be calculated only on RT-PCR tests and not Rapid Antigen Tests.

Last week, the state government also issued a government resolution slashing budgetary expenditure for the 2021-22 fiscal by 40 per cent to account for a drop in state revenue and create room for expenditure on medicines and other public health expenditure.

Meanwhile, the state government has asked all district and civic administrations to hold on to all the medical infrastructure created during the second wave and reserve 10 per cent beds in dedicated Covid hospitals for children.

“We are training doctors, paramedical staff with a special focus on paediatric management. We are aiming to create Covid Care centres in every village as well as have an added component of paediatric care in the primary healthcare facilities at every village level,” said the health department official quoted above.