India is initiating several measures to boost overall health infrastructure, primarily by asking states to designate dedicated hospitals for affected patients, ramping up procurement of ventilators and mobilising resources of railways and armed forces, amid growing concerns over whether coronavirus was beginning to spread within communities.

As of now, the country reported 873 coronavirus cases and 19 deaths.

Even though the Union health ministry and the Indian Council of Medical Research (ICMR) have been insisting that there is 'no solid evidence' of community transmission so far, the government has started scaling up health infrastructure to deal with such an eventuality.

India is under a 21-day lockdown from Tuesday midnight as part of efforts to check spread of coronavirus.

In an urgent communication, the Centre has asked all states to earmark hospitals only for treating Covid-19 patients and ramp up their capacity to manage increasing number of cases. At least 17 states have started work on it.

The armed forces are keeping ready 28 service hospitals to provide treatment to Covid-19 patients apart from five hospitals which are carrying laboratory tests for the infection.

Defence public sector undertaking Bharat Electronics Limited has been tasked with manufacturing ventilators while premier defence research laboratory DRDO is producing protective gears for medical personnel and supplying hand sanitisers and face masks to various agencies involved in patient care.

Doctors examine people with flu like symptoms at a screening facility set up amid COVID-19 outside Government Medical College hospital in Jammu, on Thursday AP

Emergency powers

On Friday, the government granted emergency financial powers to Army corps and divisional commanders to procure equipment to set up medical and quarantine facilities for affected people.

On its part, the railways has manufactured a prototype of an isolation ward for treating coronavirus patients by converting non-air-conditioned train coaches. Once the best practices were finalised in the next few days, each railway zone would manufacture a rake with 10 coaches every week, the national transporter said.

Doctors at leading hospitals on Friday expressed fear that India ran the risk of seeing the viral transmission in stage three of infection if the lockdown and quarantine norms were not diligently complied with.

As part of its preparation to deal with large volume of cases, the Centre has also directed the states to keep some beds reserved for creating isolation facilities in public and private hospitals and ensuring that stable patients are discharged as early as possible.

The health ministry has already asked hospitals and medical education institutions to procure sufficient number of ventilators and high-flow oxygen masks to be prepared for any possible influx of patients.

AIIMS task force

The AIIMS has set up a task force to develop management protocol for Covid-19 and has constituted several committees to be able to respond to challenges which may come across in coming days due to the rising infection, officials said.

The Centre has also asked hospitals to postpone all non-essential surgeries.

Arrangements adequate in Delhi

In Delhi, chief minister Arvind Kejriwal said on Friday that the spread of Covid-19 was 'quite under control' in the city and asserted that even if novel coronavirus cases went up to 100 per day in Delhi, adequate arrangements were in place to tackle the situation.

Addressing an online press conference, he said that a five-member panel of doctors, headed by S.K. Sarin, had submitted its report, prescribing the standard operating procedure for dealing with a situation involving 100, 500 and up to 1,000 new coronavirus patients per day.

Sarin is the head of the Institute of Liver and Biliary Sciences (ILBS).

A doctor checks the temperature of a passenger at a bus station during lockdown in Jammu, India on Friday, March 27, 2020. AP

‘Worse than world war’

Private hospitals too have ramped up their facilities and creating focussed team to handle any surge of patients in future.

Dr Sandeep Budhiraja, group medical director, Max Healthcare, said, 'This is worse than a world war situation. And, we are in it together.'

He said, Max group has planned a three-pronged strategy to 'meet the worse scenario' in future, in case the situation befalls on India.

'We are creating a designated facility at our Greater Noida hospital only for COVID-19 patients. It has 200 beds, 40 ICU beds and 160 wards. This will be solely for coronavirus patients,' Budhiraja told PTI.

Besides, at three hospital units, one each in north, south and east Delhi -- BLK Hospital, Max Saket and Max Patparganj respectively -- there are segregated wards for suspected patients of coronavirus, he said.

'Slowly, we are moving our non-Covid-19 patients in phases from the three units, just in case God forbid, we enter into large-scale community transmission stage which is when there will be a huge surge of coronavirus patients,' he said, adding, these three facilities will then become also designated hospitals.

But, this will happen in the planned three phases and currently 'we are in phase one of our plan', Budhiraja said.

Apollo Project Kavach

Dr Prathap C Reddy, chairman of Apollo Hospitals Group said, 'We are fighting a war not just for this generation but also for the generations to come.'

On March 26, the group launched Project Kavach, a response plan that is a comprehensive approach that encompasses all aspects from information, screening and assessment, testing, to readying the infrastructure for quarantine and treatment.

The project will bring together all the resources of Apollo Hospitals to fight for the people of the country against this pandemic, a spokesperson of the group said.

Patients consult with a doctor at a fever clinic which is operative at the Civil Hospital in the wake of coronavirus pandemic, in Lucknow on Tuesday PTI

Medical rooms in hotels

She said the group will soon be launching 'Project Stay I', an innovative strategy to create medical rooms in hotels or hostels with light medical supervision for quarantine and creating a barrier before people come into the hospitals.

'These medical rooms will be rolled out in the following cities - Chennai, Mumbai, Hyderabad, Calcutta, Bengaluru and Delhi, starting with approximately 50 in each city, going up by 50 rooms every three days, to reach an eventual target of 5000 rooms across the country. These will be calibrated as per the need,' the spokesperson said.

The importance of up-scaling the infrastructure is to be prepared in a scenario where each virus loaded patient can infect up to 4-5 people, the Apollo group said.

Health ministry officials said only five per cent of the total affected patients require critical care as they go on respiratory failure and need to put on ventilators while rest recover with supportive treatment.

Orders for ventilators

To address the shortage of ventilators in the country, Joint Secretary in the Ministry of Health Lav Agarwal on Friday said that an order has been placed for 10,000 ventilators in addition to earlier order of 1,200 ventilators.

Bharat Electronics Limited (BEL) has been asked to supply 30,000 additional ventilators in one-two months to address the shortage of ventilators in the country.

Dr Giridhar Gyani, convenor of a task force on Covid-19 hospitals, said there are few cases which are not known to have link with foreign travel or direct contact of anybody who had travelled abroad.

'If such cases come in large number then we take it as beginning of community spread. In that sense though we are not in stage 3 but it would be better that we do all our preparations,' he said.

'Luckily till today the increase in number of cases is pure arithmetic and things are under control while in community spread it goes geometrically or exponentially,' the official said.

He said effective implementation of the lockdown will help India arrest the further spread of the infection and government is fully prepared to meet any level of crisis.