Gujarat High Court
Surat Citizens Council Trust Through ... vs State Of Gujarat on 17 August, 2020
Author: Vikram Nath
Bench: Vikram Nath, J.B.Pardiwala
C/WPPIL/42/2020 ORDER
IN THE HIGH COURT OF GUJARAT AT AHMEDABAD
R/WRIT PETITION (PIL) NO. 42 of 2020
With
R/WRIT PETITION (PIL) NO. 116 of 2020
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SUO MOTU
Versus
STATE OF GUJARAT & 2 other(s)
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Appearance:
SUO MOTU(25) for the Applicant(s) No. 1
MR. KAMAL TRIVEDI, LD. ADVOCATE GENERAL with MS. MANISHA
LUVKUMAR SHAH, LD.GOVERNMENT PLEADER with MR. DHARMESH
DEVNANI, LD. ASST. GOVT. PLEADER for the Opponent(s) No.
1,2,3,5,6,7,8,9
MR NM KAPADIA(394) for the Opponent(s) No. 4
NOTICE SERVED(4) for the Opponent(s) No. 10
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CORAM: HONOURABLE THE CHIEF JUSTICE MR. VIKRAM NATH
and
HONOURABLE MR. JUSTICE J.B.PARDIWALA
Date : 17/08/2020
COMMON ORAL ORDER
(PER : HONOURABLE MR. JUSTICE J.B.PARDIWALA)
1. In response to the order passed by this Court dated 24th July, 2020, the State Government has placed on record the report as regards the conditions prevailing in the City of Surat and the areas situated at the outskirts. The report reads thus;
Page 1 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021C/WPPIL/42/2020 ORDER "REPORT ON BEHALF OF THE RESPONDENT STATE PURSUANT TO THE ORDER DATED 24.07.2020 PASSED BY THE HON'BLE COURT The present Report in being submitted in the captioned proceedings on the basis of the instructions provided by the concerned Departments of the State Government, presenting the important actions taken in compliance with the directions issued pursuant to the order dated 24.07.2020 of this Hon'ble Court with reference to various aspects referred to hereunder.
1. This Hon'ble Court whilst noting the conditions prevalent in the city of Surat and its outskirts observed vide order dated 24.07.2020. that the state ought to have been more vigilant and prepared to meet with the rapid spike of the pandemic in the city of Surat. The order records of the Hon'ble Court being informed that the testing was not ramped up and even the basic awareness to remove the fear psychosis was lacking. In so far as Surat is concerned the Ahmedabad model only had to be replicated, to prevent it going from bad to worst. Concerned at the escalating mortality rate in Surat the Hon'ble Court issued certain directions seeking a response at the earliest.
2. At the outset it is submitted that with the outbreak of pandemic in the country, foreseeing the impact, preparation for the management of the pandemic, was undertaken by the State of Gujarat since January.
2.1 Surat has witnessed very challenging times during the Covid pandemic with limitations imposed by the lockdown, unpredictable clinical course of illness and need for isolating the Covid patients. The city of Surat uniquely is faced with the challenge of protecting approximately 11.5 lakh migrant workers with over 12 linguistic communities residing in close congested habitats. Though as on today, all of them had been transported back to their native places, many of them, have started returning as factories and industries have commenced operation Seeing the rising trend in Surat, from 30.06.2020 to 10.07.2020 the entire team of experts including the Principal Secretary with other Health officers personally, camped from 30.06.2020. to 10.07.2020. ensuring that a robust and effective response mechanism is well in place to combat the probable challenges likely to erupt. Through the efforts of the State Government, in every domain right from testing per million per day, recovery rate, growth rate of new cases, doubling rate, death rate, operational Dhanvantri raths, 104 calls attended, total bed availability, the Page 2 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER district today is in a far better position to defeat the pandemic and the said fact is reflected from the trends right from 4 th July 2020 to 10th August 2020 referred to herein under. Annexed herewith and marked hereto as Annexure R1 is a copy of the chart indicating trends on the various parameters of Testing per million per day, along with graphs depicting actual data. Under her guidance the team daily monitored, the surveillance and enforcement work in the containment area reviewing and monitoring the treatment, logistics, patient facilitation with a huge augmentation with the bed capacity with the inclusion of stem cell and kidney hospital buildings.
2.2 It is pertinent to specially mention that on the 4th of July, the Hon'ble Chief Minister, Hon'ble Deputy Chief Minister, Chief Secretary, Chief Principal Secretary to the Hon'ble Cm. and other senior officers visited Surat, where they had a day long review of the preparedness to combat the pandemic, with doctors, corporation officials, key functionaries etc. On the 2 nd of August, on his birthday he once again visited Surat for the secordtime with the entire team refered to herinabove. Corona warriors and plasma donners were also felicitated.
2.3 First of its kind Community Covid Isolation Centers (17) in number have been made operational in the district, to ensure that patients recover in their comfort zones. These CCICs, which were rolled out for the first time in Surat and have been recognized by the Govt of India team as a national best practice 2.4 The strategy evolved and followed in Surat includes
1. Intensified Dhanvantri Rath operations
2. Rapid response to 104 helpline to catch pateints at early stage through active surveillence
3. Aggressive Testing
4. Micro containment Strategy
5. Suraksha Kavach Committee
6. Extensive use of Pulse Oximeter
7. Zone-wise setup of war room for efficient home isolation follow up
8. SOP and Training for diamond, textile industry workers,
9. SOP for migrant labour returnees Page 3 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
10. Treatment using Plasma Therapy
11. Community COVID Isolatation Centers
12. Augmentation of Health Infrastructure and availablity of critical medicines and injections.
A bare perusal of the above details would amply satisfy the Hon'ble court that the State Government, long prior to the order passed by the Hon'ble Court, attended to the apprehended outburst of the pandemic in the district of Surat on a war path. The print and electronic media sometimes not being informed of the complete factual data, report on the basis of the information shared through various unverified sources. Often this information is incorrect and contrary to the facts on record. As enumerated here under, the State Government has taken effective and prompt measures to arrest the spread of the pandemic.
A. Response to queries relating to the conditions prevailing in the city of Surat and areas in the Outskirts The Hon'ble Court has made certain observations regarding the conditions prevailing in Surat and has sought the response of the Respondent State on eight (8) questions. The question-wise response is as hereunder:
A. What preventive steps have been taken so far by the Health Department in Surat?
Large number of initiatives have been undertaken by the Surat Municipal Corporation (SMC) to fight COVID-19 and it's apprehended escalation, details of which are as under:
i. SMC COVID-19 Tracker: Tracking of home quarantined, positive patient contacts, ARIs individuals, daily health update and their follow-up using Mobile App and Web based application.
ii. TTT IQ Strategy (Track, Test, Treat, Isolation and Quarantine): As part of TTTIQ strategy, SMC has undertaken intensive surveillance for early identification and management of COVID-19 patients. As a part of the strategy, intensified surveillance activities by active surveillance (house-to-house) and passive surveillance through Jamini application have been implemented in Surat.
iii. Containment strategy: A scientific approach has been adopted for containment management. Based on the multiple Page 4 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER criteria like number of positive cases, population density of area, geographic situation of area etc, a containment area is finalized and declared as a Containment zone through a published notification. Door-to-Door surveillance activity, Fever clinics, IEC activities, etc. are also carried out in the containment zone.
iv. Suraksha Kavach Samiti: To ensure strict enforcement in Containment Zone and to help citizens under containment zone for their basic needs, 122 Suraksha Kavach Samitis have been formed incorporating a doctor / paramedical staff, president / secretary of society, school teacher, student, recovered COVID-19 patient, women/ youth group members and members of NGO / Welfare groups. More than 5000 volunteers are involved as part of Suraksha Kavach Samiti for various tasks.
v. Augmentation of Health Infrastructure: Along with various initiatives, it was important to manage infrastructure for Government hospitals to manage COVID-19 patients. SMIMER (Surat Municipal Institute of Medical Education & Research) infrastructure has been further increased with converting multilevel parking into "SMIMER PLUS" COVID-19 health facility along with existing SMIMER hospital, with capacity of 540 isolation beds with Oxygen beds exclusively for COVID-19 patients. The recruitment process has been completed and patients are provided quality management.
vi. Community COVID Isolation Centers (CCIC): With the rise in COVID-19 positive patients, Surat Municipal Corporation has persuaded the local communities to join this fight by creation of Community Care Isolation Center (CCIC). Under this unique initiative, the community halls generally used for marriage and other social functions are converted into Community Care Isolation Centers. These CCICs are used to provide treatment and isolation facility to the asymptomatic or mild-symptomatic Covid19 positive patients for whom it is not possible to receive home based treatment under isolation due to space constrain. Community manages the food, water supply and even medical treatment by engaging the doctors and other medical and paramedical staffs of their respective community. For those communities, which do not have their own community hall or other infrastructure, SMC has supported by providing them with municipal community hall, which are then used and converted to CCIC by different communities. This is a unique initiative wherein large scale community participation is generated and large facilities across different parts of the city are created to treat the COVID-19 patients and a large pool of medical professional has also been engaged in the fight Page 5 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER against COVID-19. So far 17 CCICs are operational with 1,109 bed capacity which can be augmented by additional 1,085 beds, if the need arises.
vii. Dhanvanatari Rath: With a view to reach out to the high risk area and provide the door step diagnosis and testing facility, Surat Municipal Corporation under the guidance and assistance of Government of Gujarat introduced "Dhanvantari Rath" which is a mobile medical van. Dhanvantari Rath provides various services like Rapid Antigen Testing, ARI case management, referral, prophylaxis, SPO2 measurement, fever/malaria/other case management, IEC activities to increase use of mask, sanitizers and hand hygiene practices. On a daily basis over 110 Dhanvantari Raths are operated across the city with average OPD of 275 individuals. The Dhanvantari Rath allocation is based on the data generated from Itihas portal and the data of the ARI patients including those consulting private practitioners. Municipal Councillors, society presidents/secretaries and other leading individuals are sensitized regarding the benefits of early identification and treatment and thus, utilise the Dhanvantari Rath extensively. The planning is done well in advance and notified to the individuals so that maximum response is received. The Rath is also accompanied by separate vehicle with Public Address System which roams across the locality and announces the availability of Rath at the door-step of the citizens.
viii. War Room: Surat Municipal Corporation has a core team for planning and implementation of various strategies and analyzing the trend and current situation in entire city through "War room, SMC Epidemic Control, Vesu". The team at the war room analyzes the data from various zones of Surat city. The MBBS intern doctors from SMIMER College are deployed for tracking and follow-up of suspects. Also, ARI cases are being tracked and follow up is being done by RBSK and AYUSH doctors. The suspects are home quarantined and monitored through SMC COVID-19 tracker application and are then followed up by the War room team for the next 7 days. In case of development of symptoms, they are referred for treatment and sampling. If suspect is more than 50 years or/and with pre-existing so-morbidity, then they are referred to CHC for treatment and sampling. SMS is also sent to suspect for CHC reference with doctor name and contact number with location link. Telephonic assistance or logistic support if required is provided to suspect to reach CHC with help of Deputy Medical officer of Health of respective zones. So far, 1,83,000 calls have been made by War room team.
Page 6 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021C/WPPIL/42/2020 ORDER ix. Use of Arogya Setu and Itihas: With a view to efficiently
utilize the resources and carry out surveillance activities in various areas, Surat Municipal Corporation is utilizing ITIHAS portal developed by IIT Chennai in consultation with PMO. Based on the Aarogya Setu data and data provided by NDMA, pink, amber and blue hotspots along with Actionable area are identified within the city. This information is useful to plan surveillance activities, placement of Dhanvantari Raths and defining the containment zones.
x. Pulse Oximeter: One of the key factors to identify COVID- 19 symptoms is checking of SPO2 level of individuals. If SPO2 level of any individual is less than 95, then the individual is required to be either admitted to hospital or needs to be brought under direct monitoring of a doctor. Considering the same, SMC has been widely using Pulse Oximeters to check the SPO2 levels of citizens. These SPO2 checking machines are used during house to house surveillance as well as at Dhanvantari Raths and Public Health Centers / Urban Heath Centers. As of now, more than 5000 Pulse Oximeters are under use.
xi. Mass Ukala distribution: Along with all intervention, it is of utmost importance to boost immunity of the community to combat the disease. Surat Municipal Corporation has collaborated with Homeopathy and Ayurveda institutions for supply of immunity booster medicines as well as hygienic and healthy "Ukala" distribution all over the city. So far, more than 38 Lac people have been covered in first round, 35 Lac people have been covered in the second round and around 20 lac population has been covered in the third round. Around 11 lac individuals have been given Aayurvedik Medicine (Samsamni Vati) as immunity booster.
xii. Plasma Therapy: Considering the positive results of plasma therapy, Surat Municipal Corporation has emphasised upon educating the COVID-19 positive patients who have fully recovered to donate their plasma. Surat Municipal Corporation runs SMIMER Hospital's Bloor Bank and has so far collected 297 plasma CCPs and it is used to treat over 260 patients of which 60% shown positive results. A Special Information, Education and communication campaign is being run to increase awareness and encourage donation by recovered patients.
xiii. SOP for Diamond and Textile and Migrant labours:
Surat being a hub of Diamond and Textile Industries, after Unlock- 1 it was important to have a Standard Operating Procedure for Diamond and Textile Industry to ensure proper implementation of Page 7 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER Social Distancing, Usage of Masks at work place. SMC has conducted numerous meetings with various diamond and textile associations to finalize the SOP for functioning. Strict implementation of SOPs is ensured by SMC to prevent further spread of COVID-19.
B. How many hospitals have been rendering the Covid treatment? And since when they have been designated?
th Since the first case of COVID-19 was discovered on 17 March, 2020 in Surat city, the Surat Municipal Corporation has declared and designated two Government hospitals, being New Civil Hospital, Surat and SMIMER (Surat Municipal Institute of Medical Education and Research) as COVID-19 hospitals. Along with these hospitals, considering surge of cases, private hospitals have also been rendered as COVID-19 hospitals since 05.06.2020. In all till date, the Surat Municipal Corporation has two Government COVID-19 hospitals and 44 designated private hospitals for curative cure of COVID-19 patients. Copies of notification of finalization of rates are annexed herewith and marked as Annexure-R_2.
C. How many isolation beds, oxygen beds, BIPAP ventilators are available in each of these hospitals? And what is the present occupancy in each of these categories?
The details of oxygen beds, BIPAP ventilators available at various hospitals and their occupancy details are annexed herewith and marked as Annexure-R_3.
D. Whether the modalities of pricing and availability of beds to the poor patients, as adopted in Ahmedabad with respect to the private hospitals has been adopted in Surat? If yes, the details thereof and since when?
In line with the Ahmedabad strategy to treat poor patients in private hospitals, Surat Municipal Corporation has identified 44 private hospitals as "Designated COVID-19 Hospitals", with designated number of beds for patients referred by SMC for which patients are not required to make any payment. Fixed charges as per MOU with respective hospitals born by SMC. Further, SMC has also fixed prices for private quota beds in private hospitals to ensure transparency. The schedule on rates are prescribed as below:
Page 8 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
Rate per day for Celling Rates Reduction Revised
Government per day for as per celling
Beds (referred private beds Hon'ble high rates per
by SMC) (old rates) Court Oral day for
(B) Order dtd- private
29-05- beds (C)
2020
(A)
Empty Bed Occupied Rs
per Day (Rs) Bed per Day
(Rs)
Ward 720/- 4,500/- 10,000/- 10%
HDU 1,080/- 6,750/- 14,000/- 10%
Isolation 1,440/- 9,000/- 19,000/- 05%
+ICU
Ventilator+ 1,800/- 11,250/- 23,000/- 05%
Isolation+
ICU
E. What is the total number of active patients in the hospitals,
Covid Care Centers and home isolation at Surat?
At present, 1,871 patients are taking treatment from Designated COVID hospitals, 183 patients are receiving care from Community COVID-19 Isolation centres and COVID Care Centres, whereas 502 patients are under Home Isolation. For Home Isolated patients, SMC has prepared a booklet explaining the Dos and Don'ts during home isolation along with necessary contact details of doctors, PHC/UHC, Asha workers to contact in- case of emergency. The home isolated patients are also visited by SMC doctors on periodic basis to keep check of health status. Further, all home isolated patients are contacted through War Room to keep check on their daily health status.
F. What special measures have been taken to prevent the Covid deaths in Surat?
Surat Municipal Corporation has taken various measures for intervention in an intensified manner to reduce mortality associated with COVID 19.
i. Treatment using plasma therapy: Apart from Government hospitals, NCHS and SMIMER, two private laboratories have also received approval for plasma collection. ii. Augmentation of health infrastructure: Total Oxygen Page 9 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER beds, ICU beds and ventilator bed capacity has been increased to provide timely care to the patients with severe illness. iii. Ensuring unstopped availability of life saving medicines:
Surat municipal Corporation is continuously procuring lifesaving medicines like Injection Tocilizumab, and Injection Ramidesivir. So far, 900 patients are given Inj. Tocilizumab and more than 2200 patients are given Inj. Ramidesivir. It is to be noted that SMC has not charged patients for extra medicines as well. iv. Availability of critical health infrastructure: Considering the situation, Government of Gujarat has provided additional 400 ventilators for Surat to ensure sufficient availability of critical health infrastructure.
v. Co-morbidity management: Efforts are being made to Identify co-morbid patients in surveillance and to ensure that all the people with co-morbid conditions receive their medicines timely. proper IEC, referral services if required, homeopathy and Ayurvedic Medicines as immunity boosters as per prescribed dosage, are some of the key measures adopted by SMC. Also all the individuals with age more than 50 years or/and with co- morbid conditions are advised reverse quarantine. vi. Extensive use of pulse oximeter to identify the patients with severe illness and timely care.
G. What steps have been taken to prevent infection from spreading to the nearby areas and other part of Gujarat?
To prevent and curtail the infection from spreading to nearby areas and other part of Gujarat, SMC has deployed teams at various check posts, railway stations, bus stations and airports for thermal screening, SPO2 measurement, ARI symptom identification of incoming and outgoing passengers. If a passenger is identified for COVID like symptoms, the passenger is directed to undergo test and is advised for quarantine at quarantine facility.
H. Surat has diamond and textile industries. Large scale infection reported amongst the workers of these two industries has been reported. What steps have been taken to ensure the safety of these workers?
Surat being a hub of Diamond and Textile Industries, after Unlock-1 it was important to have a Standard Operating Procedure for Diamond and Textile Industry to ensure proper implementation of Social Distancing, Usage of Masks at work place and standard hygiene practices at work place. SMC has conducted numerous meetings with various diamond and textile associations to finalize the SOP for functioning. SMC has also Page 10 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER trained master trainers for proper implementation of SOPs in Diamond and Textile industries. So far, 300 master trainers have been trained who have imparted training to more than 600 industry units. Strict implementation of SOPs is ensured by SMC to prevent further spread of COVID-19. An enforcement committee led by Class-1 officers has been formed including officials from Labour department to ensure strict implementation. The SOPs finalized for Diamond and Textile industry is annexed herewith and marked as Annexure-R_4. Further, for the returnee migrant labourers, SMC in consultation with various industry associations, has finalized a SOP wherein returning migrant labourers will be tested and quarantined before resuming work. Necessary training for sanitation, social distancing during work, usage of masks will be given by trainers to labourers during their quarantine period.
II Efforts undertaken by the Respondent State at New Civil Hospital, Surat
1. It is submitted that Surat has witnessed very challenging times during the COVID-19 pandemic with limitations imposed by lockdown, unpredictable clinical course of illness and need for isolating the COVID-19 patients. In addition to the aforementioned steps undertaken by the Respondent State at Surat, it is also imperative to place on record of the Hon'ble Court, certain special efforts and steps that have been taken by the State for NCHS, in order to aid the battle against COVID-19.
2. This unprecedented situation brought forth unprecedented action where throughout the preparations for management of Covid patients in New Civil Hospital, Surat were supervised by Honourable Chief Minister, Deputy Chief Minister (with personal visits to NCHS on 4/7/2020 and 2/8/2020 for supervision), deputation of senior IAS officers (Secretary level) for monitoring through daily morning meetings in the campus at 10.30 am.
3. A special team comprising of Officer on Special Duty, Physician, RMO, staff nurses and Infection Control was sent from Civil Hospital, Ahmedabad and Gandhinagar to guide in strengthening services for Covid care.
4. The following central teams visited NCHS for monitoring of Covid related work:
i. Dr. Neeraj Dhingra, Director, NVBDCP; Dr. Y. C. Porwal, Sr. Consultant (Int. Medicine) SJH, Dr. R. K. Mahajan, Sr. Consultant ( Microbiology),RML Hospital, and Dr. Anil Kumar, Assoc. Prof., Anaesthesia, LHMC visited on 20/4/2020.
ii. Shri Ashok Kumar IAS, Secretary. Water Resources, Dr. Page 11 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
Neelam Rai, Dr. Anil Gupta, Dr. O. P. Singh, and Dr. Daulat Ram Meena visited on 26/4/2020 iii. A Central Government Monitoring Team comprising of Dr. Balram Bhargav, D-G- ICMR, Dr. V. K. Paul, Member, NITI- AAYOG, Dr. Randeep Guleria, Director AIIMS, New Delhi and Dr. Aarti Ahuja, IAS visited NCHS for hand holding in Clinical Care protocols and Infection Control on 16th July 2020.
5. Upgradation of Infra-Structure 5.1 Availability of Beds with Oxygen supply:
i. Considering the need for admissions, in the first round, 500 beds of the 1150 beds in NCHS were designated to manage COVID-19 patients and 16 special rooms were reserved for Covid infection in Healthcare workers and 450 beds in NCHS awere kept side for non-Covid admissions (Obstetrics, Paediatrics, MDR TB and Psychiatry).
ii. This included all elements of infra-structure preparation of a Covid Hospital mentioned in GOI (MoHFW) guidelines with focus on designated areas for donning-doffing and maintaining prescribed distance between patients.
iii. The efforts were reinforced by preparing Stem Cell Building (New Covid Hospital) for 280 beds with oxygen supply, necessary equipment and furniture to take the dedicated beds for COVID-19 to 780. Simultaneously 525 beds in the old building of NCHS were upgraded with piped oxygen supply and installation of 13 kL oxygen tank at old building.
iv. Following the Chief Minister's visit to Surat on 4/7/2020 to review the status of COVID-19 pandemic in Surat, as a part of advanced preparedness, decision to add 800 more beds with piped oxygen supply and all necessary provisions for Human resources and equipment at New Covid Hospital, was taken. The mammoth task was completed in record time of fifteen days with installation of 17 kL liquid oxygen tank.
v. In addition, work at the PMSSY building of Super-speciality Hospital which was in core and shell status, was also upgraded to add 800 oxygen beds in the campus for COVID-19 patients including furniture, piped oxygen supply, equipment etc. The status of Covid preparedness in the campus was assessed again by Chief Minister's in his second Surat review visit on 2/8/2020.So, NCHS has always had adequate ICU and oxygen beds available during Covid pandemic commensurate to the number of Covid admissions 5.2 Availability of ICU Beds:Page 12 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER As a part of advance COVID preparedness, 40 ICU beds were assigned for Covid care which was stepped up to 120 ICU beds in the second phase and then 296 ICU beds in third phase, keeping 66 ICU beds aside for OB ICU, NICU, PICU, SICU and RICU with provision to convert them to take care of COVID-19 patients, if needed.
6 Manpower for provision of care The COVID-19 pandemic has necessitated presence of more manpower in the hospital due to requirement of isolation of the patient from family members.
6.1 Availability of Health Care Workers in the hospital with 24X7 availability and minimum three faculty rounds per day:
i. Ward boys: ICU : 1 per 5 beds and ward : 1 per 8 beds ii. Nursing : ; ICU : 1 per 2 beds and ward : 1 per 5 beds iii. ECG technicians: 12 iv. Interns: 137 v. Resident doctors : 376 + 45 deputed vi. Faculty : 270 6.2 Integrating of services provided by private practitioners: Seven critical care specialists and one infectious diseases specialist. 6.3 In times of need, deputation of various cadres of staff from other government hospitals of Gujarat has been done by the government as follows:
i. Class- 1 officers ( Specialists) -13, ii. Class- 2 officers: MBBS-23, AYUSH-8 iii. Resident doctors of Medicine, Anaesthesiology - 45 iv. Staff Nurses: 331 in batches v. Pharmacists - 46 vi. Counsellors, vii. Lab technicians- 40, viii. X-ray technicians- 28 6.4 Number of employees deployed through outsourcing (data entry operators, lab technicians, house -keeping , security etc) was also increased to fill vacant posts.
6.5 Following were enrolled as Critical Care Assistants after training for support to clinical / medical frontline Corona warriors:
6.6 Interns 6.7 Final year students of MBBS, Physiotherapy and Nursing 6.8 Other students such as MSW for patient counselling have been enrolled and technicians for support in diagnostic facilities like lab and Radiology.Page 13 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER 6.9 Patient attendants (through NGOs) have also been made available for support in patient care and social support to family 7 Equipment Services were strengthened by provision of necessary equipment in required numbers through government supply. A Copy of the chart indicating the details of equipments is annexed herewith and marked as Annexure R 5.
7.1 Ventilators :
i. As part of Covid preparedness, initially 52 of the 72 functional ventilators were designated for Covid patients. ii. Considering the expected increase in requirement, the Respondent State provided 420 extra ventilators taking the total number of ventilators available at NCHS to 740, of which 113 were given to SMIMER and 135 to private hospitals in Surat for management of Covid patients.
iii. As on 08.08.2020, the NCHS has 492 functional ventilators. iv. NCHS had adequate number of ventilators during Covid pandemic out of which maximum 85 were in use on any given day. 7.2 Over and above, other resuscitating equipment like multipara monitors (363), syringe pump (479), ABG machines (9), pulse oximeter (150), ECG (25), haemodialysis (24) and HFNC (80) were also added through government supply.
7.3 Ambulances for transport of Covid patients:
i. NCHS has seven ambulances.
ii. 108 has 30 ambulances in the city and 11 in the rural area. 15 of 108 ambulances in city and 2 in rural area are dedicated for transfer of Covid patients with provision of using the general ambulances for transfer of Covid patients if the need arises .
iii. BLS Ambulance with oxygen supply is also kept parked at Samras facility for prompt transfer to NCHS of patients kept in this isolation facility which is just 5 kms from the hospital.
8 Patient Care at NCHS 8.1 Dedicated Flu OPD: Round the clock OPD services are available in the Flu OPD with a cumulative OPD of 21,857 patients seen till date in OPD. Naso-pharyngeal and oro-pharyngeal swab collection for RT-PCR was taken. Rapid Covid Antigen testing is done in the OPD as per the latest ICMR guidelines. Covid pandemic situation is an unusual situation in which indoor Page 14 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER patients are hypoxic, often have loss of taste, are in isolation in the hospital where their family members cannot attend to them. Till date, 12,545 Covid patients have been admitted to NCHS 8.2 Defined Admission protocols have been implemented with entry of details in HMIS and Dhaman softwares. Patient and family are explained about the patient condition from time to time. Toiletry kits ( toothpaste, toothbrush, scrapper, napkin and small towel) have been provided to the indoor Covid patients . 8.3 Patient treatment at NCHS:
i. Clinical and medical treatment of Covid patients:
NCHS follows defined Covid treatment protocols as per Government of India (MoHFW) and Government of Gujarat guidelines released from time to time.
8.3.1 Covid nursing care protocols are also defined through SOPs.
ii. Support service protocols include:
Provision of hygienic nutritious diet as per patient needs ( regular ,liquid , anti-diabetic, high protein diet, salt restricted diet and chronic kidney disease diet) distributed as five meals Laundry facility for patient wear Sanitation including provision of bed pans, adult diapers, attendant to accompany to washroom Volunteer services for assisted feeding Provision of electric kettle for heating water and steam inhalation ii. Mental health support services include:
Bedside counselling by counsellors
Provision of motivational books through library
Music therapy
Yoga and Pranayam as per clinical condition of the patient
celebration of special occasions like Rakhi
8.4 Services for the attendants include:
i. Attendant dome (waiting area)
ii. Round the clock services of help desk ( at +91-261- 2701800) with hunting line for interaction with attendants and with Page 15 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER facility of video- calling between patient and attendant. Till date the Help desk has received 5783 audio calls and has co- ordinated 722 video calls between patients and attendants. Fourteen smart phones with video calling facility were purchased for this purchase.
iii. Drinking water and provision of Ukada
iv. Sanitary block
v. Food to needy by NGO
vi. Relative counselling including Health education and
Infection Prevention measures like handwashing, physical distancing, provision of masks, etc vii. Control room services viii. Parking facilities ix. Traffic management 8.5 Defined discharge process is followed with i. Briefing at discharge counter ii. Provision of discharge kit to "Covid Vijeta" with immunity boosters , masks, instructions about plasma donation and drinking water.
iii. Counselling about importance of convalescent plasma donation iv. Drop back facility 8.6 Till date 7233 patients have been discharged , 2917 transferred from NCHS and 200 sent for Home Isolation. Considering the number of patients admitted and discharged / transferred, with recovery rate of 77.6%. 8.7 As a result of the counselling efforts, NCHS has collected Covid Convalescent Plasma (CCP) from 127 donors . Overall 223 Covid patients have been provided CCP from NCHS. 8.8 Transfer policy :To rationalise availability of beds as per clinical need, following options are available:
i. Transfer to Samras for stable patients on room air and some on less oxygen requirement ii. Transfer to designated Covid private hospitals under Surat Municipal Corporation quota.
8.9 Supervision at work areas:
i. A total of 450 CCTVs are installed inside and outside the Covid hospital and 148 in the old building, covering every area with supervision by authorities with connectivity to video wall in Page 16 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER control room and help desk.
ii. Linkages have been provided at Honourable Chief Minister's dashboard for direct supervision and interaction by Honourable Chief Ministers with patients and healthcare workers. .
9 Procedure after Covid related death:
9.1 In the unfortunate situation of death of a Covid patient, the MoHFW/ GOI guidelines for "Management of Death after Covid"
are strictly adhered to for dead body management. 9.2 Death in the hospital is informed to Control Room which is manned 24X7 by SMC Fire department representative, medical officer, nursing officer who inform the patient relative about death. 9.3 Following formalities including i. death notification, ii. preparation of the body, iii. appropriate double packing of the body in transparent body cover, iv. identification by relative in designated body holding area v. documentation of handover is done as per defined SOP. 9.4 All formalities from death notification to the relative to body hand over for transportation is completed within two hours of death. 9.5 The transportation of the dead body to the crematorium is done by SMC Fire department in designated dead body vans. Dead body vans are decontaminated after every single use. 9.6 Notification of Covid deaths:
i. All deaths at NCHS (Covid and non-Covid) during these months have been notified to the concerned authorities as per the government guidelines and are uploaded in Covid-19 portal. ii. All Covid deaths have been audited by the Death Audit Committee constituted as per Government of India (MoHFW) and Government of Gujarat guidelines and the daily Covid death audit report is also been submitted to the authorities. 10 Covid infection in Health care workers at NCHS Covid -19 infection has affected the whole world and healthcare workers face a special situation of increased risk of infection during patient care and need for more patient support due to clinical patient condition and lack of patient relative by the bedside. Infection Prevention and Control measures were strengthened at NCHS as part of preparedness for Covid :
(i) Infrastructural modifications for Covid included a. segregation of Covid and non- Covid areas in the old hospital by barricading, Page 17 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER b. Specific Covid related signages for directional movement and access restriction without PPE c. creation of designated donning and doffing areas in both buildings, d. ensuring availability of adequate handwash areas, e. use of automated machines for floor cleaning f. creating ambulance decontamination areas etc.
(ii) Trainings related to Infection Prevention and Control :
a. Staff of all categories (class 1,2,3,4, students, volunteers) have undergone hands-on-trainings related to Covid infection including transmission, clinical features, infection prevention before Covid posting.
b. Online certificate programmes like CCMC and IGOT were made mandatory for all staff. 235 faculty members and 323 residents attended these online trainings.
c. Refresher trainings and on-site trainings are also arranged from time to time related to Infection Prevention and Control including Bio-Medical Waste management SOPs .
d. Strict surface cleaning protocols and regular sanitisation/ decontamination of all critical areas of hospital with sodium Hypochlorite spray.
e. "Buddy" system is followed in Donning area to ensure adherence to donning protocol which is also displayed on the site. f. All staff working on Covid duty are provided Personal Protection Equipments (including whole body cover with hood, N-95, shoe cover, face shield, gloves etc.) of government approved quality in adequate quantity .
g. Hand wash facilities and adequate hand sanitisers are available at all points in hospital and offices.
h. Protocols related to Infection Control Prevention measures and Clinical management are displayed at all work areas. i. Periodic rounds are conducted by Infection Prevention Team which is headed by a Microbiologist.
j. Ambulance and dead body decontamination k. Strengthening BMW segregation and disposal was done (Total BMW generated in July 2019: 34898 kgs and Daily BMW Page 18 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER generation in July 2019: 1200 kgs)
(iii) In addition to the aforementioned steps, the following efforts have also been undertaken:
a. all staff have been given the option of using allopathic/ homeopathic (Arsenic elbo-30)/ ayurvedic ( Shamshamani Vati and Ukada) prophylaxis measures supplied through government of Gujarat and b. are also provided hygienic, nutritious, immunity boosting diet during Covid duty.
c. Special arrangements have been made for accommodation including food, laundry and transport services of on duty staff of all cadres to prevent spread of infection. 11 Supply of PPE kits at NCHS:
11.1 Personal Protection Equipment kits with whole body cover, shoe cover, gloves, N-95 masks, face shields have been available through hospital supply supplemented by purchases as and when required.
11.2 Adequate supply of PPE kits, N-95 masks, triple layer masks, surgical gloves and sanitisers has been available at NCHS . 11.3 A bird's eye view of some relevant details:
a. Total supply during Covid:
PPE kit procured/supplied- 122324 N-95 - 190930 Surgical gloves-578425 Triple Layer Mask- 1019210 Disposable caps- 334600 Hand sanitiser 500mL/350mL : 17061 iii. Daily consumption:
PPE kit - 2100 N-95 - 2345 Surgical gloves-4500 12 Availability of required injections at NCHS: 12.1 Adequate supply of all required medications including Page 19 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER injections like Tocilizumab, Etolizumab and Remdesivir and Tablets Favipiravir has been available at NCHS.
i. Inj Tocilizumab 400 mg- 553 amps
ii. Inj Tocilizumab 80 mg - 85 amps
iii. Inj Etolizumab- 233 amps
iv. Inj Remdesivir - 1660 amps
v. Tab Favipiravir - 190400 tabs
12.2 NCHS has also provided these injections to patients admitted in private hospitals after approval by Committee appointed by Collector office.NCHS has also given 100 Inj Etolizumab and 81410 tablets of Favipiravir free of cost to private hospitals for use in their patients.
13 Oxygen supply at NCHS:
13.1 Initially oxygen supply was through Dura and Porta oxygen cylinders.
13.2 As part of Covid preparedness, Liquid Oxygen tanks of 13 kL at New Civil hospital building and 17 kL at New Covid building were installed and and process for installing 20kL Liquid Oxygen tank at PMSSY building of Super-speciality Hospital was also initiated. 13.3 The average daily oxygen consumption at NCHS increased from 2095 cu.m. on 1st January 2020 to 36029 cubic meters on 10th July 2020 and reduced to 18033 cu.m. on 9/8/2020.
A. Response to the twelve directions issued by the Hon'ble Court It is submitted that the Hon'ble Court has issued twelve directions on various issues starting at page nos. 38-41. The direction-wise response of the Respondent State is as follows:
1. Appropriate notification / resolution / circular enhancing the fine to a minimum of Rs.1,000/- for not wearing masks.
In pursuance to the direction issued by the Hon'ble Court for increasing the fine to Rs. 1,000/- for all those not using face covers, it is submitted that Respondent State has passed the Government Resolution dated 13.08.2020, whereby the amount of fine for not wearing mask in public has been increased from Rs. 200/- to Rs. 1000/- and the same has been made uniform across the State. The Respondent State is making all efforts to ensure strict implementation of the said Government Resolution. A copy of the said Government Resolution dated 13.08.2020 is annexed Page 20 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER hereto and marked as Annexure-R_6.
2. Inflow of People from Surat into Ahmedabad It is submitted that pursuant to the further direction of the Hon'ble Court to stop the inflow of people coming to Ahmedabad from the city of Surat, all the public transports from Surat have been banned to prevent the spread of infection. State Transport buses from Surat have been stopped. All the vehicles coming from Surat are checked at entry point and every single are tested. No passenger vehicle is allowed to enter in Ahmedabad city from Surat without going through the mandatory testing. Noteable this procedure was also neing followed prior to the dirrections issued by this Hon'ble Court.
3. Close watch and vigil at the Airport by the State The Hon'ble Court has also directed the Respondent State to keep a check at the Airport and on the passengers before they are permitted to leave the airport. In this regard, it is submitted that screening is being carried out at Sardar Vallabhbhai International Airport, Ahmedabad. All the passengers arriving at Airport are checked by medical team and if found to have symptoms, they are referred to Hospital and tested. 24X7 medical team with Ambulance is deputed at Airport.
4. Entry points of Ahmedabad The Hon'ble Court has directed the Respondent authorities to keep a check on the entry points of Ahmedabad. In this regard, it is submitted that the Ahmedabad Municipal Corporation has initiated screening of all persons entering in Ahmedabad city at all entry point. All persons coming from Surat are tested by Rapid Antigen Test at entry point and if any person is found positive he or she is not allowed to enter in city and is admitted in hospital.
5. Steps for Rickshaw drivers to enforce directive to wear face masks The Hon'ble Court has stressed upon the importance of wearing masks and has passed the further direction asking the State to take steps against all rickshaw drivers who may permit any passenger to board without face mask. In this regard, the State Government has issued the directives to all rickshaw drivers to wear a mask and also compel their passengers to do so. Concerned Authorities also have been directed to ensure the compliance of this rule or to collect the fine from rickshaw drivers. Annexed herewith and marked hereto as Annexure R 7 is a copy of a Government Resolution issued for the said issue.
6. Warnings to shop keepers to enforce directive to wear face masks Page 21 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER Similar directions have also been given for shopkeepers to wear mask and make their customers to wear masks, use sanitizer and keep social distancing at shop. If customer would not follow the rules, shopkeeper will have to pay the fine. All shopkeepers are instructed to keep sanitizers at their shop.
7. Implementation of social distancing and other preventive norms in Malls 7.1 The Hon'ble Court has observed that hundreds of people are seen in different malls across the city of Ahmedabad, more particularly, Ahmedabad One Mall at Vastrapur, Ahmedabad, without wearing masks. The Hon'ble Court has directed that in such cases, necessary action should be taken not only against the shop keepers of the mall but even against the owner of the management of the mall, in accordance with law. It is pertinent to note that malls in the city of Ahmedabad have been given permission to open only after their consensus to follow the rules for COVID-19 prevention and control.
7.2 It is submitted that on 3/08/2020, as per the order dated 3/08/2020 issued by the AMC, Ahmedabad One mall was sealed as it was found breaching the rules pertaining to social distancing, wearing of face masks, etc. It is further submitted that on 9/08/2020, as per the order dated 9/08/2020 issued by the AMC, the Central Mall in Ahmedabad city was also sealed by AMC as it was found breaching the rules pertaining to social distancing, wearing of face masks, etc. AMC officials have instructed all mall owners and ensured that all persons entering in the mall would be screened by thermal gun and must wear a mask.
8. Awareness campaign 8.1 In view of direction given by Hon'ble court state has formed an awareness committees a notification in this regard issued on 13.08.2020. A copy of the said GR is annexed here with. Annexure R 8 8.2 The Hon'ble Court has directed the Respondent State to increase the awareness and to remind the people not to become complacent. In this regard, it is submitted that regular and consistent steps are undertaken in this regard across the state among the public.
8.3 A strong Information, Education and Communication (IEC) Campaign is being carried out by the State with the involvement and cooperation of religious leaders, senior details and famous singers. The points covered under the said campaign are as follows:
Page 22 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021C/WPPIL/42/2020 ORDER i. COVID-19 brief about Disease, Symptoms, Precautions to be taken. ii. Importance of Mask, How to utilise and dispose it. iii. How to maintain Hand hygiene & social distancing. iv. Precautions to be taken by international passengers. v. Precaution to be taken while Home Quarantine. vi. Precautionary steps to be taken by Senior citizen.
vii. Ayurvedic remedies and Homeopathic medicines to cope up with COVID-19 & boost Immunity.
viii. Message by Leading Medical fraternity on Coughing etiquette, Home Quarantine, Hand Washing, Social distancing, Mask usage. ((Dr. Bharat Bhagat, Dr. Atul Patel, Dr. R K Patel, Dr. Dilip Mavlankar, Dr. Tejas Patel) ix. Celebrity endorsement to create awareness on health etiquettes (Kinjal Dave, Parth Oza, AvindVegda, Devang Patel, Malhar Thakar, GeetaRabari, KirtidanGadhavi, IrfanPathan) x. Measures to be taken by Doctors, Healthcare workers, Police while getting out side from home. xi. Appreciation of all Corona Warriors - Doctors, Healthcare workers, Police and Sanitation workers xii. Telemedicine, 104, 1100 xiii. Aarogya Setu & IVRS xiv. Precautionary steps to be followed After lockdown, Reverse quarantine Measures 8.4 The efforts undertaken at the State level are as follows:
i. Religious leaders, senior doctors & famous singers have endorsed for campaigns e.g. Dr. Bharat Bhagat, Dr. Atul Patel, Dr. R K Patel, Dr. Dilip Mavlankar, Dr. Tejas Patel, Kinjal Dave, Parth Oza, Avind Vegda, Devang Patel, Malhar Thakar, Geeta Rabari, Kirtidan Gadhavi, Siddarth Sanderiya, Darshan Jariwala, Irfan Pathan, etc. ii. 45 "Video Quicky" have been prepared and featured on Websites, YouTube Channel and various Social handles.
iii. 21 Television Spots have been broadcasted on 15 Page 23 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER Gujarati Channels continuously from 6th March onwards and continuing the same.
iv. 16 Radio Jingle aired on 7 Radio stations across Gujarat from 7th March onwards and continuing the same. v. 13 Newspaper advertisements has been released in 93 Newspapers' across Gujarat in Gujarati, English, Hindi language.
vi. 218 LCD/LED Screen advertisement at Railway Stations for Corona Awareness vii. (LCD Screen -Ahmedabad - 91 Screen, Rajkot-70 screen , Vadodara - 55 Screen & LED Wall Surat- 1 screen, Vapi- 1).
viii. 400 Namaste Gujarat Signage has been placed at Sachivalay&all government officials.
ix. 1656 Social Media Posts - Creative, Videos, Government initiatives towards corona epidemic, Guidelines letters, Testimonials from Corona warriors, Daily Press Brief Live till date 8.5 The efforts undertaken at the local level are as follows:
i. 144 Television Spots has been broadcasted on local channels at respective locations. ii. 18 Radio Jingle &10051miking slots aired on Radio stations at respective locations.
iii. 523 Newspaper advertisements, 905 Hoardings, 34,511 Banners, 91,67,995 Leaflets, 2,29,092 Signages have been prepared for Corona Awareness at local levels.
8.5 Gujarat has adopted multi-pronged strategy for combating COVID. Keeping in sync with the epidemic, appropriate steps were taken to control and mitigate the situation. In order to further consolidate the achievements gained on clinical front (decreasing fatality rate and improving testing and management), there is a crucial need to sustain and further improve the community behavior to prevent transmission of the virus while trying to return to a new normal routine.
It is difficult to enforce behavior, legally or otherwise, and if done; it is not sustainable. Well aware of this, the Health & Family Welfare (HFW) Department has, since the start of the pandemic, focused on creating awareness through various Information, Education and Communication (IEC) measures including mass media & social media campaigns, radio - print - TV advertisements and messages, promotion through leaders and celebrities, etc. Once the rapid explosive phase of the epidemic passed, in order to intensify the awareness campaign so as to bring about a sustainable behavior change; HFW Department Page 24 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER focused on Interpersonal Communication (IPC) strategy for Behavior Change Communication (BCC). IPC involves person-to- person communication with an aim to personify and contextualize the messages so as to attain better outcomes.
The HFW Department has partnered with the Centre for Social and Behavior Change, Ashoka University, Delhi for developing an IPC strategy for the state. Based on community level data and research, IPC material (cards, booklet, guide) was developed and subsequently piloted in Mahisagar district. Annexure R 9 Subsequently, IPC strategy was conceived and cascade training was done to train all the front line workers in effectively engaging with the community through IPC for effective BCC. This strategy is now being rapidly scaled up and is being rolled out in other districts as well. This will enable the frontline workers integrate COVID with routine health counselling. This will not only decrease the stigmatization and panic for the disease but also help in enabling people to live safely by decreasing their risk of exposure.
9. Stronger Infrastructure, provision of PPE Kits and Training 9.1 It is submitted that vide the ninth direction, the Hon'ble Court has directed as follows:
"[9] We direct the State Government to work towards building the medical infrastructure stronger. Provide safe and effective Personal Protective Equipment (PPE), encourage the recruitment of new doctors and nurses, set up nurse training programs and encourage people to join the healthcare."
9.2 In respect of the strengthening of infrastructure, the following points are sought to be placed on record:-
i. The state government has declared six Government teaching hospitals attached to Government Medical Colleges and eight Teaching Hospitals attached with GMERS Medical Colleges has designated Covid-19 Hospitals.
ii. The State Government has delegated the powers to all municipal commissioners and district Collectors to take necessary actions under epidemic act 1897.
iii. The State Government has taken various actions like surveillance, diagnosis and treatment to prevent further transmission of Covid-19 disease, wherein treatment is most important aspect. The state government is committed from the beginning to cope up the situation developing from time to time since February-2020 and accordingly in February-2020, 1200 Page 25 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER bedded hospital situated in civil hospital, Ahmadabad campus was declared as a designated covid-19 hospital and it was upgraded with all necessary facilities. Then after the state government declared all government teaching hospitals, all teaching GMERS hospitals and all district hospitals as designated covid-19 hospitals, moreover, state government has designated private hospitals for treatment of COVID-19 patients. All municipal commissioners of the state have entered memorandum of understandings with private hospitals in their respective municipal corporation areas so that the patients of covid-19 hospitals can get treatment in private hospital also along with government hospitals. The State Government has also designated Employees State Insurance Scheme Hospitals of central Government situated in Ahmadabad and Ankleshwar as covid-19 hospital. The copies of the various G.R. are annexed here with and marked as Annexure R-_10.
iv. The most important aspect of the treatment of the covid-19 hospitals is availability of ventilators in Covid-19 hospitals. The state government has increased numbers of ventilators in designated covid-19 hospitals. The detail of availability of ventilators is given in a tabular form and annexed as Annexure R 11.
v. In order to meet with requirement of necessary specialist like Physicians, Anesthetist, Critical care expert and pulmonologist etc., Government has delegated powers to local authorities at district level to recruit / engage private Doctors. The Government has also processed to recruit Doctors with private practice or without private practice in various Medical Colleges and District hospitals. The copies of details of recruitment is given in a tabular form as Annexure R-_12(Colly.) vi. The government has constituted an expert committee for extending telemedicine services. This committee is holding video conferences on daily basis and this way treating doctors of all the covid-19 hospitals are getting necessary line of treatment and advice for patients through telemedicine. The Medical Education department has also recruited 200 patient attendants for three months with fix pay of Rs.14719/- per month. A copy of the order dated 22-05-2020 is annexed here with and marked as Annexure R 13. The Government has taken assistance of willing students studying in government medical colleges, Dental Colleges, Ayurved and Homeopathy colleges and Nursing Colleges. These students are assisting the doctors treating patients in Covid-19 hospitals. The government has also taken assistance of doctors at UG and PG level for assisting in Covid-Page 26 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER 19 hospitals. As an incentive they are given a rebate of twice the period of bonded service, of the period served in these Covid hospitals. A unique incentive of counting double the term of the services by the MBBS and PG Doctors towards bond period is extended for voluntary services.
9.3 In respect of increasing the training of healthcare professionals to fight the battle of COVID-19, it is submitted that the State Institute of Health & family Welfare (SIHFW) being the apex institute of Training and capacity building for department of Health & Family Welfare has continued its support to the department during this difficult situation of COVID -19 pandemic by providing continuous physical and online trainings to health staff on all new guidelines updated periodically as well as provided technical support by preparing literature on COVID-19 in the form of modules, Guideline, PPTs, developing training material in Gujarati language. Apart from this, SIHFW is also involved in quarantine management and different preventive activities. Details of all work done is mentioned below:
i. Physical Training a. Orientation of SIHFW staff regarding COVID-19 and Quarantine ward management. Details regarding the number of persons for whom such orientation has been conducted are as follows:
Allied
Sr. Doctor/ Nursing
Training Name Health Other Total
No. MO Personnel
Personne s
l
Orientation/Induction
1 Training at COVID 1378 4225 2834 2925 11362
dedicated
facilities
Ventilator Care & Infection
2 3371 6134 1542 0 11047
Prevention Training
3 Swab Collection Training 732 1782 664 0 3178
Infection Prevention &
4 6244 11749 10545 11173 39711
Control
Training (Physical &
Webinar)
Total 11725 23890 15585 14098 65298
b. Orientation/Induction training is completed at 272 DCH, DCHC and CCC facilities. The same is still ongoing for newly Page 27 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER deputed staff.
c. Total 65,298 staff of different cadres have been trained in different aspect of COVID care at hospital level over a period of 4 months.
d. All teaching training institutions e.g. DTC, DTT, ANM schools, GNM schools, B.Sc. Nursing colleges as well as Govt. and GMERS Medical Colleges are involved in disseminating trainings at district level to all health care staff. e. SMO DTT/DTC are working as Training Nodal Officer for COVID Dedicated facility, doing training need assessment in of their districts and organizing trainings based on TNA. f. Continuous handholding of COVID facility staff by SMO DTC/DTT and medical colleges especially building their capacity on IPC aspects.
g. SIHFW has planned for Training Impact Assessment in coordination with PSM department of Medical Colleges. ii. Online Training/ Distance Learning a. The State has established a 3 tier system for training hosted at State level; ToT webinars, Medical Colleges and District level webinars using CISCO webex platform and plexusMD. Handholding of COIVD facilities was done by webinars in which case discussions and tele-mentoring was started.
b. At the State level, a Total 27,517 participants have been trained by SIHFW in 72 webinars of 216 hours. All sessions are uploaded at YouTube channel of SIHFW, Vadodara. Different webinars were organized in collaboration with AD (ME), AD (MS), State Quality Cell, State IDSP Branch, Gujarat State AIDS Control Society, Gujarat Nursing Council, Gujarat State Pharmacy Council, and UNICEF-Gujarat.
c. Details of the number of webinars and the number of participants are as follows:
Sr. No of No of
Topic
No. Webina Participants
r
1 Orientation of CISCO WebEx 4 453
2 Basic of COVID-19 - Police, NSS, NCC,
3 144
NYKS, Civil
7
Defense Department
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C/WPPIL/42/2020 ORDER
3 Clinical Management of COVID-19 11 564
4
4 Infection Prevention and control measures 14 677
9
5 Field Surveillance and Supervision during 4 137 COVID-0 19
6 Administration Management during COVID- 12 537 19 7 7 Testing strategies, Sample 3 126 collection and transportation for 6 COVI - 19 8 Psycho Social Care in COVID - 19 pandemic 16 671 3 9 Special/Motivational Sessions 5 327 4 10 Maternal Care& COVID-19 2 187 5 11 Child Care& COVID-19 1 474 12 COVID-19 AYUSH component Webinar 10 203 2 13 KMC component in COVID-19 Webinae 2 356 14 Stregthening of urban area during COVID-19 1 412 d. At the district level, 1,23,325 participants have been trained by Medical Colleges, DTTs and Nursing Colleges in various training with 925 webinars of 1850 hours. Training data has been uploaded in COVID Warrior website on daily basis. Details are as below -
Para Cadr Doctor Nurse Volunteer Total Medic e s s s s field surveillance 4798 6623 7368 41499 60288 & Supervision Quarantine Management 1542 1550 4847 5386 13325 Clinical 1144 3155 2353 976 7628 Management Protocol Medical Nursing care in 350 494 30 NA 874 non COVID area Psycho Social Care 3166 4853 3391 585 11995 Basics of COVID-19 for 2157 3662 1634 2895 10348 Civil defense officials Page 29 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER and Police Administration & 862 4015 2706 938 8521 Management during COVID-
19(Pregnant woman also)
Session for NA NA 351 9995 9995
Counselors/Pharma
cist
Total 14019 24352 22680 62274 123325
iii. Online Training Methodology
a. iGOT- Integrated Government online Training:
Gujarat is top most state for implementing iGOT application in India. Registration in iGOT application is of 1,51,619 persons. Course registration in iGOT is 9,49,503 and course completion count is 6,79,474 is done on iGOT platform. Daily follow-up and data analysis is done by SIHFW for iGOT. Ten (10) Gujarati courses are created by SIHFW and included in iGOT platform. Now trainings are available in Guajarati language on iGOT-Diksha platform. A copy of a table containing the details (State-wise) of course registrations and course completion count where the state of Gujarat is a Top performer, is annexed herewith and marked as Annexure-R_14.
b. Plexus MD: CCMC is an online training program specially created to help doctors, nurses and healthcare workers learn about latest aspects of management and care of COVID -19 patients as well as crucial aspects of self- protection and infection prevention and control. The following needs to be noted in this regard:
A total of 56,165 participants have enrolled to the CCMC programme in which Doctors - 17532, Nurses
- 22993, Healthcare worker - 15640. We crosses 50000 users milestone within 22 days of launch. 29 lakh minutes of training - 50000 hours of training delivered on CCMC platform.
56% of course participants are on active COVID-19 duty.
More than 93% of these participants have said that the course has helped them improve the quality of care they deliver.Page 30 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER c. SATCOM: 14 SATCOM sessions are arranged for various COVID -19 training topics to strengthen peripheral health workers capacity.
iv. Other activities:
a. Module Preparation: Module for Ventilator care and infection prevention training was prepared by SIHFW in coordination with Anesthesia department. It is widely used across the state by 31 training centers for Ventilator care and infection prevention training. Purpose of module development was uniformity of information during training. Module regarding psychosocial care for vulnerable groups has also been prepared by SIHFW in-coordination with UNICEF and GSACS. From 15.07.2020, NHM RCH and other program ToTs and Trainings have also been started. b. The Training Committee consists of the following officers:
Chief Personnel Officer - Chairperson Additional Director (Public Health) - Member Additional Director (Family Welfare) - Member Additional Director (Medical Services) - Member Additional Director (Medical Education) - Member Director (SIHFW) - Member B. An overview of the response of the State to COVID-19 The Respondent State has been fighting the battle against the pandemic of COVID-19 by making all possible efforts and is committed to increasing such efforts to meet all new challenges. In this regard, an overview of the initiatives taken by the State are mentioned hereunder in order to enable the Hon'ble Court to get a better understanding of the details regarding the efforts that are being made by the State:
A. Governance and Leadership
I. A Core Committee chaired by the Honourable Chief
Minister is constituted, which is meeting daily and monitoring the daily COVID situation, decide the strategies and plan the actions.
II. CCTV feeds from all COVID hospitals are included in the CM dash board to monitor the hospital care from state highest office.
III. To fast track purchases, a High powered Purchase Committee is constituted.Page 31 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER
IV. Crisis Committee is constituted under the Chairmanship of
Principal Secretary (Health). Daily review of district situation is carried out.
V. State level team of IAS & GAS officers to support Principal Secretary (Health) in management of crisis created. Regional level responsibilities allocated to four senior IAS Officers. Similar structure at district/corporation level is created.
VI. State Task Force of eminent physicians and public health experts has been created.
VII. A team of experts created for preparation of clinical protocols, guidelines and advisory.
VIII. A research committee is constituted to promote and facilitate research on COVID.
IX. Recruitment, fund utilization and procurement powers delegated to district magistrate for prompt and quick actions.
X. Experts from Community Medicine Department of medical colleges are assigned districts and Municipals Corporation to technical support the epidemic management based on the data analysis and field visits. Also they are involved in training of field health force as well monitoring and mentoring community surveillance and other community preventive measures.
XI. Data Driven actions developed at state and every district wherein data of surveillance, ITIHAS, 104, 108, Oxygen Saturation Death audit, Triage facility, OPD used to monitor the tread and identify problematic geographical area or groups.
XII. Special incentive to the health workforce involved in the COVID activities. (Detail to be included) B. Health System Strengthening:
I. Creation of 1200 bedded Dedicated COVID hospital, in Ahmedabad in a short span. It is the largest COVID hospital in the Ahmedabad. Also four dedicated COVID hospitals are created in Ahmedabad (SVP Hospital) Vadoara (GMERS-Gotri), Surat (Cancer Hospital Building, GMC) & Rajkot (PMSSY building). II. Additional Beds from Gujarat Cancer Research Institute.
III. 750 bedded COVID hospital in Surat are to be created by
converting STEM cell hospital
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IV. Provision of COVID beds in private hospitals. MoU carried out
with the Private Hospitals.(Ahmedabad, Surat, Vadodara) V. Provision of Oxygen centres by use of Oxygen Concentrators at the COVID Care Centres, CHC and PHC to manage the oxygen saturation at the places.
VI. Community Isolation Centres are created. VII. COVID Testing facilities was created in Ahmedabad started on 7 th February at Jamnagar on 8th March ahead of first case reported. Six more labs were operational within 10 days of first case (19 th March). Currently 59 laboratories (36 Govt & 23 private) are operational with daily testing capacity (RT-PCR, CBNAAT, TrueNAT) of more than > 10,000.
VIII. HR policy is framed for COVID care.
IX. Additional Human resources was mobilized from within the system. Mandatory services extension to employees retiring in 2020 X. Private consultants are involved in the critical care in COVID Hospital (Ahmedabad, Rajkot, Surat, Vadodara) XI. Filling of posts of MO, Specialists and Faculties on 11 month Contractual basis, appointing NHM, RKS and outsourcing agencies.
XII. Resident doctors, medical students roped in for clinical as well as supportive medical and health care activities. XIII. More than 10,000 volunteer doctors, AYUSH, Nurses trained on ventilator care through one day hands on training. Also, trainings like infection prevention, swab collection etc were conducted XIV. i-GOT - an online training platform of Government of India is extensively used. Gujarat is the first in the entire country for COVID training registration and completion. XV. Non-essential services were reduced or closed to provide additional human resources in dedicated COVID hospitals XVI. GMSCL has placed order for 59 categories of medical equipments worth ~100 crores and equipments worth Rs. 85 crore already supplied (Till 12th August) XVII. Adequate supplies of essential medicines Hydroxy Chloroquine, Azitrhomycin, Tocilizumab injections are ensured. Apart from these medicines, 47 types of other medicines worth 22,7 crore have also been procured XVIII. Provision of masks and sanitizers on subsidized rate at all the shop of Amul-chain of dairy.
C. Community Interventions:
I. For early Identification of the cases two rounds of active surveillances were carried out in the Gujarat State in the month of April and May and then after regularly being carried out in the containment zones, hot spots, emerging hot spots etc. strategically. Every day 5,393 health teams carry out screening of Page 33 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER nearly 5.6 lakh persons .
II. Around of 5000 local volunteers for surveillance in urban areas. III. Surveillance of SARI/ILI initiated at Public/Private health care facilities.
IV. Extensively use of ITihas (IT enabled Integrated Hotspot Analysis System) to identify the hotspots and emerging hotspots to plan community surveillance, early identification activities and other preventive measures. 469 emerging and 961 potential hotspots identified so far.
V. Extensive use of the Pulse Oximeter in the field viz. community surveillance, medical care at door step through Dhanvantari Rath, monitoring of home isolated patients etc. for early identification of the hypoxic patients.
VI. 104 free telephone helpline intensely promoted for COVID help like information, counselling and seeking help of medical care. More than 9.5 lakh calls received and 17,331 cases further linked with the medical care till 12th August.
VII. Dhanvantari Rath, a Mobile Medical Van deployed in the entire Gujarat, which visits the 4 to 5 hot spots daily and provided medical care, screen the people, and carry out basic rapid antigen testing. 1,604 Dhanvantari Raths are deployed across the state and total 55,46,952 beneficiaries were provided medical care/screened and 11,625 were referred for further medical care till 12th August.
VIII. Stringent contact testing strategies implemented. 11,14,743 contacts have been traced & 2,62,384 high risk contacts tested so far.
IX. To protect elderly and comorbids; strategy of reverse quarantine is used.
X. Use of immunity booster drinks (Ayurvedic Ukala), Samsamni Vati, Arsenicum Album in the field and COVID care centre across the state.
XI. Intense awareness activities are being carried out in the mass media and social media platform.
XII. Indian Medical Association, local NGOs, community & religious leaders are involved for community mobilization. XIII. "હું પણ કોરોના વોરિયર" campaign lead by Hon'ble chief minister to increase awareness about COVID.
XIV. Opinion makers and leaders were involved in delivering message on social media and TV and radio spots.
XV. Proactive social messaging through various social media platform such as Facebook, Twitter, YouTube etc. XVI. A special Inter Personal Communication toolkit is created with the support of Centre for Social Behaviour Change, of Ashoka University for behaviour Change. tandard Operative Procedures are developed for the offices, Diamond Units and Textile Units.Page 34 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER D. Clinical Care :
I. Developed state clinical protocol by group of experts and released as early as 29th March 2020.
II. HOPES strategy in clinical care: Heparin, Oxygen, Prone positing, Eliminating exertion and Steroids is coined and used across the State.
III. Gujarat is among the first state to include of Tocilizumab drug with clinical advisory for effective use. IV. A special arrangement for essential needs and food are made for patients admitted to COVID hospitals. They are given a kit on admission consists of towel, tooth paste, brush soap etc. They are provided 6 to seven time food in day including tea and snacks. Patients are provided discharged kit.
V. A residential arrangement is made for the patient's relatives in the hospital campus. (Ahmedabad, Surat, Vadodara) VI. A control room is created in hospital for answer any query related with Patients.
VII. Video calling services are created to have a conversion between patients and their relatives in the wards. VIII. A ceiling for medical care in Private Hospitals is fixed by the Government to stop and unscrupulous cost in the private sector. IX. Since 6th April 2020 a regular state level tele-mentoring session of one to one and half hour with all the hospitals involved in the management of COVID patients which was mentored by the group of experts. Now it has been expanded with Daily regional telementoring for all the six regions of the Gujarat. X. Established India's first public sector plasma Bank in V S Hospital, Ahmedabad. Started plasma therapy in COVID hospitals across the state and nearly 300 patients in Surat have been treated with plasma therapy along with at other places XI. Services of Patient attendants, counsellor created in the COVID hospitals to meet the patients' ancillary care as well as psychological support.
XII. Yoga and Music Therapy are involved as a part of medical care for improving psychological and physical health. XIII. Special support teams for crematorium are created to due to strict protocol maintenance of the cremation.
XIV. More than 70 research projects on COVID are going on/completed.
XV. Gujarat Biotechnology Research Centre (GBRC) mapped entire genome sequence of SARS-CoV-2. It is one of the first institute to do in the state.
10. In response to direction number 10, State Government has introduced the insurance scheme for all Corona Warriors, other than health department like Police, Education, Revenue, etc. who lost lives during their duty and for health Page 35 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER department central government insurance scheme PMGKP is available. The relatives of all Corona Warriors from all department, who have lost their lives have been facilitated by Hon'ble Chief Minister of Gujarat. Another 50 Doctors, Paramedical staff and other field workers will be honored on 15th August, 2020 by Hon'ble CM at state level independence day function and another 68 will be honored at district level function at concerned districts.
11. A details regarding awareness campaign is briefed in detail above.
12. District wise tabular data of total tests performed, total samples tested positive, total persons discharged, total patients home quarantined, total deaths and total deaths where deceased tested COVID-19 positive are published in public domain online on https://gujcovid19.gujarat.gov.in/ dashboard. Annexure R 15 V Testing and establishments of Laboratories across 11 districts of the State As regards the establishment of COVID-19 Laboratories in every District of the State of Gujarat, it is stated that according to ICMR, there are set eligibility criteria / protocols for a laboratory to achieve, in order to be granted approval for for conducting COVID-19 tests. However, it may be be noted that as far as RT-PCR tests are concerned, for every district, at present either RTPCR or CBNAAT/TrueNAt (equivalent to RTPCR) testing laboratories are made available. Also, State has developed a mechanism whereby, no one is to travel long distances to get himself/herself tested. Samples are being taken at Urban Health Centre/Community Health Centre/ Sub District Hospital/ District Hospital/ Hospital attached to medical college situated in his / her district and the same is then transported to the nearest laboratory in the prescribed manner. Apart from this, at present, the State is also undertaking Standard Q Covid-19 Antigen Tests in every district, which also takes care of the situation that no person is to travel from one district from another for Covid-19 testing. Also hereby we would like to draw attention of the Hon'ble court regarding testing done so far in the state till date, i.e 13/08/2020- a total 11,59,822 tests have been undertaken. Initially, as per the then prevelant needs, an average of 4000 to 5000 tests were being conducted per day. However, at present, the State administration is conducting about 40000 to 50000 tests per day. If we examine the ratio of the average number of tests per day, per million, in last fifteen days, it is about 450 test per day per Page 36 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER million which is much higher than expected test per million per day, as recommended by ICMR which is an average of 140 per day per million.
Date No. of test done
28.07.2020 22248
29.07.2020 22914
30.07.2020 25067
31.07.2020 26704
01.08.2020 26303
02.08.2020 23255
03.08.2020 19769
04.08.2020 20735
05.08.2020 24374
06.08.2020 24569
07.08.2020 26591
08.08.2020 26272
09.08.2020 30985
10.08.2020 29604
11.08.2020 41647
12.08.2020 50124
13.08.2020 50817
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C/WPPIL/42/2020 ORDER
VI Social gatherings
The state government has issued the necessary government resolution restricting social gatherings for any event, social or otherwise. Breach of the guidelines and restrictions contained therein would entail penal consequences. The present deponent craves leave to submit the ground scenario as existant across various parts of the state to further elaborate of the above issue. "
2. The gist of the report may be stated thus;
"Ever since the first case was detected in Surat during March 2020, the city administration has taken all necessary measures against COVID-19. On 31st July PSMGMC expressed a possibility of a total number of cases crossing the 17,600 mark. Roughly 4,500 beds were to be kept ready, as a part of preparedness. As on 13rd August, cumulatively 13166 cases have been reported and 1,998 beds are occupied. There is a significant improvement in the COVID management situation in Surat. Presently, active cases are coming down and recovery rate is increasing every day. SMC has taken unidirectional approach including strengthening of Active and Passive Surveillance, augmentation of health infrastructure, capacity building of staff, fast recruitment of additional staff required for augmented infrastructure, making available lifesaving medicines to citizens, setting up of Community COVID Isolation and Health Centers, usage of Dhanvantari Raths & fever clinics, aggressive testing, containment strategy, efficient Co-Morbid management, war room etc. Actions Taken Governance With regards to handling of COVID-19 Pandemic in effective manner, continuous guidance has been Page 38 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER received from Central and State Government.
Principal Secretary, Health and Family Welfare Dept., Government of Gujarat visited Surat from 30.06.2020 to 09.07.2020 and helped SMC for better management of pandemic situation and also helped in setting up SOPs for Diamond and Textile Industry and implementation of Community COVID Isolation Centers.
Hon'ble Chief Minister Shri and Deputy Chief Minister Shri, regularly takes review of the situation in all cities of Gujarat and provides necessary directions and guidance on regular basis. Hon'ble Chief Minister and Deputy Chief Minister visited Surat on 04.07.2020 and on 02.08.2020 to review the situation.
Further, a team of AIIMS director Dr. Randeep Guleria, NITI Ayog member Dr. Vinod Paul, ICMR Director General Dr. Balram Bhargav, Additional secretary to Union health Ministry Aarti Ahuja visited Ahmedabad and Surat to review the situation. On 16.07.2020 and 17.07.2020, team visited Surat. Useful inputs were received from the team and team was satisfied with the efforts of SMC to combat COVID-19 situation. Team also appreciated various initiatives of SMC including Community COVID Isolation Centers and SOPs for Diamond and Textile Industry.
Preventive steps Surveillance A. Active surveillance through APX-R Strategy:
Surat Municipal Corporation has well established system of active surveillance. The grass root workers Page 39 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER are the team of ANM/ASHA and PHW (Primary Health Workers). House-to-House survey with 2340 teams involving 4670 primary health workers and other paramedical workers / teachers / clerical staff has been carried out using unique model of APX-R survey methodology. Using this methodology, teams performs house to house surveillance. Entire population has been covered by the teams for 19 to 20 times so far, and more than 3 lac houses with high risk population have been identified. Intern doctors from SMIMER Medical College are also appointed for regular telephonic follow up of all ARI patients. They also provide the counselling facilities and IEC with special emphasis on social distancing and respiratory etiquettes. Deputy Medical Officer of Health monitors active surveillance in direct coordination with Medical Officer of Health and Deputy Commissioner Health & Hospital, SMC.
C. Passive surveillance through Jamini application Surat is probably the only city in India to have such system of collecting ARI patient details from Private clinics and hospitals using Jaimini Application. 1734 Private clinics, 675 private hospitals and 51 UHC/PHCs are registered under Jaimini Application who provide ARI patient details on daily basis. So far, 158116 number of ARI cases are reported through Jaimini Application and 21111 patients are referred to hospitals.
To enhance the scope of Jaimini Application further, SMC has registered 35 number of radiology centers performing HRCT (High Resolution CT Scan of Chest to diagnose CORAD Level of COVID-19 infection) . Till date 14,425 number of HRCT patients have been registered through Jaimini Application and tracked using COVID-19 Application.
B. Dhanvantari Rath Page 40 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
With a view to reach out the high risk area and provide the door step diagnosis and testing facility, Surat Municipal Corporation started 35 fever clinics during the lockdown period and later under the guidance and assistance of Government of Gujarat introduced "Dhanvantari Rath" which is a mobile medical van. Dhanvantari rath provides various services like Rapid Antigen Testing, ARI case management, referral, prophylaxis, SPO2 measurement, fever/malaria/other case management, IEC activities to increase use of mask, sanitizers and hand hygiene practices. Till date 10,69,700 citizens have taken benefits of Dhanvantari Raths. On a daily basis over 121 Dhanvantari Raths are operational across the city with average OPD of 275 individuals per Rath.
C. Containment Strategy Surat Municipal Corporation has adopted scientific approach for containment management. Based on multiple criteria like number of positive cases, population density of area, geographic situation of area etc, a containment area is finalized and declared as Containment zone through a notification. Door to Door surveillance activity, placement of Dhanvantari Rath and Rapid Antigen Testing, IEC activities, etc. are carried out in containment zone.
Foot operated sanitizer dispensing machines are installed in slum area, railway stations, bus stands and other high footfall areas for the first time. Hand washing stations are also installed at various places including slums and areas with high footfalls.
Suraksha Kavach Samiti: To ensure awareness and behavior change by community itself and to help citizens under Page 41 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
containment zone for their basic needs Suraksha Kavach Samitis are formed. So far, 480 Suraksha Kavach Samiti are formed incorporating a doctor / paramedical staff, president / secretary of society, school teacher, student, recovered COVID-19 patient, women / youth group members and members of NGO / Welfare groups. More than 5000 volunteers are involved as part of Suraksha Kavach Samiti for various tasks.
D. 104 Helpline:
To diagnose the cases at earliest, with main aim to reduce mortality, Surat Municipal Corporation has adopted decentralized strategy of response from 104 calls. The assigned team of doctors and paramedics attend the patients within shot period of time (less than 2 hours) and provides preventive, promotive, and curative services. Till date, over 4017 calls have been attended by team and more than 50 patients have been referred timely to the hospital to ensure optimum care. Timely follow up of all calls have been ensured and monitored continuously from "War room team, Epidemic Control room, Vesu"
E. Extensive usage of Pulse Oximeters:
One of the key factor to identify COVID-19 symptoms has been identified as checking of SPO2 level of individuals. These SPO2 checking machines are used during house to house surveillance as well as at Dhanvantari Raths and Public Health Centers / Urban Heath Centers. As of now, more than 5392 Pulse Oximeters are in use. (4700 by field and surveillance staff and 692 distributed to home isolated patients who did not have Pulse Oximeter). At Dhanvantari Raths, more than 12 lacs people are checked for SPO2 Page 42 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER levels out of which 1500 patients were referred to hospitals because of less than 95% SPO2 level. This has also helped in reducing the mortality rate.
F. Enforcement:
Enforcement of fines for not wearing masks and spitting has been strictly implemented by SMC in coordination with Police Department. So far 5.21 Cr. Fine has been imposed to 1,42,456 individuals. As per Government of Gujarat's notification from 11.08.2020 the same has been increased to Rs. 1000 as per announcement from Government of Gujarat.
Action Taken I. TTT IQ Strategy based tracking (Track, Test, Treat, Isolate and Quarantine) From the early stage of COVID-19 pandemic, SMC had adopted TTT IQ strategy to fight the disease. The strategic approach focuses on early identification of patients with symptoms, perform testing and impose isolation and quarantine to break the chain of spread. SMC has tracked more than 1,79,636 such individuals.
J. Contact Tracing As part of TTT IQ strategy, rigorous contact tracing has been done to early isolate the contacts of positive patients. Within 4 hours of positive result, field teams identifies the contacts like family members, business contacts, social contacts. Every contact is captured under SMC COVID-19 Tracker K. Augmentation of health infrastructure:
In anticipation of surge of positive cases in coming days, SMC started augmentation of SMIMER Hospital by converting a Multi-Level Parking into a COVID-19 Hospital named SMIMER+ in the month of April 2020 with capacity of 540 isolation beds (All with Oxygen beds) exclusively for COVID-19 patients.Page 43 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021
C/WPPIL/42/2020 ORDER Total Oxygen beds, ICU beds and ventilator bed capacity has been increased to provide timely care to the patients with severe illness. Overall Bed capacity has been increased from 4856 to 7075.
SMC has also created COVID Hospital at Bamroli CHC with capacity of 80 beds and Pal CHC with capacity of 67 beds.
Rapid recruitment process has been done to make available additional human resources especially Doctors, Paramedical Staff and support staff. Till date 164 doctors, 310 staff nurse, 39 lab technicians, 226 ward boy, 106 aayas, 2384 multipurpose health workers have been recruited on contractual basis.
L. 21. Enforcement measures and SOP for Diamond, Textile and Migrant labours:
Surat being hub of Diamond and Textile Industries, after Unlock-1 Diamond and Textile industrial units opened up. It was important to have a Standard Operating Procedure for Diamond and Textile Industry to ensure proper implementation of Social Distancing, Usage of Masks at work place and standard hygiene practices at work place.
On 28th June, most of the diamond units in Katargam and Varachha area were declared as clusters. So that infection related to Diamond worker does not spread in other areas of city. Various notifications issued to ban street food vendors, pan shops, tea stall etc so as to prevent crowding in these diamond industry dominated areas.
On 6th July 2020, a notification was issued by Municipal Commissioner to close all the diamond markets from 9th July 2020 to 13th July 2020 under Page 44 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER Epidemic Disease Act 1897 for prevention of disease among diamond workers.
Because of these interventions cases dipped from diamond units from 12th July onwards. Due to persuasion by SMC, diamond traders in Mini Bazar and Choksi Bazar extended their voluntary lockdown from 19th July to 31st July. A mass screening activity was taken up to cover the entire diamond market area of north zone within two (2) days. During the activity, 21 teams involving 172 employees were formed to cover 146 diamond units where 24,567 diamond workers were screened and 2,45,670 medicines were distributed to the workers.
Municipal Commissioner by his order no.
PRO/281/2020-21 dated 05.07.2020, has issued a notification with regard to formation of cluster containment area of any textile unit even if a single case comes as a positive case. Many diamond as well as textile units were put under cluster containment and strict lockdown as enforced in order to restrict the infection spreading. The major textile markets including JJ Textile market, Surat Textile Market, Millennium Textile Market and Raghukul Textile market were shut by SMC as a part of this cluster containment strategy.
Municipal Commissioner conducted 5 meetings with diamond associations and 5 meetings with textile associations to revise working methodology. The guidelines including SOP for Diamond Units, Diamond Markets and Textile Industry were published on 08/07/2020.
SMC has also trained master trainer for proper Page 45 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER implementation of SOPs in Diamond and Textile industries. So far 300 master trainers have been trained who have imparted training to more than 1600 people from 110 diamond industry units and more than 60 textile industry units.
By Municipal Commissioner order, vigilance teams are formed including officials from SMC and various GOG departments to ensure adherence to this SOPs in all reopened units of both the industries. These teams do surprise checking of the industrial units daily.
The teams till date have surveyed almost 552 textile/ diamond units. 76 units have been closed/ sealed due to non-compliance of the rules/ procedures set in the SOP. 281 units have been fined with a penalty of RS 6,32,800/- for the same.
SMC SOP for diamond industries allowed only one worker to sit on the emery wheel for the cutting and polishing of diamonds instead of previous norm of four (4) workers, to contain the spread of COVID-19 infection. Even the diamond markets were restricted to have their operations from 2 PM to 6 PM to contain the virus in diamond units. SOP for Diamond Market, Diamond Industrial Units and Textile Market are given in Annexure 4, 5 and 6 respectively.
Special SOP for Migrant Labour Returnees After the subsequent Unlocks declared by the Government and restarting of various industries, a huge number of migrant labours are returning to the city. SMC has formulated an SOP for tracing/ tracking and health check-up of such labours before they resume their duty. Various teams, comprising of SMC Page 46 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER officials Railway, GSRTC and RTO, have been setup for tracing of such returnees and ensuring adherence to the SOPs by industries before allowing such workers to resume the duty.
Further, SMC has developed a Software Application to keep tracking of returnee migrant labours.
Summary
4th July 13th August
2020 2020
Testing per million per
136 1,753
day
Recovery rate 62% 77.3%
Growth rate of new cases 4.10% 1.82%
15.8
Doubling rate 45 days
days
Operational Dhanvantari
105 121
raths
112
54 calls per
104 calls attended calls
day
per day
Bed Capacity 4,856 6,996
Bed Occupied 996 1998
Bed Available 2868 4998
Comparison of Three Dates
4th 21st
13th
July July
August
202 2020
2020
0
No. of Tests 751 2116 8767
Tests Per Million 423
136 1753
Per Day
No. of Positive 201 225 181
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C/WPPIL/42/2020 ORDER
Cases
67. 68.0%
Recovery Rate 77.3%
1%
386
Bed Capacity 4744 6,996
4
Bed Occupied 996 3189 1998
286
Bed Available 1535 4998
8
ANALYSIS
3. This Court discussed various issues concerning the city of Surat in the course of the hearing of this matter.
4. Mr. Amit Thakkar, the learned counsel appearing for the writ applicant in Writ Petition (PIL) No.116 of 2020 gave us a fair idea of the practical difficulties faced and experienced by the people of Surat. He pointed out that, as on date, there is one Government Civil Hospital in operation, one hospital run and managed by the SMC, 44 Private designated hospitals and 200 Community Isolation Centers. He further pointed out that around 1871 patients are under treatment of Covid 19.
5. Mr. Thakkar suggested that the life saving drugs in the form of Dexamethasone Injection should be made available at the earliest.
6. He further pointed out that even at the time of discharge of the patients from the Hospital, a particular patient may be in need of supply of oxygen. Some mechanism should be evolved to provide the facility of Page 48 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER oxygen at the residence of such patients.
7. He, thereafter, pointed out the problem as regards the cashless mediclaim policy. He pointed out that this issue needs to be taken with the IRDA.
8. He, thereafter, pointed out that there are no sufficient numbers of the dead body ambulance (Dead Body Van).in the city of Surat. The administration should provide few more Vans to carry the dead bodies to the crematorium.
9. He also pointed that there are no sufficient numbers of Ambulances. He, thereafter, pointed out few deficiencies in the nursing staff, more particularly, the patients are not attended in the hospital at the earliest. In the last, Mr. Thakkar submitted that the authorities should evolve some mechanism by which counseling is provided to the patients, i.e., psycho care.
10. Mr. Kamal Trivedi, the learned Advocate General and Ms. Manisha Luvkumar Shah, the learned GP appearing for the State very positively responded to all the above referred suggestions put forward by Mr. Thakkar. Both the learned counsel submitted that all the suggestions made are already taken care of, and in any case if there is any further requirement, appropriate steps shall be taken in that direction.
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11. The picture that emerges as regards the conditions prevailing as on date in the State of Gujarat is quite frightening. Although all the necessary steps are being taken to combat with the situation of Covid 19 Pandemic, yet the machinery needs to be gear up and the State should be prepared to meet with the worst of the situation. The cases of Covid 19 in Gujarat has crossed the Mark of 82,000 with 1126 more cases reported in 24 hours. The total number of cases now stands at 82,017. According to the data available as on date, with 20 more patients succumbing to the infection, the death toll has reached to 2,822.
12. The last Sunday, i.e, 16th August, 2020, marked the 29th consecutive day of more than 1,000/- new cases of Covid 19 in a day. It was also the 10th day so far when the daily count crossed the mark of 1,100/-. The highest, so far, was 1,159/- cases reported.
13. On Sunday, i.e., 16th August, 2020, the maximum of 252 cases were reported in Surat, taking its tally to 17,985/- It was followed by 165 in Ahmedabad, 111 in Vadodara and 98 in Rajkot. Jamnagar reported 58 cases, Morbi witnessed 46 cases in 24 hours, Bhavnagar reported 43 cases, Panchmahals 39, Dahod 28, Gandhinagar 27, Bharuch & Banaskantha 26 each, Junagadh 21, Mehsana 18, Kutch 17, Amreli, Gir Somnath and Mahisagar 15 each and Navsari, Patan, Surendranagar and Valsad 10 each.
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14. As many as seven patients died in Surat, four in Ahmedabad, two each in Amreli, Bhavnagar and Kutch and one each in Gir Somnath, Rajkot and Vadodara. These figures are released by the State Health Department.
15. In terms of the daily cases, the State of Gujarat is placed 14th among the States. The number of recovered cases rose to 63,710 with 1131 more patients getting discharged from the hospitals.
16. The report that has been filed by the State, referred to above, with respect to the measures that have been taken in Surat, reflects encouraging trends and facts. We all, at the end of the day, are working towards the common goal of battling this Covid 19 Pandemic. From the report, we have been able to discern that the Chief Minister, the Health Minister and other officials of the Health Department have been regularly visiting the city of Surat and have also camped there. We appreciate this, but at the same time, we have now reached to the ultimate conclusion that such efforts needs to be put in for all the major cities of Gujarat where the cases of Covid 19 are on the rise.
17. We may record here that the report submitted by the State runs into almost 46 pages of this order covering almost all the aspects with regard to the steps taken by the State as well as Surat Municipal Corporation. We only wish Page 51 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER to mention here the summary given at the end of the report in the form of two tables providing figures indicating the improvement in the situation over a period of time as mentioned therein. Both the tables are reproduced below:
"Summary 4th July 2020 13th August 2020 Testing per million per day 136 1753 Recovery Rate 62% 77.3% Growth rate of new cases 4.10% 1.82% Doubling rate 15.8 days 45 days Operational Dhanvantari raths 105 121 104 call attended 112 calls 54 calls per day per day Bed Capacity 4856 6996 Beds Occupied 996 1998 Beds available 2868 4998 Comparison of Three Days 4th July 2002 21st July 13th August 2020 2020 No. of Tests 751 2116 8767 Tests per Million per day 136 423 1753 No. of Positive Cases 201 225 181 Recovery Rate 67.1% 68.0% 77.3% Bed Capacity 3864 4744 6996 Beds Occupied 996 3189 1998 Beds Available 2868 1535 4998 Page 52 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER
18. The report, referred to above, has brought to our notice the details of the various aspects of the Civil Hospital at Surat known as the NCHS. We would like to be informed about such details and aspects regarding the conditions prevailing in all the Civil Hospitals across the State of Gujarat, more particularly, Vadodara, Rajkot, Bhavnagar and Gandhinagar.
19. We would also like to call for some relevant information so that we can work upon the same and put forward our suggestions.
20. The first and the foremost direction, we intend to give, is to the Chief Secretary, State of Gujarat. The Chief Secretary is directed to constitute a team of five high ranking IAS Officers, not below the rank of Joint/Additional Secretary, at the earliest. The members of the Committee, that shall be constituted, shall immediately take a tour across the State of Gujarat and visit all the Civil/Government Hospitals to take stock of things prevailing over there. There is lot of hue and cry at various other Civil Hospitals as regards the treatment, services etc. We direct the Committee Members to prepare a comprehensive report as regards the conditions prevailing in all the Civil Hospitals/Government Hospitals in the State of Gujarat where the Covid 19 patients are being treated. The Committee Members shall, very minutely, look into the deficiencies, if any, at such Civil Hospitals so that such Page 53 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER deficiencies can be cured and taken care of.
21. We clarify that we are not asking the State Government to undertake this exercise only with a view to point out or highlight the shortcomings and deficiencies in the overall administration of the Civil/Government Hospitals across the State of Gujarat. We are asking the State Government to undertake this exercise with a definite and laudable object. Nothing in this world is perfect. There are bound to be few deficiencies and shortcomings in any type of administration. The idea, with which, we are asking the State Government to undertake this exercise is to ease the difficulties and the problems faced as on date by a common man, more particularly, the members hailing from the poor strata of the Society. This exercise will enable the State Government to provide better medical services in the State of Gujarat during this period of Covid-19 Pandemic. The deficiencies or the shortcomings that may be noticed by the Committee Members can be taken care of so that the quality of medical services and overall administration may improve. The circumstances, as on date, are such that it is difficult for a common man to come forward and point out his problems. It is with this spirit that the State Government shall undertake the exercise. We expect the Committee Members to effectively interact with the resident doctors, interns, superintendence, nursing staff, and above all, the patients and their family members, attending the patients in the Hospital. Such interaction will go a long way Page 54 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER in achieving the object, with which, the exercise is to be undertaken.
22. Let this exercise be undertaken at the earliest.
23. Our next date of hearing of the main Writ Petition (PIL) No.42 of 2020 is 4th September, 2020. By that time, the Committee Members shall try their best to cover all the Civil Hospitals and place an appropriate report before this Court.
24. Considering that there are almost 11.5 Lac workers and labourers employed in the various industries in Surat, and also having regard to the fact that the Country is slowly moving towards the "Unlock Phase", the influx of such migrant labourers will be on the rise in the coming months. While the initiative of having a separate Standard Operating Protocol for the Diamond & Textile Industries is appreciable, we would like to know whether such a protocol is in place for the other industries too.
25. We would also like to know how many industries are there in Surat and how many have become functional as on date.
26. We would like to know how many workers have resumed and have been integrated back into the workforce.
27. We would also like to know what is the frequency of Page 55 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER testing in these industries.
28. In the last, we would like to know the exact details of "strict implementation" of the SOP''s in such industries.
29. We have also noted the availability of the various life saving drugs in the Civil Hospital, Surat and also the fact that such drugs are being provided to the patients in the private Hospitals. However, we would like to inquire whether there is a safety-cum-checking mechanism in place to ensure that the patients in the private hospitals, for whom such drugs are provided by the State, are actually being administered to them or not. In essence, our question pertains to the process of verification regarding the receipt of the life saving drugs by the beneficiaries concerned.
30. We expect a comprehensive report on all the above referred aspects by the next date of hearing. At this stage, we would like to say something. We make it clear that from now onwards, the report that may be filed before this Court, shall be in the form of an affidavit, duly affirmed by the Principal Secretary, Health & Family Welfare Department, State of Gujarat.
31. In view of the above, WP (PIL) 116 of 2020 does not require any further consideration as all the issues raised therein have already been either taken care of by the State Page 56 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021 C/WPPIL/42/2020 ORDER Government or the Surat Municipal Corporation or if not already taken care of, as per the statement and assurance given by the learned Advocate General and the learned Government Pleader, they would be given due consideration. WP (PIL) 116 of 2020 is thus disposed of.
32. Post the WP (PIL) 42 of 2020 for further hearing on 4th September, 2020 along with allied matters.
(VIKRAM NATH, CJ) (J. B. PARDIWALA, J) Vahid Page 57 of 57 Downloaded on : Sat Feb 27 18:14:22 IST 2021