Covid19: Situation in UP chaotic, says Allahabad HC; lays out guidelines to streamline state’s public health infrastructure

THE Allahabad High Court Tuesday observed that the overall situation in major cities of Uttar Pradesh was chaotic with the current Covid surge.

"Whether it is day or night the ghost of Corona is marching on the roads and streets of the major cities of the state and it can be anybody's fate. Those who are resourceful will survive and the rest as histories of past pandemics, tell us may die for want of proper healthcare", the court said.

On the shortage of oxygen supply, a bench of Justices Siddharth Varma Ajit Kumar said if even after seven decades of our attaining freedom with so many heavy industries set up, we are not able to provide oxygen to our citizens, it's a matter of shame.

"Government hospital should be provided with sufficient medicines and injections including Remdesivir for patients to be treated, oxygen supply to hospitals should remain uninterrupted", the bench said.

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It said the government in its wisdom had resolved to only weekend lockdowns to break the chain and had further proceeded with some measures as a sequel to that. Even though the number of positive cases had been shown to have reduced a little, nothing remarkable seems to have been achieved on the public health care front to the satisfaction of the people, the court said.

The court dismissed the plan placed before it by the UP government to curb the pandemic. It said it wanted the government to come up with more stringent measures to stop the "Sursa like mouth" of the pandemic.

It added two things were required to be streamlined immediately: A) the management of public health infrastructure, and B) raising or enhancing the infrastructure to at least meet 1% of the city's population in every district of the state.

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It, thus, directed the government to take the following steps in Lucknow, Prayagraj, Varanasi, Agra, Kanpur Nagar, Gorakhpur and Jhansi:

• Major government hospitals should have a health bulletin system twice a day apprising people of health updates of the patients to avoid visiting attendants to hospitals. The hospitals may use large screens to give details of patients and their saturation levels. This will definitely help in reducing the number of visitors every day to the hospitals and chances of spread of further infection. The government is also directed to declare on its district portal of the above cities the occupied and vacant positions of beds in covid wards and ICUs of all government hospitals and covid assigned private hospitals and government is also directed to make wide publication of its district covid portals and sites in news papers and also through public announcement systems. 
• Mere antigen-negative report should not be a ground to throw a patient out of the hospital as such patients can still infect others. They needed to be shifted to non-Covid wards for at least a week and for this government needs to gear up to set up makeshift wards on the campus of the hospitals if there is a space so that there may not be problem of nursing staff and health workers. Availability of oxygen is to be ensured in those wards also as SPO2 level still can be on a lower side.
• Every bed in level two hospitals must be supported with a BiPAP machine and there should be availability of High Flow Cannula Mask at the rate of one per two beds and there should be ventilator available in ICUs at the rate of one per three beds available in ordinary covid wards.
• Government hospital should be provided with sufficient medicines and injections including Remdesivir for patients to be treated, oxygen supply to hospitals should remain uninterrupted. This should be ensured at all cost so that no one should die for want of oxygen. If even after seven decades of our attaining freedom with so many heavy industries set up, we are not able to provide oxygen to our citizens, it's a matter of shame. We further direct that despite rules regulations framed for transporting and disposal of industrial oxygen, it should be immediately diverted to the use of people making it Medical Oxygen and its immediate uninterrupted supply for the said purpose be ensured by govt
• Health workers should be engaged on contract basis. Also such other staff including data feeders and computer operators should be likewise employed as testing sample and their collections are to be carried out on a very large scale continuously so that a large number of the cities' population is at least tested for Covid and it gets its result in time. It is unfortunate that even one percent of the city's population of each of the major districts of the State that are hit by Covid has not been tested so far ever since the second wave has hit the State
• The management of the Doctors, medical and paramedical staff needs an urgent attention. They are all working day and night and are getting infected as well when they remain amidst the Covid patients day and night. Effort should be to rotate the staff six hourly to give it the required rest.
• Now since the existing medical health 18 infrastructure in the major cities of Uttar Pradesh has attained saturation, a sustained growth thereof by way of enhancement has to be made. While building structure is a time taking task, optimum use of existing building should be made and setting up of makeshift wards upon the open space on the campuses of the hospitals should be thought of; the Government and district administration is directed to study viability of setting up more and more Level1 covid centres with all requisite facilities so that people voluntarily approach there and stay to curb further spread and help in admission to L2/L3 as per need
• The number of ambulances must be increased immediately and these ambulances that are requisitioned or purchased must be well equipped with life saving devices;
• The Government must ensure that every death in all covid hospitals and assigned private hospitals and other Covid Centres in every district is reported 19 to a Judicial Officer to be appointed by District Judge at the end of the day. The Government shall also ensure the correctness of the data forwarded to the officer concerned each day. It is also directed that the police station Incharge officer, in whose territorial limit the cremation place is situate, shall ensure that cremation in Covid death cases is strictly followed as per the guidelines in this regard issued by the Government. He shall also ensure that the details of every covid death is entered in the register maintained at the cremation area which shall also be communicated to the concerned municipal body or Nagar Nigam. The Government shall ensure that every hospital where covid death has taken place, the dead body is packed as per the protocol before it is sent to the cremation place to be finally cremated. The Municipal Commissioners of Nagar Nigam and other officers of Nagar Palikas must be put to task to ensure disposal of dead body of a covid deceased strictly as per protocol.
• Above all the administration of government hospitals is emerging as a larger issue these days and it should be addressed. Food, sanitation and other budgetary aspects should not come in the way of treatment of those admitted and patients must be supplied with good quality food and potable water and paper napkins at every meal which should be served at least 4 times a day in all levels of covid hospitals and covid centres
• Sanitization of hospitals, its corridors and washrooms must be undertaken at least three times to four times a day
• The hospitals that have been taken over or assigned as Covid health centres must be ensured to be well-equipped with all needed medical devices including BiPAP machine High Flow Cannula Mask and ventilators and that too all should be in sufficient numbers and constant oxygen supply must also be ensured to these hospitals.

Besides, the high court summoned details from the UP govt of a number of hospital beds, beds in ICU, statistical details of oxygen supply, availability of life-saving drugs including Remdesivir etc., in govt and private hospitals in Prayagraj, Lucknow, Varanasi, Agra, Kanpur Nagar, Meerut, Ghaziabad, Gautam Buddha Nagar, Gorakhpur and Jhansi.

The court also made it clear that it would not tolerate any paperwork or public announcements declaring the steps taken to combat the virus as it was now an open secret that the government had become complacent in the belief the virus had weakened by the end of 2020 and had involved itself in other activities, including the panchayat elections.

"Had it been constantly vigilant, it would have prepared itself to face the onslaught of the pandemic in its second wave. Posterity would never forgive us if we remain oblivious to the real public health issues and let the people die for want of adequate health care", the court said.

The matter will be next hear on May 3.

Click here to read the order