1. We lost over 2300 people in the Second Wave, between April and now. What is your assessment of our performance in reduction of mortality?
AD: Compared to average mortality rate at National level, ours mortality rate is lower. We have been able to keep death under control. We could have been further able to reduce the deaths had we not had a scenario where people showed up at the hospitals late, or tested late when the symptoms were full blown. The second factor that contributed to deaths were the Variants of Concern that were circulating in J&K. We had Delta and Alpha variants reported in a huge proportion of our cases. The Delta variant was more severe while Alpha variant was more severe. These two reasons contributed a lot to our mortality. Of course there is always a scope to improve our performance as far as clinical care is concerned. We are trying to do that and reduce the mortality further.
2. Second wave mortality was lesser than the first wave mortality in terms of percentage. Many attribute it to the mutated virus. What changes were made infrastructure-wise to minimise deaths?
AD: Our most significant achievement has been that no one was denied a bed and no one was denied oxygen. Even at the peak, we had vacant beds. Many people opted to stay home and reported late to hospitals, many times resulting in an uncalled for outcome – severe illness or death. But we had a good capacity to tide through the wave because healthcare infrastructure saw a major boost.
We ramped up capacity of Category I, II and III Hospitals and the number of oxygen beds and number of ICU beds. Cat I beds increased from 800 to 2200, Cat II beds increased from 1800 to 4200, Cat III beds increased from 4100 to 12000 beds. We were able to increase the much needed oxygen supported beds from 660 to 6100 beds, nearly nine times. The ICU beds increased from 215 to 687 now. This was a major exercise to find beds.
3. Peripheral healthcare has not been able to share the burden of COVID19. What have been the major lacunae?
AD: That is right to some extent but you see we have been able to increase our ICU beds 2.5 times, a good number of these in the peripheral sector. In each of our DRDO Hospitals – Jammu and Kashmir, we have been able to set up 125 ICU beds. Our referral hospitals are meant to cater to severely sick patients and we were able to create more ICU beds at GMC Jammu, GMC Srinagar’s SMHS Hospital, SKIMS Soura by utilizing ventilators from field (peripheral healthcare), those that were yet to be installed and utilized. These had been arranged through the PM Cares fund.
We were able to increase ventilators but ventilators have a limited use in our settings. Not many families opt for invasive ventilation for their patients. BIPAPS are being used well and we have a good number of those now.
4. Oxygen capacity increased in April and May but high-flow is still a problem in most districts? What is happening on that front?
AD: It started in August last year when 82 oxygen plants were sanctioned for us. Of these, 43 have been made functional, many at district level. It increased our capacity to 53000 liters per minute from 15000 liters – 350 percent increase. We are in the process of installing and making the rest of the oxygen plants functional to augment infrastructure at all levels.
Only late last week, GoI sanctioned 32 more oxygen generation plants for us and work will soon start on these. We are also setting up oxygen generation plants in sub-district hospitals and primary health centers with World bank assistance. We will have 30 oxygen plants, 15 each for Jammu and Kashmir divisions. All of this sums up to 144 oxygen generation plants in the UT. Not all of this is in big hospitals. A number of peripheral hospitals, district level and lower, and new GMC have been included and their oxygen capacity is witnessing a major boost.
5. Much in the pipeline, what is the timeline for completion?
AD: Many of these are under progress and by August, we hope to see a majority of these up and running.
6. Before the third wave is projected to hit?
AD: Let us hope we don’t have the Third Wave.
7. ICUs have a limited role but there are none for COVID out of Srinagar. Any plans on this?
AD: The Action Plan submitted by the Apex Committee on Third Wave preparation has recommended that ICU beds be increased in medical college hospitals. If we are able to get financial support, we would want to have more ICU beds in these Institutions. We have already proposed to GoI and the State Government and we are hopeful to get a sanction on these soon.
8. A ventilator is nothing without manpower and manpower is scarce to come by. Has J&K overcome any shortage in this regard?
AD: We have two strategies to improve our manpower scenario – train the existing human resource for delivering critical care and recruit, wherever necessary. We have issued an order to all the medical colleges in J&K, directorates of health and others to identify and send us a list of people who we will get trained in intensive and critical care. These will be trained in GMC Srinagar and Jammu, SKIMS Soura and probably outside too if necessary. We have also recruited manpower to work in ICU settings at our two new DRDO hospitals – Anesthesia Assistants, Lab Technicians, Nurses, Paramedical staff, X-ray technicians and other categories. Recruitment will continue and will be need based.
9. Healthcare has been suspended for all other patients except COVID. Any chance it will be resumed soon?
AD: We understand the significance of resuming non-COVID activities as soon as possible. We have started OPDs in GMC Jammu recently, in GMC Srinagar too OPDs will restart soon in a phased manner. We are working closely to get our designated hospitals resume non-covid activities and equipping the DRDO hospitals to cater to the requirements of the pandemic, as much as they can. Right now, the patient load has decreased so we can do that.
10. Third Wave is being feared for its perceived magnitude. What is our preparation?
AD: The Third Wave Committee that has been having consultation with specialists from all the relevant fields on better preparation for third wave has been very strongly recommending that we are able to identify variants early. This is possible if we start Genome sequencing here and we are exploring the possibilities on this front. It is also important, as per the Committee, that we have a better and more vigorous surveillance to pick up early trends. We also need to ramp up our ICU capacity and as I said, it is underway. We are also improving our Ambulance Services and making Mobile Testing possible for far-flung areas.
11. Are we seeing any progress on projects like Children Hospital?
AD: Children Hospital has been delayed due to the various changes it saw in the project plan since its inception. It was a 200 bedded hospital earlier which later changed to 500 bedded Mother and Child Hospital and then later to an exclusive Children Hospital. Then there was cost escalation and many administrative approvals were required. It should be complete now.
12. Medical Education, especially undergraduate education, has also taken a hit. What is the outlook for that?
AD: As the situation improves, we will consider starting MBBS classes on campuses. Coming months are crucial. Post-graduate classes were never halted and are going on, examinations too.