Adequate preparation is required to tackle the speculated third wave of Covid-19 infections, according to experts in Lucknow.
The role of well-trained paramedical staff and zone-wise management of medical services will be important in this respect, they said.
“A first referral system is required where anyone with early symptoms can be guided and assisted for quick admission. Such a system wasn’t there during the first and second waves,” said Dr Piyali Bhattacharya, senior paediatrician at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) general hospital.
Dr Bhattacharya is a member of the team on skill development (paediatrics) that is training medical staff across the state to prepare infrastructure and manpower for the third wave.
“Quick admission will reduce the need for ICUs,” Dr Bhattacharya said.
“We are already developing infrastructure and adding oxygen-supported beds every day at hospitals along with PICUs (paediatric intensive care units) and NICUs (neo-natal intensive care units),” said Prof Kauser Usman, head of the department of geriatric medicine at King George’s Medical University (KGMU).
Lucknow has about 250 paediatricians, including 23 posted at government hospitals. Two big paediatric Covid centres at KGMU and Lok Bandhu Hospital are ready, and more are coming up.
In September 2020, when the first wave struck Lucknow, a total of 24,719 cases were reported during the month and there were 335 deaths. During the second wave in April, 1,17,971 cases and 586 deaths were reported.
“The second wave was stronger and the infection spread was faster by at least five times. The deaths, too, were more, despite the fact that we had experience from the first wave,” said Dr Usman.
“You don’t know how many beds will be sufficient, but one thing is known from experience that given quick medical assistance, the number of serious patients can be kept low. Hence developing a large chunk of beds with oxygen, medicine and trained paramedical support will help keep the need for ICU beds low. This is what we need to do for the third wave,” said Dr Abhishek Shukla, secretary general, Association of International Doctors.
Doctors also said setting up paediatric ICUs and neonatal ICUs with trained staff was a must as medical care of children was different from adults.
“More than having just the infrastructure, if we have adequate number of trained paramedical (personnel), we can ensure not many children will need ICUs. Also, the city should be divided into zones and each zone should be managed by a separate officer,” said Dr PK Gupta, former president of Indian Medical Association-Lucknow.
“It would also be important to make a list of Covid hospitals in advance. Hence when a wave comes, there will be no confusion or delay in starting Covid treatment by those pre-listed hospitals,” said Dr Sandeep Kapoor, director Healthcity hospital.
“This way, non-Covid facilities will also run smoothly,” he said.
What Lucknow has developed
In the second wave, Lucknow had about 9000 beds at 72 government and private medical facilities. This number included over 1400 ICU/ventilator beds. Doctors said the number of beds needed to be increase further.
There are 308 beds for children who may need admission in hospitals during the third wave. A 156-bed unit with liquid oxygen tank is ready at KGMU and this includes a 50-bed PICU. Balrampur Hospital has 40 beds with ventilator support for children in the paediatric ward. Lok Bandhu hospital has kept a 27-bed PICU (paediatric intensive care unit) ready while a 100-bed women. A child Covid unit too is ready and another 100 beds can be added here.
The Civil hospital has a 10-bed PICU and a separate paediatric unit is functional on the hospital campus. A 60-bed paediatric ward will be ready by June 15 at Dr Ram Manohar Lohia Institute of Medical Sciences. All these units will have paediatricians and (paediatric management) trained paramedical staff.
“Not all children or patients need hospitalisation. Also, children above 14 years can be put on the ventilators used for adults. Hence more than number of dedicated paediatric hospital beds, quick response will be significant the next time we have a Covid wave,” said Dr Bhattacharya.
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