New Delhi: Easing of lockdown combined with pandemic fatigue, lack of community adherence to Covid appropriate behaviour and evolution and circulation of more transmissible variants of SARS-CoV-2 viruses all played a part in the second surge that India witnessed during April to May, the government told Rajya Sabha Tuesday.
A number of central teams deployed to states and union territories during February to May pointed out lack of adherence to Covid appropriate behaviour and sub-optimal efforts at containment in certain geographies, Minister of State for Health Bharati Pravin Pawar said in a written reply to a question on the reasons for rise in COVID-19 cases in April-May across the country.
“Easing of lockdown combined with pandemic fatigue, lack of community adherence to COVID appropriate behavior and evolution and circulation of more transmissible variants of SARS-CoV-2 viruses all played part in second surge that India witnessed during April to May 2021,” she said.
In view of non-availability of any definitive anti-viral treatment adherence to Covid appropriate behaviour, the test-track-treat approach and boosting vaccinations are the best public health intervention available to minimise the risk of infection, preventing strains of health systems and avoiding excessive mortality, she said.
On whether shortage of medical oxygen cylinders and essential medicines were felt in various states and the number of patients who died due to non-availability of oxygen, Pawar said the health infrastructure in the country was strained due to steep rise in cases during the months of April-May.
The government of India has supported the states and undertook a series of action including further strengthening of existing health infrastructure to ensure provisioning of sufficient hospital beds, drugs, medical oxygen and other consumables to aid proper clinical care of COVID-19 patients, she said.
Elaborating on the ongoing initiatives, the minister said with the intent to reduce the risk of cross infection to non-Covid patients as well as to maintain continuity of non-Covid essential health services in the country, a three-tier arrangement of dedicated Covid care centres, dedicated Covid health centres and dedicated Covid hospitals has been implemented in the country.
The government in addition to providing services through hospitals/facilities available under the Ministry of Health also roped in tertiary care hospitals under ESIC, Defence, Railways, paramilitary forces, steel ministry etc. for management of COVID-19 cases.
Further, many large temporary treatment facilities were established by DRDO to manage the surge in cases in the country. Due to concerted actions of central and state governments, the isolation bed capacity and ICU bed capacity which was merely 10,180 and 2,168 before the first lockdown (as on March 23, 2020) could be increased to 18,21,420 isolation beds and 1,21,671 ICU beds (as on July 16, 2021).
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Additionally, the reliance on imports with respect to ventilators was mitigated with concerted efforts of governments and industry under the ‘Make in India’ vision, the minister said.
Till now states and union territories and central government institutions have been allocated 56,218 ventilators of which 48,060 have been already supplied (as on 13th July 2021). Taking note of spread of the disease to peri-urban and rural areas in many districts, Ministry of Health on May 16 issued an “SoP on Covid19 Containment and Management in Peri-Urban, Rural and Tribal Areas”, the reply stated.
With the intent to protect the pediatric age group in current and any future surges of cases, guidelines for management of Covid in children were also issued on June 18. The guideline provides guidance on the management of acute presentation of COVID-19 as well as Multisystem Inflammatory Syndrome (MIS-C) in children and adolescents found temporally related to COVID-19.
Oxygen cylinders and concentrators are being procured and being supplied to States. Further PSA plants have been sanctioned across the country to augment oxygen supplies, the reply said.
In addition, ‘India COVID-19 Emergency Response and Health System Preparedness Package: Phase-II’ was also approved by the Cabinet with Rs 23,123 crore (with Rs. 15,000 crore as central component and Rs 8,123 crore as state component) for implementation from July 1 to March 31, 2022.
“Health is a state subject. Detailed guidelines for reporting of deaths have been issued by Union Health Ministry to all states and UTs. Accordingly, all states and UTs report cases and deaths to Union Health Ministry on a regular basis. However, no deaths due to lack of oxygen has been specifically reported by them,” the reply said.
In response to a question on the reasons for why the situation was not anticipated by government and the officers/agencies responsible for lackadaisical approach, though health is a state subject, however, in view of ongoing pandemic, the health ministry continued to maintain constant vigil over the evolving COVID-19 situation in the country.
While the government launched vaccination in January, states were regularly reviewed and requested to never to lower the guard and on importance of stringent containment and surveillance measures, enhancing testing, planning for essential infrastructure and logistics and ensuring community adherence to Covid appropriate behaviour as the mainstay for Covid management, she said.
Formal communications were regularly sent out to states on current trajectory of cases, need for adherence to Test-Track-Treat approach for containment of outbreaks, need for adherence to COVID appropriate behaviour and vaccination, she added.
These communications were in addition to the detailed reviews conducted at the level of Minister for Health, Cabinet Secretary, Secretary (Health & Family Welfare) wherein various challenges related to COVID-19 management were discussed and deliberated with the states, the reply said.
All states and districts were also provided with detailed toolkit on containment besides template for preparation of District Action Plan to monitor and prepare for any surge in cases, Pawar stated.
High level and multi-disciplinary teams were deployed to 22 states and union territories to review the current situation of COVID-19, assess reason/s for surge, review preparedness and response activities undertaken by the states and provide supportive supervision to state and district administration to institute requisite public health measures. Directions issued by the Supreme Court and High Courts from time to time are being implemented, she said.
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