Second wave: Bihar fails to learn lessons as medical infra faces pressure

Amid Bihar government claims that it is better equipped to check the spread of COVID-19 infection this time, the ground reality is different as the state’s overstretched health infrastructure is struggling to cope with the situation.

“We simply lost one year and didn’t work on our weaknesses. We have to act quickly to provide better health care to the people and save their lives,” says a Patna-based doctor. The way things are in the state, Bihar has overtaken Maharashtra as far as the spread of the infection is concerned. The COVID-19 spread in Bihar is 22.47 per cent, the highest in the country. It is followed by Uttar Pradesh (20.02 per cent) and Odisha (15.73 per cent).

Despite these grim figures, many shops remain open till late in the evening even when the government has announced a shutdown from 7 pm till April 30 and functions continue at several religious places despite an order for their closure for the general public.

One of such religious function at Govindpur Devi Daura village in Patepur block of Vaishali district is on without any hindrance. The function, which started on Tuesday (April 13), will continue for 10 days. Nearly 500 people participate in the temple ceremonies daily. Such religious functions, coinciding with ‘Chaitra Navratri’, are being organised across the state.

Transport services, too, remain unaffected — auto rickshaws, mini-buses and other modes of public transport are packed with the people as Covid-19 protocol is thrown to the wind.

According to the state official data, the number of positive cases has increased alarmingly in the last two weeks, from 1,907 cases on April 1 to 23,724 cases on April 14 till 4 p.m. Bihar’s recovery rate stands at 91.4 per cent now, registering a significant fall after it recorded 99.06 per cent on March 26 this year. Till 4 pm on April 14, 1,651 people have lost their lives due to the pandemic.

Delay in the RT-PCR reports

A senior health official, posted at a government hospital in Supaul district, said, “As per the guidelines, the RT-PCR method is used for 70 per cent tests, but samples collected at the hospital are sent to Patna Medical College and Hospital (PMCH) for the confirmation.” He said it takes almost a week before test reports reach from Patna and for that period, there is no restriction on the movement of suspected patients. So, there is always a danger of a positive person spreading the infection, he said.

The official said that districts are given the target of performing anywhere from 500 to 800 RT-PCR tests every day, depending on the population of a district. “My hospital is waiting for reports from PMCH for as many as 4,000 samples,” said the health official. He said that RT-PCR test reports should be available in 24-48 hours so that medical intervention could be made immediately and cases could be prevented from going out of control. The situation is similar across the state as swabs collected at the district hospitals are sent to various major hospitals in cities like Patna and Darbhanga for the RT-PCR testing and preparation of test reports. Delays in getting reports are common. People are complaining that they do not receive messages about the status of their tests on their registered mobile phones.

Laxity in monitoring patients

A government doctor said monitoring of patients in home quarantine is not adequate. Recalling his own experience, he said that last year, in most cases, people once tested positive were sent to COVID care centres or quarantine centres and they were allowed to return to their homes till they tested negative, even if it took four tests one after another. He said when patients are home-quarantined, there is not effective monitoring as sometimes the patients don’t like medical teams’ frequent visits to their homes.

In several cases, people do not follow home quarantine norms and they even put others at risk of contracting the virus by moving out from their homes. No re-test of a patient is performed and it is assumed that one should test negative for the coronavirus after two weeks.

The monitoring of patients becomes more difficult after their names are removed from the system after 10 days.

Covid patients are quite reluctant to be quarantined at the designated centres and instead insist on home quarantine, said another health official. They are ready to give an undertaking that they would be held responsible if something happens to them, he added.

Migrant workers

Altogether 223 migrant workers who arrived from Maharashtra by various special trains have tested positive till April 13. Divisional Railway Manager (DRM) of East Central Railway (ECR) Sunil Kumar said that detection centres have been opened on railway platforms at various stations, including Danapur, Patliputra junction, Patna junction and Rajendra Nagar terminal. Most trains coming from Maharashtra terminate at Patliputra junction and those passengers testing positive are kept in the isolation centres.

Also read: As states face Remdesivir crunch, people turn to black market to save kin

Meanwhile, Chief Minister Nitish Kumar has instructed officials to revive quarantine centres to tackle the migrant rush in the state. But it has to be seen how effective it would be in days to come. To check the virus spread by those coming from Maharashtra, Punjab and Kerala, Patna airport director on the direction of district administration has asked airlines not to allow passengers to board planes until they possess RT-PCR negative reports. After landing in Patna, passengers have to spend 10 days in home quarantine.

Scarcity of beds

COVID beds at nearly 20 government and private hospitals in the state capital are already full even as All India Institute of Medical Sciences (AIIMS), Patna, Patna Medical College and Hospital (PMCH) and Nalanda Medical College and Hospital (NMCH) are finding it difficult to admit referred cases. In the private sector, Paras HMRI and other major hospitals are also facing similar problems.

Bihar has about 1,700 ICU beds, out of which nearly 1,000 beds are in the private sector hospitals. Bihar has over 300 ventilators in the government sector and another 500 ventilators in the private sector.

State health minister Mangal Pandey said 30 additional beds for COVID patients have been provided to AIIMS, PMCH and NMCH. There is also a possibility that AIIMS, Patna will be declared as a dedicated COVID hospital.

Is it different from the last time?

One of the significant differences in this wave is that the testing has begun on a large scale from the very beginning. Bihar Health Minister Mangal Pandey says the spike in cases this year was because of higher testing in the state. He said the state was testing around 90,000 samples daily that was 30 times more than the 3,000-4,000 samples being tested in the initial three months of the pandemic in the state during the first surge.

Also read: Children too highly susceptible to COVID-19 in second wave

Another difference is that this time, infection among children below 15 years is apparently on a higher side this time. The infection among children below 15 years of age was less than one per cent in the state capital last year but the figure has jumped to around 10 per cent this time. Three children below 15 have succumbed to the infection in the last 10 days.

Patna Civil Surgeon Dr Vibha Kumari Singh has said that children who are allowed to move out to play games run the risk of exposure to the virus.

Dr A P Sinha, posted at a government hospital in Bhojpur district, says the government has the advantage of the last year’s experience. He said the government is not finding much difficulty in identifying and opening quarantine centres this time as it already did last year. There is, however, more emphasis on home quarantine this year, he added.

Testing & vaccination

The workload of doctors, paramedics and nurses has increased tremendously as vaccination is going on along with the testing. “They are coping with the increased burden but there is always a fear of fatigue in the workforce,” a doctor said.

An official at the health centre said the higher-ups are also fixing separate targets for both vaccination as well as testing. Since health officials have to meet the targets with the same workforce, they face serious challenges.

According to the official data, the number of total beneficiaries under the vaccination programme (both first and second phases) is 54,64,210 while 1,32,426 were vaccinated (both first and second phases) on April 14.

Shortage of oxygen & Remdesivir

Private hospitals in the state capital are facing shortage of oxygen and Remdesivir vials. President-elect of Indian Medical Association (IMA) Dr Sahajanand Prasad Singh says almost all private hospitals are confronting with the problem of oxygen shortage.

“The state government should take immediate steps to ensure that oxygen is available in private hospitals as well as in government hospitals,” he said, adding officials should also pay surprise visits to hospitals to check whether oxygen is available in cylinders.

Remdesivir vials have vanished in the state capital and are being sold in the black, allegedly as high as Rs 15,000 per vial. Dr Singh says raids should be conducted to arrest black marketers.

The recovery rate will improve to 95 per cent if the government ensures availability of oxygen and other drugs used in the COVID treatment in hospitals, Dr Singh said.