Reflecting trends elsewhere in the state because of the migrant influx, Bihar’s Khagaria district, 170 km east of Patna, has seen a surge in the number of Covid cases from 0 to 96 in just 14 days. But except for two deaths — of a severely ill patient from Delhi and a diabetic from Mumbai — all are in the Level-I stage of “pre-mild” or “mild”, requiring isolation or quarantine.
Yet, officials have their fingers crossed.
The Indian Express visited Khagaria on the first stop of a countrywide series that will track hospital inventory in Covid-care facilities far from urban areas.
And what it found in the district was that in the precious time the lockdown gave, the local administration cobbled up a basic first line of defence: a swab collection centre, a 100-bed Level-II dedicated facility for moderate cases with pneumonia symptoms, and a Level-I care centre of 200 single rooms in two buildings of a training institute.
But then, what Khagaria doesn’t have is its big challenge: No ventilator or ICU in public facilities, only two in private hospitals. Only 37 government doctors for 135 posts. One ambulance with basic life support equipment out of 17 available.
With an expected influx of at least 50,000 migrants, the wishlist on District Magistrate (DM) Alok Ranjan Ghosh’s table is getting longer: At least 10 ventilators, 200 beds, 1,000 PPE kits, 20 doctors and four BLS ambulances.
“So far so good,” says Ghosh. “But with cases rising fast with the mass return of migrants, we need to be prepared for an emergency situation. Our cases started rising with the movement of Shramik special trains (on May 1). So far, 31,500 migrants have returned, and another 8,000 more are likely to come within a week.”
It was on May 8 that Khagaria logged its first four cases, all workers returning from Delhi’s Azadpur Mandi. By Friday afternoon, the number of cases had reached 96, including 44 from Delhi alone. So much so, the local railway station is now being called “virus point”.
“At present, we have 200 beds and 250 PPE kits, we have also attached all private high school buildings and hotels for Covid care. Basic infrastructure is not the issue. We need extra human resources,” says the DM.
More so, because only 25 cases have been tagged as symptomatic, and officials have moved to random screening of arrivals from high-risk areas. “Our challenge is the growing number of asymptomatic cases,” says Deputy Development Commissioner (DDC) Ram Niranjan Singh.
For Khagaria, then, the fight against a pandemic of unprecedented scale starts at the station.
Here, The Indian Express found a team of paramedical staff and policemen on duty with an ambulance stationed outside. As migrants arrive from Delhi, Maharashtra, Gujarat, West Bengal and Haryana, they are registered, screened and taken to quarantine centres at blocks, panchayats and villages.
The second step is the swab collection centre at the ANM training school, which also receives samples from the seven primary health centres in the district. On duty are two nurses and two lab technicians, all wearing PPE kits and collecting samples in the presence of a doctor.
“The samples are sent to the Rajendra Medical Research Institute in Patna for testing, and we usually get the reports in two days,” says Shashi Kant Kumar, in-charge of the centre and also manager at the civil hospital.
“We have 400 cover-all kits that are used by lab technicians collecting swabs and nurses on duty at the Level-I and Level-II centres. The hospital needs at least another 400 cover-alls for a month. There are 250 PPE kits but we need about 2,000 for a month,” says Kumar.
The doctor on duty at the swab centre, Barun M R, says the staff is “trying to be equal to the task”. “So far, we have had no moderate cases with pneumonia. But once we have these cases, we would need eight doctors in all for four shifts in a day. At the moment, if such a situation arises, we will divert doctors from the civil hospital. We have an adequate number of oxygen cylinders, including 33 smaller versions to be kept by the bedside of patients,” he says.
The next stop is the Level-I facility for “pre-mild and mild cases” at the District Institute for Education and Training (DIET). The entrance is well-guarded. No one is allowed to meet the patients, each of whom has a separate room.
Officials say most are migrant workers who are being provided additional food, apart from breakfast, lunch and dinner, on demand. “The patients have been asked not to interact with each other, but they have to share the common toilets. Food is served outside their rooms while patients are asked remain inside with doors closed,” says DM Ghosh.
The Level-II facility at the General Nurses & Midwifery (GNM) institute does not have any patient, yet. And, for Level-III treatment in severe cases, the nearest dedicated hospital is the Nalanda Medical College and Hospital in Patna.
“Khagaria is ready for the challenge,” the DM insists. “It is an unprecedented situation for all of us. We have to tide over it.”
Barun, the doctor, is more specific: “With the present infrastructure, we can deal with about 1,000 cases. But we need more doctors. And if we get ventilators, it would be a great asset.”
But the lasting takeaway is a chilling incident narrated by DDC Singh, who witnessed the ravaging effects of the virus. “On May 19, I was on duty at the railway station when a man got off a Shramik train from Delhi, and started vomiting. He was running a high temperature. He was taken in an ambulance to the civil hospital, where he died within an hour. His test report has come, it’s positive.”
This, says Singh, is why the district’s public healthcare system desperately needs those ventilators.
“Had there been a ventilator at the hospital, the patient could have been put on life support and even referred to a hospital in Patna for better treatment. He was the only son of his widowed mother. He was just 21.”
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