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Widespread testing, oximeters responsive ambulance system ready avbility of beds via Delhi Corona app

Widespread testing, oximeters responsive ambulance system ready avbility of beds via Delhi Corona app
Arvind Kejriwal
New Delhi July 26, 2020:Delhi Chief Minister  Arvind Kejriwal had stressed to Health Department officials that the biggest priority was to ensure minimal deaths due to Covid-19. Multiple initiatives were taken specifically keeping this objective in mind, and monitored personally by the Chief Minister, which led to a major decline in COVID deaths between early June and July. A detailed analysis of deaths due to COVID-19 in Delhi carried out by the Health Department, GNCTD, for the period 1-12 June and 1-12 July has revealed a 44% decline in deaths – from 1089 during 1-12 June to 605 during 1-12 July.
The analysis revealed that deaths in Delhi government COVID hospitals saw a 58% reduction from early June to July – from 361 deaths to 154 deaths. In comparison, deaths in Private COVID hospitals saw a 25% reduction from June to July and deaths in Central govt COVID hospitals saw a 55% reduction. Hospital-wise analysis of deaths revealed that the % death rate (total deaths vis-à-vis total admissions) in Central government’s RML hospital was 81% in June, which dropped to 58% in July. In Safdarjung Hospital – another Central government facility, the % death rate dropped from 40% in June to 31% in July. Similarly, the % death rate in LNJP hospital – Delhi govt’s largest COVID hospital – dropped drastically from 28% in early June to 16% in early July. Delhi govt’s Rajiv Gandhi Super Speciality Hospital turned out to be among the best Covid hospitals in the national capital in terms of death rate – 6% in early June and 7% in early July.
Analysis of death figures carried out by the Health Department also revealed that a large number of people who got admitted in early June arrived in critical condition and passed away within 4 days, many within 24 hours. During 1-12 June, % of all deaths that took place within 4 days of admission was 67%, whereas % of deaths that took place within 24 hrs of admission was 34%. In comparison, during 1-12 July, % of all deaths that took place within 4 days of admission was merely 35%, whereas % of deaths that took place within 24 hrs of admission was 15%.
This radical turnaround was possible due to the single-minded focus of CM Arvind Kejriwal on initiatives that would directly help prevent deaths, as well his daily monitoring of the status of critical patients. Hon’ble Minister of Health, Shri Satyendar Jain said “CM Kejriwal has been personally monitoring the daily status of critical patients and deaths due to COVID from the beginning. His emphasis on timely implementation of crucial initiatives to prevent deaths has helped turnaround the situation, and restore public confidence in Delhi government’s hospitals.”
Five key initiatives that were key to the reduction of deaths due to COVID in Delhi are:
1. Widespread Testing:* From an average of 5,500 tests per day, Delhi scaled up its testing to reach an average of 21,000 tests per day in early July. As on date, Delhi’s current testing rate of 50,000 per million is by far the highest in the country. This ensured that suspected COVID patients could access testing facilities easily without losing time or getting serious, as also reflected in the fact that fewer patients who got admitted in July died within 24 hrs or first 4 days.
2. Oximeters:* Delhi govt supported Home isolation programme from the beginning, even against Centre’s opposition, and decided to provide Oximeters for free to all home isolation patients. A total of 59,600 oximeters were purchased and distributed. This ensured that patients in home isolation could monitor their vitals and in case of becoming serious, would lose any precious time in transferring to hospitals.
3. Responsive ambulance system:* Based on observations in many states where government ambulance system could not cope with a surge in COVID cases causing dangerous delays in the transfer of critical patients to hospitals, in some cases even deaths, CM Arvind Kejriwal ordered for a rapid expansion of ambulance fleet right at the beginning of lockdown. Daily reports of ambulance fleet and response times were monitored by the CM. The ambulance fleet increased from 134 at the beginning of lockdown to 602 in early July, and the response times dropped from an average of 55 mins on average to 20-30 mins.
4. Availability of beds and Corona app:* To ensure patients could easily find a bed in a hospital of their liking – be it private or government – without running around multiple hospitals and losing precious time in the process, CM Kejriwal took several decisions that saw the capacity of COVID beds increase drastically from around 3700 in end May to 15,000 in early July. The decision to launch Delhi Corona app, first and the only such app for any city or state in India, also ensured no time was lost in locating hospital beds for critical patients.
5. Focus on ICU beds:* Seeing the number of deaths increase in early June and based on conversations with several health experts and doctors, CM Kejriwal emphasized the expansion of ICU beds the most. From less than 500 ICU beds in early June, Delhi today has over 2200 ICU beds in Covid hospitals, about 1400 of which are vacant.
With the objective of further reducing death rates, CM Arvind Kejriwal has directed Health Department officials to focus on government hospitals with the highest death rates or those having highest proportion of deaths taking place in wards instead of ICUs, and recommend specific measures that need to be adopted. Analysis of deaths from 1-23 July revealed that the government hospitals with the highest death rate are RML (39%), Safdarjung (35%), GTB (22%), AIIMS Delhi (20%) and LNJP (15%). The % of deaths that took place in wards in these hospitals in the period 1-23 July was 43% in RML, 42% in GTB, 38% in LNJP and 18% in Safdarjung. Similarly, Rajeev Gandhi Super Speciality Hospital had a death rate of only 7% in this period and was asked to share its best practices so that the same could be adopted in other hospitals.

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