Like many regions of the country, the second wave of the Covid hit the district of Sonipat (adjoining Delhi) really hard with the positivity rate reaching a high of 54.71% on 25 April 2021. With the second wave came different sorts of challenges of which oxygen supply was most critical, given the non-existent perennial supply system for the hospitals including the 500-bedded Medical College at Khanpur Kalan.
The challenge of medical oxygen was altogether new for Sonipat like many other districts in the country. This, coupled with close to 60% patients coming from Delhi, led to quick saturation of bed capacity in Covid hospitals of the district by 25 April 2021. Consequently, a dual challenge of increasing oxygen beds on one hand and managing oxygen demand within the available quota on the other was faced. As on 24th April, the district was receiving a daily quota of 9 MT liquid oxygen. To add to the worries, the agency responsible for supplying around 4 MT daily oxygen to Medical College had pulled out. As the state allocated oxygen quota was being determined elsewhere, the focus was on mobilization of resources and managing within this quota for which the following line of action was undertaken:
PSA Plant: A 200 LPM capacity PSA plant approved under PM Cares Fund was lying idle since February as the Agency didn’t install it and district health team didn’t realise its importance. With the help of one Prof. Jogendra from Pacific College, Sonipat, PSA oxygen plant was commissioned at Civil Hospital Sonipat on 30th April. This helped increase the number of oxygen beds at Civil hospital.
Oxygen Audit: Nodal officer was appointed for oxygen supply and officers were positioned at each of the bottling plants and hospitals. A multi-pronged approach was adopted to prevent wastage and siphoning off of medical oxygen at bottling plants and in hospitals. A formula was put in placeabout average consumption on the basis of guidelines issued by MoFHW. Accordingly, average consumption in all hospitals was calculated. A committee was also constituted for oxygen consumption audit in all hospitals. Quota was now being allocated to hospitals based on their patient load. These steps helped save 2-3 MT of LMO per day. This resulted in the increase of oxygen beds from 605 to 791 by 1st May. Moreover, the district quota was increased to 13 MT on 2nd May by the Government which helped further increasing the number of oxygen beds to 950 including 90 ventilators.
Augmenting Oxygen Storage: By end of April, 2021, the district had only one Bottling Plant with storage capacity of 20 MT which was catering to more than 25 hospitals. Through concerted efforts two more bottling plants licenses were facilitated for medical oxygen and a storage capacity of 50 MT was added within 15 days.
LMO Tank at BPS Government Medical College, Khanpur: With a daily oxygen demand of more than 450 D-Type cylinders, the Medical College was the major consumer for oxygen in the district. With every passing day and increase in patient load, it was becoming difficult to maintain regular supplies through cylinders. With the help of one of the Bottling Plants, an LMO storage tank with 12 MT capacity was installed within a week at BPSGMC. This gave a major boost to oxygen supply at the Medical College and the number of oxygen-supported beds increased from 150 to 350. This also resolved issues related to oxygen flow pressure and refilling and transportation of oxygen cylinders.
PSA Plant at BPSGMC: To further augment oxygen availability in the district and to tackle any unforeseen situation in days to come, a PSA oxygen generation plant under CSR has been installed at Govt Medical College, Khanpur with a capacity of 1000 LPM. Installation of one more PSA Plant with 1000 LPM capacity by DRDO is under progress.
At one point in time, the district had more than 7000 active cases and 90% of them were under home isolation spread across the geography of the district. To monitor them on a regular basis was a challenge given the inadequate manpower in the field.
With the support from young MBBS/PG medical students from BPS Medical College, a motto – Chase The Patient – was coined. Tele-consultation services were provided for all home isolated patients. 120 PG students of the Medical College were engaged to monitor all the home isolated patients of the district. The students were divided into 15 area-wise teams, each team connected with their respective Community Health Centre (CHCs) and Urban Health Centres (UHCs).
A team of IMA doctors was roped in which constantly supported patients with their COVID treatment, psycho-social care and post COVID recovery issues. Timely tele-consultation meant that scores of patients were provided early medical care and prevented from being hospitalized.
Even as oxygen bed capacity was being increased across the district, it was observed that admission in COVID facilities was leading to disconnection of patients with their family members, due to restrictions. This was especially true for those not possessing smart phones. Covid treatment protocols couldn’t be violated. However, families were especially feeling anxious to talk to patients and know their health status. The District Administration accordingly initiated e-Samvaad wherein 6 tablets have been provided to Civil Hospital, Sonipat and BPS Govt Medical College to facilitate interaction of admitted patients with their family members. During a fixed time slot, the attendant/ family members can now interact with their patient on video call through WhatsApp/ Google Meet/ Zoom. The Nursing Staff dedicates themselves for this purpose in the given time slot.
Given the exponential rise in cases across Sonipat, it was important to set up a central COVID Control Room to address all citizen queries and to manage the situation on-ground. A team of 40 teachers and operators was trained to work round the clock in three shifts. Dedicated helpline catering to all citizen queries around vaccination, testing, bed availability, oxygen cylinders, movement passes and for lodging complaints against black marketing, overcharging, were made operational.
Imaginative planning, meticulous execution and untiring efforts by this young IAS officer, Shyam Lal Poonia and his team have helped the district sail through the second wave. Positivity rate is now below 2% and hospital bed occupancy is less than 20%. They made it happen amidst trying set of circumstances.
Anil Swarup has served as the head of the Project Monitoring Group, which is currently under the Prime Minister’s Offic. He has also served as Secretary, Ministry of Coal and Secretary, Ministry of School Education.