Lok Sabha Question No. 79 (STARRED), answered on 2021-07-23
Subject: Third Wave of Coronavirus
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Y. S. Avinash Reddy, Jaskaur Meena

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA STARRED QUESTION NO.7 9 TO BE ANSWERED ON THE 23 RD JULY , 2021

## THIRD WAVE OF CORONAVIRUS

## 79.     SHRI Y.S. AVINASH REDDY: SHRIMATI JASKAUR MEENA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether there are warnings by health experts/authorities about a pro advent of the third wave of Coronavirus in the form of Delta variant which is likely to affect children, if so, the details along with the timeline ther
- (b) the details of the preparedness to combat the intensity of the third wave by  ensuring  adequate  health infrastructure  like  hospitals,  ICU  beds,  oxygen supply,medicines and other medical equipments;
- (c ) whether COVID vaccination is likely to mitigate the impact of the t wave, if so, the details thereof and the steps taken in this regard part make COVID vaccine accessible to far - flung and rural areas;
- (d)  whether  the  Government  is  preparing  any  scheme to  administer  nasal vaccine/using imported injectable vaccine to children across the country; and
- (e) if so, the details thereof along with th e trials conducted, the outcome thereof and the time by which it is likely to be launched?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## ( SHRI MANSUKH MANDAVIYA)

(a) to (e): A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 79 FOR 2 3 RD JULY, 2021

…..

(a) and (b) : Multiple waves have been noticed across the world during pandemics including the COVID - 19 pandemic. The wave may occur either due to mutations in the virus or d ue to the available pool of suscep tible population, which in turn is also dependent on various pharmaceutical and non -pharmaceutical interventions for management of the pandemic.

According to the World Health Orga nization, the Delta variant of SARS -CoV - 2 has shown higher transmissibility than other mutant Variants of Con (VOCs) identified to date. There is however no scientific evidence either India  or  globally,  to  show  that  children  get  disproportionately infected  with Covid- 19  including  delta  variant.  Children,  if  infected,  generally  r asymptomatic  or  exhibit  mild  symptoms  and  do  not  get  severe  diseas However, Union Health Ministry has issued specific Guidelines and has a vised States to upgrade he alth infrastructure with respect to pediatric cas management. Ministry of Health & Family Welfare monitors the trajectory COVID - 19 in the country as per the details provided by the states. The health approach and clinical management protocol fo r Delta variant still remain the same. Five - fold approach of Test, Track, Treat, Vaccinate and adherence COVID - Appropriate  Behavior  (CAB)  remains  the  strategy  for  COVID - 19 containment.

Health is a state subject, Government of India provides required te chnical support to States and has also supported the states towards further streng of  existing  health  infrastructure  to  ensure  provisioning  of  sufficient beds, drugs, medical oxygen and other consumables to aid proper clinical of COVID - 19 patients.

Some of the ongoing initiatives to strengthen health infrastructure includ

- With the intent to reduce the risk of cross infection to non - COVID patients as well as to maintain continuity of non - COVID essential health services in the country, a three - tier arrangement of dedicated COVID - 19 health facilities [(i)  COVID  Care  Center  (CCC);  (ii)  Dedicated  COVID  Health  Centre (DCHC) and (iii) Dedicated COVID Hospital (DCH)] has been implemented in the country.
- Government  of  India,  to  supplement  th e  hospital  facilities  has  roped  in tertiary care hospitals under ESIC, Defence, Railways, paramilitary fo Steel Ministry etc. Further, many large temporary treatment facilities established by DRDO to manage surge in COVID - 19 cases in the country.
- Due to concerted actions of Central and State Governments, the isolation capacity and ICU bed capacity which was only 10,180 and 2,168 before t first lockdown (as on 23 rd March 2020) in being enhanced continuously and is currently at 18,21,845 isola tion beds and 1,22,035 ICU beds (as on 20 th July 2021).
- State/UTs and Central Governments institutions have been allocated 56, ventilators  of  which  48,446  have  been  already  supplied  (as  on  19 th July 2021).

With regards to medical oxygen supplies, the fo llowing actions are being taken:

- The daily liquid medical oxygen (LMO) production, which was about 5700 MTs per day in August 2020 increased to a high of 9690 MTs as on 13 May 2021. This was done by enhancement of LMO production in steel plants a well as in other LMO plants.
- A system for real - time monitoring of oxygen production in steel plants an distribution of oxygen to States/UTs was also put in place. Restriction imposed on industrial use of oxygen.
- A dynamic and transparent framework for al location of medical oxygen in consultation  with  States/UTs  and  all  the  stakeholders  such  as  rel Ministries, manufacturers/suppliers of liquid oxygen etc. has been prepa
- Online digital solutions viz. Oxygen Demand Aggregation system (ODAS) and  Oxygen  Digital  Tracking  System  (ODTS)  have  been  developed  to ascertain the demand for medical oxygen from all medical facilities a track their transportation.
- In order to avoid wastage of medical oxygen, guidelines on rational u oxygen  were  issued on  25 th September  2020,  and  further  revised  and disseminated to States on 25 th April 2021.
- 1,02,400  oxygen  cylinders  were  procured  in  April  and  May  of  2020  an distributed to States. Further orders for additional 1,27,000 cylinde been  placed  on  21 st April  2021,    (54,000  jumbo  cylinders  (D  type)  and 73,000 regular cylinders (B type). Deliveries of the same have starte 24,207 (24,511 B - type and 8,893 D - type) cylinders have been delivered as on 7 th July 2021. In addition, around 4962 B - type and 189 5 D- type cylinders are in - transit.
- To  generate  oxygen  at  the  health  facility  level,  PSA  plants  are established in hospitals, especially in far flung areas enabling the ho become self - sufficient in generation of oxygen for their needs and thereby, reduce the burden on the medical oxygen supply grid across the country.
- Further, to fast - track the availability of Medical Oxygen in rural and pe -urban areas, more than 18,000 Oxygen Concentrators have been allocated various States.

To ensur e provisioning of drugs for managing COVID - 19 cases in the country, the following actions are being taken:

- A  COVID  Drugs  Management  Cell  (CDMC)  has  been  set  up  in  the Department of Pharmaceuticals (DoP) to oversee the management of smooth supply of drugs u ed in COVID - 19 management.
- A  Drugs  Coordination  Committee  (DCC)  has  been  constituted  as  an institutional mechanism under Department of Pharmaceuticals for effici decision making on all the issues with respect to COVID - 19 related drugs including availa bility through inter - departmental consultations.
- Remdesivir  is  a  patented  drug,  manufactured  in  India  under  volunta licenses granted by Gilead Life Sciences USA (the patent holder) to 7 I pharmaceutical companies. Manufacturing capacity was augmente d from 38 lakh  vials  per  month  to  nearly  122  lakh  vials  per  month.  In  additio additional manufacturing sites were approved by the CDSCO, thus increasing the manufacturing sites from 22 to 62.
- All  States/UT  and  State  Drugs  Controllers  have  been  request d to  verify stock of the drug and check other malpractices and take effective ste curb hoarding and black marketing of Remdesivir.
- 'Advisory  for  Rational  use  of  Remdesivir  for  COVID -19  Treatment'  was issued by MoHFW on 7 th June 2021, for managing CO VID - 19 patients under Emergency Use Authorization for a select sub - group of patients only.
- Various measures to improve the availability of Amphotericin B (liposom through a multipronged approach of augmenting production and import an ensure  equitable  d istribution  to  States/UTs  were  taken.  Five  existin manufacturers  were  called  upon  to  increase  production  of  Liposoma Amphotericin - B  while  six  additional  firms  were  given  permission  by DCG(I).

In  order  to  augment  human  resource  for  Covid  management  so  as to ensure adequate healthcare staff in hospitals, States/UTs have been advis following:

- To  persuade  MBBS  passed  out  doctors  preparing  for  NEET  (PG)  to  join Covid care duties.
- Medical  interns  may  be  deployed  in  Covid  Management  duties  under supervisi on of their faculty, as part of internship rotation.
- Services of final year MBBS students may be utilized.
- The  service  of  final  year  PG  student  (both  broad  &  super - specialty)  as residents may continue to be utilized.
- B.Sc  /  GNM  qualified  nurses  may  be  uti lized  in  full  time  Covid  nursing duties in ICU etc. under supervision of Senior doctors and nurses.
- Final  year  GNM  or  B.Sc  (Nursing)  students  awaiting  final  exam  may  be given full time Covid Nursing duties at Government / private facilities the super vision of Senior faculty.
- The  services  of  Allied  Health  Care  professional  may  be  utilized assistance in Covid management based on their training and certification
- NHM norm for contractual human resource engagement may be followed by States /UTs for engaging additional manpower.

Ministry  of  Health  &  Family  Welfare  continues  to  provide  technic guidance  for  managing  various  aspects  of  COVID - 19.  So  far  more  than  150 guidelines/advisories/SoPs/plans have been provided to States/UTs.

Taking note of ingress of COVID - 19  pandemic  in peri - urban and rural areas, Ministry of Health & Family Welfare on 16 th May 2021 issued an SOP on COVID - 19  Containment & Management in Peri - urban,  Rural & Tribal areas.

Guidelines for management of COVID - 19 in children has been issued on 18 th June 2021.

To provide financial support to States/UTs, 'India COVID - 19 Emergency Response  &  Health  System  Preparedness  Package:  Phase -II'  has  also  been approved  by  the  Cabinet  with an  outlay  of Rs  23,123  crores    and  is  to  be implemented from 1 st July 2021 to 31" March 2022.

It includes support to State/UT level for ramping up Health Infrastru including those in rural, tribal and peri - urban  areas  closer  to  the  community, providing support for procurement of drugs and diagnostics to enhance ser delivery at district and sub district levels for management of COVID - 19 cases (including pediatric care) and for maintaining a buffer of dru gs, support for IT Interventions  such  as  implementation  of  Hospital  Management  Informatio System and expanding access to tele - consultations in all districts, and suppor for capacity building and training for all aspects of management of COVID - 19.

(c) CO VID - 19 vaccination protects from severe manifestation of disease a improving  herd  immunity  and  is  accordingly  likely  to  mitigate  the  imp COVID - 19  may  have  with  any  future  resurgence.  Vaccines  currently  bein utilized for immunization offer substantial protection again COVID - 19 besides reducing severity of disease, hospitalization and deaths.

In  order  to  improve  vaccine  accessibility,  vaccine  manufacturers being provided requisite handholding to increase production. Newer vacci are also being pla nned to be included in the COVID - 19 immunization activities which  will  further  improve  availability.    Government  of  India  has  ens improved accessibility of safe COVID - 19 vaccination services through increase in vaccination centres, citizen friendly upg radation of Co - WIN,  establishment of 24x7 national call center to address queries from general public on CO -19  and  the  vaccination  process.  Accessibility  of  vaccination  is  also improved through involving Private COVID - 19  Vaccination  Centres  (CVCs) , Workplace CVCs & 'Near to Home' CVCs.

(d) to (e) : Central Drugs Standard Control Organization (CDSCO)  has granted permission to conduct of phase I clinical trial of intranasal ad vector COVID- 19 vaccine (BBV154) (in Age group ≥18 yrs. and above) to M/s Bharat Biotech International Limited, Hyder abad on 12.02.2021.

So  far  as  injectable  vaccine  for  children  is  concerned,  CDSCO  h granted permission to conduct clinical trials of COVID - 19 vaccines in children to following Manufacturers in the country.

The details along with trials, stage - wise aras under:

- Phase II/ III clinical trial: M/s Bharat Biotech, Hyderabad (in Age gro 18 years) for Whole - Virion Inactivated SARS - CoV - 2 Vaccine on 12.05.2021
- Phase  III  clinical  trial:  M/s  Cadila  Healthcare  Ltd.,  Ahmedabad  (in group ≥12 yrs and above ) for DNA based Corona Virus Vaccine 04.01.2021.

The outcome of clinical trials depend on data emerging from the trial for the purpose of its approval for launch in the country.

Further, CDSCO has not granted permission to conduct clinical trial any imp orted COVID- 19 vaccine on children in the country.