In anticipation of a possible surge triggered by Covid19’s Omicron variant, Minhaj Masoodi evaluates the state and status of the infection management in Kashmir in the backdrop of deficits made visible by the second wave
In April 2021, when the second wave of Covid19 made headlines, a sense of panic gripped people all over, more so in Kashmir, the region numerically dominating the infections. The delta-variant triggered wave badly exposed the operational and infrastructural deficit of hospitals and other logistical requirements. People were seen gasping for breath and all of a sudden Oxygen became a scarce commodity.
In Jammu and Kashmir, the administration scrambled for a response to the mounting cases, at one time, 5000 a day. To meet the infrastructural and operational demands in the region, the government set up DRDO’s 500-bedded Covid Hospital at Srinagar’s Khonmoh. Hajj House was converted into a 100-bed Covid19 hospital. Besides, the facilities and oxygen plants were upgraded at other tertiary and secondary care hospitals.
Though Kashmir had massive morbidity, the mortality was less because the Delta variant that circulated in Jammu did not reach Kashmir. That helped tide over the crisis.
This time, however, it is a new Covid19, Omicron (B.1.1.529) that the World Health Organization (WHO) sees as a ‘virus of concern’. As reported by South Africa on November 24, it is now found around the globe. In India, two cases were also confirmed from Karnataka.
With memories of the second wave still fresh in the minds of people, there is a genuine concern about this variant’s high infectiousness and transmissibility. The variant reportedly has thirty mutations in the spike protein and as per anecdotal evidence has a high risk of re-infection also. The mutations could allow it to dodge the protection granted by vaccines.
Dr Naveed Nazir Shah, who heads the Chest Diseases Hospital in Srinagar, said that there is a chance that it might escape the immune system but cannot say anything with conformity. “Maximum vaccines are predominantly in the spike protein only. So, there is a chance that a large number of mutations may let it escape from the antibody response in the body,” he said. “There is still a possibility that vaccines will give some protection against the virus, but it depends on how the virus behaves in different parts of the world.”
Dr Nazeer said early studies suggest that despite the high infection rate, the severity of the disease has not been that high. “With the details, we have had, although omicron variant is seen to be highly infectious, but the severity of the disease is not that much. We see the majority of the patients who have been infected have been seeing fewer symptoms.”
“But it is too early to tell,” he added.
Regarding the fears of omicron creating a situation worse than was seen during the second wave, Dr Nazeer said, “When the majority of patients are mildly symptomatic, there will be no need to hospitalize, they will be able to stay in home isolation.”
“During Delta and second wave, we did not see the crisis that we saw in places like Delhi. We shouldn’t be having any problem,’ he said optimistically.
The second wave made the health infrastructure kneel on its knees. Places like Uttar Pradesh and Delhi suffered the most. Pictures of pyres burning in Delhi presented a dystopian look. Although, Jammu and Kashmir did not suffer like the people living in Delhi or UP for that matter, but in a place where the health sector is not adequate, the situation was ugly for sure.
The region has a doctor-patient ratio much below the WHO recommended ratio of 1 doctor per thousand patients. As a result, in peripheral districts, people are often referred to premier hospitals located in the city precincts, which puts a burden on the tertiary level care of the patients.
The New Hospital
Medical Superintendent, DRDO Hospital, Srinagar, Dr Rasheed Parra, however, said the preparations are much better than they were during the second wave. He said the current capacity of DRDO’s Covid Hospital is 510 beds, all oxygen capable, with 125 Intensive Care Unit (ICU) beds.
However, he said, “Every bed has an oxygen port. So, every bed can be converted into a high flow oxygen bed, if the need be.”
Availability of oxygen remained a burning issue during the second wave. People could not find oxygen readily available. They had to wait in queues sometimes, while at other times if they did, the refill cylinder was not easily available.
The DRDO Hospital, however, is dependent on the supply of liquid medical oxygen that is imported from other states. “If that supply remains unhindered and uninterrupted, there should be no problem,” Dr Parra said. “Ideally, it is sufficient if we get a tanker every third day then we can run 500 beds without any problem.”
The hospital currently has 56-kilo litres primary LMO tank and a secondary tank of around 7 kilolitres.
“Rest we have two PSA plants. They are there to support us. But they cannot support 500 beds.”
Unlike this new hospital, all other hospitals operate with inbuilt medical oxygen plants or the industrial oxygen that various units in Kashmir and Jammu manufacture.
Although the Covid19 curve was very steep during the initial months of the second wave, however, with the help of restrictive measures like lockdowns, curfews and fines levied on people for violations of SOPs besides upgrading the infrastructure at the time, the administration was able to flatten the curve by August end.
Nonetheless, during the peak, there was a vacuum felt in the administrative response with many castigating the administration for the delayed response. It was during this time, that NGOs came to the fore to alleviate people’s sufferings by providing necessary care and logistics.
The Social Groups
SRO Kashmir was one such organization. It along with other NGOs fulfilled critical patient needs by providing bulk oxygen cylinders and oxygen concentrators to the needy besides providing other necessary gadgets.
SRO Kashmir’s Mohammad Afaaq Sayeed said this time around the preparation is reasonably better should the omicron variant of the Covid19 do any damage. He said that they have doubled their equipment base this time around.
“During the second wave, we had around 200 concentrators, 190 of which were of 5-litre capacity, rest 10 litres and around 250 oxygen cylinders,” Afaaq said. “Now, we have over 250 concentrators, around 40 ten litre concentrators which are more in demand and 750 oxygen cylinders, with most of them, bulk cylinders.”
SRO Kashmir has prepared for such eventualities in advance. “We analysed the statistics after the second wave. We realised that people basically need oxygen at home. But because the valley faces electricity shortages during winter, we purchased these many bulk cylinders from Maharashtra. This is the only NGO with so much of oxygen in stock.” They have also procured generators for power back up, should people feel a need.
They have also procured non-invasive ventilation machines, portable ventilators. “We saw during the second wave; people were worried because ventilator beds were not available. Many died without ventilators. So, we ordered a few of them, besides other equipment including infusion pumps, patient monitors. Basically, all the equipment to create full-fledged ICUs.”
“At any given point in time, we can create 5-6 ICUs with our own equipment. Obviously, there will be support from the government where they can tell us there is a need and space, we can do that.”
Kashmir’s electricity woes during the winter are epic. The demand peaks during winter due to an increase in heating load. The earlier two waves either arrived in spring or early summer, during which electricity is reasonably better supplied. However, the emergence of omicron has coincided with the arrival of winter in Kashmir. There are fears among people that should the situation go south; the lack of electricity could compound the problems particularly for those who will need oxygen concentrators and don’t have electricity back up.
Chief Engineer Power Distribution Corporation Kashmir said they have increased the supplies but the demand surge is too huge. He said the consumers must opt for judicious use so that fair distribution is possible.
“Overall,” Afaaq said, “We are better prepared than the last time provided the administration can ensure the supply of liquid oxygen from the factories.” He said that NGO set-up is far better than any other region in India.
However, it is also a known fact that people, in general, have let their guard down. The use of SOPs and guidelines are rarely being observed and no distancing norms are followed. As a consequence, the cases are steadily rising, with the majority of cases in Kashmir being reported from Srinagar. Jammu and Kashmir’s active case count was almost 1700 at the time of filing this report.
Authorities are also being accused of partisan while permitting the gatherings. While the Jamia Masjid in Srinagar continues to remain locked, authorities permitted more than 26000 people fly from distant south Indian states to Shadipora for rituals in the Jhelum river.
Meanwhile, the Srinagar district administration has announced that those people who hide their foreign travel history will have to face legal punishment besides a fine of Rs 20,000. “Since there is an international airport, those travellers with international travel history will be mandatorily undergoing RTPCR tests at the airport,” District Magistrate Srinagar, Asad Aijaz, said. “And until the results of those tests arrive, they will be kept under administrative quarantine.”
Those who come out positive will be kept at DRDO Covid19 Hospital at Khonmoh and those who test negative, shall be put in-home quarantine and hotel quarantine in case of tourists for seven days during which they shall be monitored by the respective Chief Medical Officers. He also said that administrative quarantine would be of two types. One will be offered by the government. Another is the paid administrative quarantine.