WORSENED: The condition of the patients who have been shifted to the super specialty block has worsened due to the cyclone. The CM claims that it’s a minor matter and it happened and the windows were left open.

By Rajan Narayan

The new wave of covid-19 which has led to 2,152 deaths as on May 18 and cumulative cases of 1,37,418 which has been cited as the city with the highest positivity rate and the lowest vaccination rate is entirely a result of complete mismanagement by the Chief Minister Pramod Sawant and Health Minister Viswajit Rane…

BOTH at the national level and the level of the states, there has been gross mismanagement with respect to the second wave of covid-19. Indeed, if as a country we had taken precautions, perhaps there would have been no second wave. The two major contributors to the second wave have been the kumbh mela and the elections in five states. In violation of all covid protocols and common sense millions of sadhus and ordinary pious citizens were permitted to indulge in the holy river Gang snan or bath at Haridwar amidst puja revelry at the maha kumbh mela. We are just beginning to see the consequences as literally thousands of dead bodies float down the river Ganga. People in the hinterland don’t even know what the double mutant coronavirus covid-19 is nor the need to take it seriously. The majority of the heads of the Akharas (heads of the various religious groups) are either dead or infected with covid-19. The number of positive cases in the largest state in the country that is Uttar Pradesh (of Chief Minister Yogi Adityanath fame) has climbed up to 15 lakh with as many as 17,000 deaths.
Among those who have been infected are UP Chief Minister Yogi Aditiyanath and half his cabinet. Besides covid-19 the further contamination and infection of the river Ganga with the thousands of rotting dead bodies may give birth to other epidemics. Indeed, it is a case of “Ram tere Ganga maili” and that too after so much funding going into the cleaning up of one of the country’s most cherished and worshiped rivers. Even as the construction of the new Ram temple is speeding ahead in Ayodhya!

EC SPREAD COVID-19

THE other major contributory cause to the fresh wave of covid-19 pandemic and with casualities exceeding 2.50 crore with deaths exceeding 2.7 lakhs, is the gala elections held in the five states of West Bengal, Assam, Tamilnadu, Kerala, Puducherry. Some of the states witnessed huge poll rallies observing neither masking nor physical distancing. The PM himself addressed as many as 22 meetings in West Bengal alone. Home Minister Amit Shah and Prime Minister Narendra Modi led the campaigning in the states which went to polls.They were so obsessed with winning the elections that they forgot all about the virulent contagion covid-19.
In every one of the states where elections were held there has been a huge increase in the number of covid-19 cases, especially in Tamil Nadu, Kerala and West Bengal. To the extent that the High Court of Tamil Nadu has accused the Election Commission of being guilty of murder by spreading covid-19 because it permitted the huge rallies and did not even enforce minimum precautions like masking and distancing. After being sworn in the new chief ministers of the states concerned have had to get themselves admitted in covid-19 hospitals.

NOT ENOUGH OXYGEN

IRONICALLY, in many states in the country, including the national capital, New Delhi and our own Goa, a majority of the deaths are not due to covid-19 but due to shortage of oxygen. This is primarily because the Central government assumed responsibility for the distribution of oxygen and failed to do it speedily and in time to save the patients.
As in other spheres PM Narendra Modi, Home Minister Amit Shah and Health Minister Harsh Vardhan have proved to be totally incompetent. Regrettably they have been favouring BJP-ruled states at the expense of states ruled by the Opposition parties. The most notorious example is that of the country’s national capital of New Delhi. The Supreme Court had to order the Central government to make available to Chief Minister of Delhi Arvind Kejriwal 700 MT of oxygen that had been agreed on. On an average even as the cases were going up New Delhi were getting only 500 MT of oxygen.
In the case of Goa for want of expert leaders and shoddy advance planning, over a period of 12 days, over 300 people died — due to a drop in the pressure of oxygen for covid patients in the Goa Medical College and hospital, which is the primary public healthcare centre in Goa.
Prime Minister Modi in Delhi and the Chief Minister of Goa Pramod Sawant are both repeating each other’s platitudes like parrots, that there is no shortage of oxygen but it is just a question of logistics. In simple words oxygen is available in the western states in the country but it has to be transported to the rest of the country which are covid hotspots such as Karnataka, UP, Kerala and West Bengal. Oxygen is transported in tankers and the road network in India is so bad that it can take 10 to 15 days for oxygen to reach the states and cities where there is as shortage of oxygen (or black marketers of oxygen have taken over the job of dispensing oxygen).
So that is why we now see images on TV of Indian Air Force and private transport aircraft moving oxygen cylinders from one part of the country to another and from Saudi Arabia to Singapore to India.

LOGISTICS PROBLEM

THE huge spike in covid-19 cases has led the country to take desperate measures like running oxygen trains. This simply means that dozens of oxygen tankers are loaded on to rakes which transport the oxygen to the covid-19 hotspots. The fact that the new variant is very virulent and can infect the lungs of patients within 48 hours makes the urgency of moving oxygen rapidly much more important. Which is why India is importing large quantities of not only oxygen but also oxygen concentrators. This do not have to be refilled and can be used 24×7. But the concentrators may be used in mild to medium cases because they have a capacity of a maximum of ten cubic litres of oxygen. The minimum requirement for a serious covid-19 pateint is 60 litres per minute.
In the case of the GMC where more than 300 deaths have taken place between April 30 and May 12, 2021 by the admission of GMC’s Dean Shivanand Bandekar himself, the situation is more complicated. In most major modern hospitals oxygen cylinders are built on stilts at the top of hospital blocks. Oxygen flows downwards through piping to the bedside of the patients in the wards and rooms. In the case of the GMC the main oxygen supply tank is literally underground, much like underground water tanks in many Goan buildings and houses.
Oxygen movement needs trolleys, each stocking containing 48 cylinders. It is obvious that the sole supplier Scoop Industries Pvt Ltd (Scoop Oxygen), given a ten year contract, does not have the cylinders needed to transport oxygen to the main GMC building. The reference to expert drivers is because the trolleys have to be reversed down a narrow passage leading to hospital basement where they have to be aligned properly with the underground storage tank.
This whole process of manually filling the tank not only takes time but leads to a drop in pressure when refilling is on. Most deaths have been attributed to this obsolete method of filling oxygen tanks at the GMC. This has gone on for over a fortnight and a strict warning has gone from the Goa Bench of the Bombay High Court to the GMC powers that be to start the process of putting up its own oxygen tanks so that trolleys will become unnecessary.
Fortunately, the new super speciality block at the GMC to where 350 of the 1,000 odd covid patients have been shifted, has a separate oxygen tank. The South Goa District and North Goa District hospitals have oxygen tanks, but no ventilators.

DESPERATE SHORTAGE

CHIEF MINISTER Pramod Sawant is right. Not only in the case of oxygen but also in the case of other requirement like medicines and oximeters, there is a desperate shortage. We can understand a shortage of oximeters needed to give to patients who opt for self-isolation. But it is scandalous that there should be a shortage of oximeters in the GMC and other hospitals. Oximeters cost barely Rs2,000. If bought wholesale they should cost even less. Surely the GMC, which is spending in multiple crore on all aspects of covid-19, ranging from testing to treatment can afford to make sure that it has a sufficient stock of oximeters. Which are even more important than oxygen cylinders as oximeters keep a patient in touch with oxygen saturation in the blood. These are simple instruments measuring oxygen level in the blood, reportedly a key factor indicating the status of the lungs, whether they are okay or in need urgently of oxygen support so that a patient’s respiratory function is maintained. We are now told the GMC has even stopped giving essential medicines to patients who have been admitted and are asking relatives to buy the required drugs, absurdly from the Wellness chemists which are sole suppliers of medicines to the GMC.

TOTAL MISMANGEMENT

NEVER have we seen such total mismanagement both at the state and the national level. Imagine needing four IAS officers stationed at the GMC all night to ensure that there is no drop in oxygen pressure — to prevent any more fatalities. Despite the presence of the four IAS officers there were 13 deaths on May 15. Surely this is the responsibility of doctors and hospital staff on duty and not IAS officers who may not even be able to recognised a drop in blood or oxygen pressure.
In theory the government has a website which is supposed to inform you of the availability of beds in various covid hospitals. None of the numbers to be accessed work when required. In any case if you do not have a smartphone or a computer you will not know where the beds are available. The biggest problem in Goa is that the majority of those who test positive everyday simply opt for home isolation rather than go to the nearest government covid centre.
Most patients probably cannot afford to go to corporate hospitals or private nursing homes which have been taken over by the government to run as covid centres. From Monday, May 17, the government has taken over admissions to 50% of the beds in private hospitals which have minimum faciliteis for the use of covid-19 patients. This includes hospitals which have only one ventilator or two ICU beds. The majority of the private nursing homes and the even the corporate hospitals, employ Ayurveda and homeopath staff to be resident doctors. So the other major problem is trained manpower with experience in dealing with covid-19 patients.
The Goa branch of the Indian Medical Association is supposed to provide at the very least tele-consultation to patients opting for home isolation. In practice none of them do so. And if you want a home visit from a private medical private doctor it can cost you between Rs10,000 to Rs20,000 per visit.
Whenever there is a major disaster, the first priority is to set up a central control room. When Goa was hit by the cyclone Tauktae the Disaster Management Agency of the Government of India set up a control room to co-ordinate the management of the disaster. In the case of covid though which is a much bigger disaster compared to cyclone or storm there is no around the clock central control room in Goa in charge of covid operations. Nobody knows who is in charge.
Even worse is the fact that in states like Goa there are on-going one-upmanship conflicts between ministers, like the one in Goa between Chief Minister Pramod Sawant and Health Minister Vishwajeet Rane. Many claim that in fact the oxygen crises is partly because of alleged disagreement on commission cuts to go to whom on providing the anti-parasitic drug Ivermectin. The drug has been selected to be given as a preventive measure to potential covid patients for five days. The CM and the Health Minister keep contradicting each other and blaming each other for every problem connected with the management of covid-19 in the state. We do not know what to believe as news dailies carry conflicting reports, depending on whose side they take.
For instance, a daily close to BJP President Tanewade, himself a covid-19 victim, has claimed that the executive committee of the BJP is not happy with the manner in which the CM has been handling covid-19. Pramod Sawant has been putting all blame on his Home Minister Vishwajit Rane. But surely the buck stops at the CM’s door.
The good news is that the lockdown which the CM insists on calling curfew seems to have partly worked. The number of recoveries are more than the number of new cases lately. With the completion of the setting up oxygen tanks at the GMC the problem of mortalities due to a drop in oxygen pressure may be solved.
However, unless there is a professional approach and the entire process from testing to treatment to vaccination is co-ordinated and streamlined professionally — covid-19 cases in Goa may not come down as speedily as we hear they are coming down in Maharashtra. Maharashtra has been handling the covid crises on a war footing far more competently than Goa.