Rapid augmentation of COVID-19 hospital capacity in India

350+ Beds in 6 States and going strong.
Rapid augmentation of COVID-19 hospital capacity in India

The second wave of the COVID-19 pandemic sadly hit very close home when many of us and our friends ran from pillar to post looking for hospital beds, oxygen cylinders, antivirals, etc. Hospital infrastructures across states in India were under immense pressure due to the high rate of COVID-19 associated hospitalizations. The importance of adequate hospital infrastructure vis-à-vis beds, oxygen concentrators, oxygen cylinders, etc. became starker than ever before.

A healthcare worker at the District Civil Hospital, Tarn Taran, Punjab which was extended with a now operational 24-bedded hospital

Augmentation of hospital capacity through ‘Extension hospitals’:
The Office of PSA undertook several activities to assist the nation in mitigating the impact of COVID-19. The activities included enabling the design of oxygen generators and concentrators, telemedicine, and increasing hospital capacity. One such activity was to support states with the establishment of ‘extension hospitals’, which included assisting with all the steps necessary to get temporary hospitals commissioned. The primary objectives were, 

• Rapid augmentation of COVID-19 hospital capacity in areas of acute need, and 
• Creation of model processes & guidance for scale-up across India.

Extension hospital at Civil Hospital, Faridabad, Haryana. Augmented by 96 beds

The impact:
The Office reached out to almost all states seeking interest in temporary extension hospitals. Several states responded, emphasizing the need for oxygen in all beds. The exact locations were identified based on prompt requests received from the state government and/or their health agencies, and commitment to complement the hospital capacity with medical. The duration required to supplement the existing hospitals with additional capacity was a few weeks. The states provide utilities and staff from main hospitals to support the extension hospitals. Extension hospitals are being commissioned in six states, and oxygen support equipment was provided in one other state. Three of the hospitals in Haryana and Punjab are already in use. 

Location of hospital sites where extension hospitals have been commissioned.

Extension Hospitals:
To identify potential hospital technology solutions, members of the Office of PSA reached out to technology-based companies inviting their interest to join the initiative. 

To meet the very large demand from states, and a rapidly expanding pandemic, proactive efforts were made to identify several organizations having the designs of prefabricated hospitals. Several public and private suppliers were identified and approached; three of whom agreed to join the initiative. These three represented three different categories of entities, namely, a Public Sector Undertaking, a corporate major, and a startup: 

• Andhra Med Tech Zone (AMTZ) - A Govt of Andhra Pradesh PSU specializing in medical equipment and capable of supplying all medical requirements for the COVID-19 pandemic. 
• Tata Steel’s Nest-in – Tata Group’s Tata Streel Limited, whose Nest-In division has an existing design of container-based hospitals, and of which a 550-bed facility was established in Kerala during 2020 to fight COVID-19.
• Strawcture Eco – Strawcture Eco uses AgriBioPanels made of more than 90% straw and a proprietary binding adhesive and then compressed at high temperature & pressure.

Role of donors:
Several donors and philanthropic groups approached the Office of PSA expressing interest to help India mitigate the second wave’s impact. While the various funders who expressed interest firmed up their commitments, immediate resources offered by the Novo Foundation of Denmark, facilitated by the Embassy of Denmark, were catalyzed to meet the needs of the states. Efforts are on to support the pending demands through other donors/philanthropic agencies.

Are ‘Extension Hospitals’ the solution to inadequate hospital infrastructure?
While modular hospitals come with a range of advantages vis-à-vis installation, cost, time spent on site, and others, they do have certain limitations. The variation in sizes and shapes of the modules is limited. The overall design and aesthetics create perception problems that, in turn, affect the way these hospitals are received for patient care by patients themselves, families, and hospital personnel. A school looks different from a hospital. Modular construction comes with the challenge that the design may not be entirely context or user-specific and needs customization. Lastly, some challenges come with assembling and transporting, and handling these modules to the site of construction.

A work in progress. Location - District Hospital, Dimapur, Nagaland (50-bedded extension hospital)

The idea to augment hospital capacity through extension hospitals was a result of quick decision-making by various stakeholders. Considering the challenges that come with setting up modular hospitals, and ensuring scalability of these extension hospitals to different scenarios, the Office of PSA has designed a study to assess the effectiveness and viability of these extension hospitals. This study will examine the following parameters:

• The extent of use of facilities to house patients, compared to the initial demand;
• Response and attitude of patients and medical personnel to extension facilities vis-à-vis the main hospital; and
• Review of medical outcomes patients admitted to these facilities vs those in main hospitals.

The desirability and standardization of such facilities for future implementations will be determined based on the report findings from the study. 

This effort to enable additional medical facilities in India to fight the COVID-19 epidemic was conducted in a time of immense urgency, with thousands of lives at stake. Multiple decisions were taken quickly, to enable rapid deployment of hospital beds. All the decisions and their impact will be evaluated through the impact study, whose findings will be used to inform future such interventions.