With hospitals choked for space and oxygen, some residential communities have begun setting up a few beds, cylinders and medicines for members right within their premises
Namrata Kohli | New Delhi A Covid care facility set up within the clubhouse at the Emaar Palm Terraces Select in Gurugram
With the chronic shortage of medical oxygen, ventilators and critical drugs at hospitals across the country grabbing the headlines for quite a while now, some housing societies in Delhi NCR have begun to think out of the box and are using their clubhouses and other free spaces to set up Covid care centres for their members.
One such is Emaar Palm Terraces Select Community in Sector 66, Gurugram. On April 23, the Resident Welfare Association (RWA) put together a Covid-care facility in its clubhouse – five hospital beds with two oxygen cylinders and two concentrators, a male nurse and some medicines. Says Gurmukh Singh, President, Emaar Palm Terraces Select: “At that time, the shortage had not hit us that badly and it was still feasible to procure the infrastructure. One of our members is at Philips so he got us concentrators. Some doctor members drew up guidelines such as ‘this facility should be regarded as in between home and hospital and not a replacement of hospitalisation. The patient and his family should be in touch with the respective physician and share the prescription with the paramedic, who will work like a bridge between patient and physician’, etc.”
Singh says the community created a Covid task force with 15 volunteers that ended up saving three lives with support from the doctors and other residents. What also helped was the availability of space in the form of a clubhouse where they could create this Covid care facility.
At Dwarka’s DDA community, where there wasn’t any clubhouse or community centre, the RWA still went ahead with Covid care facility, converted the ’14ft by 10ft’ RWA office into an isolation centre with two beds and two oxygen concentrators. Says Umesh Kala, President, Gangotri Apartments in Sector 12, Dwarka: “I contacted the district magistrate’s office on April 23, and got some infrastructure, after which a few other societies such as Neelachal Apartments also got the necessary amenities sanctioned from him. We had a few nurses within our community, residents of the society who operated and trained a few people to use the oxygen concentrator. With 1,200 residents in our society, it was important to take this contingency measure.”
Ditto in Noida Extension at Gaur Saundaryam, where a Covid care facility was created mid-April, to cater to about 5,000 residents in 1,500 flats. The facility consisted of eight beds, two nurses, four oxygen concentrators and other items such as oximeters, sanitisers, gloves, PPE kits. What helped was the availability of sprawling space, as they have a huge banquet hall with good ventilation and air conditioning. Says Manoj Gaur, MD, Gaurs Group and VP North-Credai National: “We had contacted the CMO who categorically refused to recognise any such facility saying they can’t provide any staff. Also, there were technical issues such as which patient needs to be moved where and at which point, what needs to be done if the patient’s condition deteriorates and there is oxygen depletion. So, it was decided at the level of societies, to regard this at best as an isolation centre.”
Gaur added that if the issue becomes severe, the patient will have to be shifted to the hospital. Doctors in the society made a WhatsApp group and many people pooled in their resources. “We are also taking care of society staff and ensuring they are retained and don’t leave us during these times of Corona. In fact, the staff is needed more now than ever before for maintenance of electricity, lift, water supply, sanitisation, garbage cleaning. An unhygienic or ill-maintained society can spoil things further,” Gaur added.
Dr Praveen Gupta, Director and Head, Neurology, Fortis Memorial Research Institute, Gurugram endorses the concept of a Covid facility in residential communities. He says, “At this point, there is a lot of panic over Covid and there is an isolation requirement which not everybody can fulfil in small homes with limited space. If mild or early Covid is treated at the society level, then we can actually prevent a lot of cases from progressing to moderate and severe.” He says typically out of 100 infected people, the majority may not require anything other than oral medicine. If such people use the isolation centres in their residential communities, hospitals won’t be as stressed and can focus on more serious patients.
“In fact, isolation centres can be extended to other large facilities too. It is perhaps time to channelise and creatively use institutional real estate – we have a large number of clubhouses, schools lying vacant for over a year,” says Gupta. “Had we been a little proactive and done some homework, we would not have had this crisis – I would say just like isolation centres are being set up in hotels, why not set them up in schools, colleges or less luxurious places where ordinary people can access the same facilities at lower prices.”
Gaur says his firm had offered Noida authorities the use of its school, IT parks, hotels but they refused saying they had no staff or oxygen. “Even now we can create a 200-bed facility within two days but we need help from authorities to arrange manpower,” he says.
A note of caution for any Covid care facility made at community level. Says Yogesh Mittal, GM-Delhi NCR, Portea Medical: “It requires careful consideration who should be sent where–which patient is quarantined at home, who goes to the society’s isolation centre and who goes to hospital. At present there are no proper guidelines. But home isolation is for mild and asymptomatic patients who don’t have comorbidities like heart, kidney problems. However, if your oxygen level falls below 90, and if you have comorbidities, then you need hospitalisation. To track changes in the lungs, one requires a CT scan which is only possible in hospital. Also, the nurse needs to be under constant supervision of a doctor.”
So, let’s look at how you organise it. Let’s say you have a club or common area where you can put 4-6 beds, much like in a dormitory, and organise one nurse who can work in tandem and on the directions of a doctor. The doctor can give a daily ‘online’ round to all 5-6 patients and prescribe them oral medicines and injections.
There are two things Covid care facilities in residential communities can help achieve. First, if one person in a large family is infected, he can be immediately transferred to this room to contain the spread. Second, oxygen can be administered at the society level by the nurse and patient’s vitals monitored regularly via teleconsultation with a doctor. Many people can be cured at that level.
Says Kala: “We have seen only 3-5 out of 100 require hospitalisation. If we can take care of the majority of our residents, this is bound to reduce the load on hospitals. Moreover, people won’t panic that much. Apart from physical support, this offers psychological support, too.”
Many societies have procured medicine stocks and kept them in Covid care facilities. The generic drug list has been primarily drawn by the doctors in the community, and includes prescriptions from the patient’s physician, but not drugs like Remdesivir. Says a member of an RWA in Indirapuram, “In order to help residents in distress and manage emergencies, any resident in need can pick medicines for immediate use by signing the register. We have not decided whether to charge or not but at least this will help in the need of the hour. If there are two members in a family, and both are Covid-positive and in quarantine, they can access these medicines.”
Most gated communities have budgeted Rs 5 lakh and more for this infrastructure. Of this, the capital cost is about Rs 2 lakh but the significant chunk is the operational cost which amounts to Rs 3 lakh on the conservative side. Currently paramedical staff such as a trained nurses charge anything from Rs 8,000 to Rs 20,000 per day. In one community in Gurugram where they managed to keep a skilled male nurse for Rs 8,000 on 24×7 basis, the price is quite a “steal” in today’s times. However, the RWA says the “running cost of this nurse is hurting us. He has worked at Fortis ICU for seven years, and is a little more specialised than what we probably require or can afford. Ideally, we want someone charges Rs 1.5 lakh a month.”
Food is almost free as it is volunteered by residents. Having a restaurant in the gated community helps, as residents can choose between light snacks and elaborate thali meals. But people are forthcoming and have made a roster of sending meals for the support staff.
One issue that has surfaced in societies is that of sharing the cost. One resident says, “All activities involving cash should first be discussed with the owners before taking the decision, more so because people are losing jobs and salaries. Helping the community should always be voluntary. Strangely nobody wants to discuss money.” However, RWAs say that over 90 per cent of people are supportive. One president says, “About 98 people out of hundred are supportive. And if two have issues, you just need to ignore. After all, you can’t do any good work if you start thinking of pleasing everyone.”
The other hurdle is the escalated cost of every healthcare device and service. Everything is at least four times the original cost. There are freelance nurses in the market who are charging more than doctors at the moment. Says Portea Medical’s Mittal, “The pricing of paramedical staff has gone up by 100-200 per cent the past 10 days and patients are willing to pay anything for their service. Prices are so unrealistic that it pains us to even quote them – we feel guilty and it seems like we are doing some black-marketing to be quoting 15,000 per day for a nurse.” He says everyone is involved in this kind of corruption. Even the patients are pushing up prices by going to unregistered local bureaus and don’t bat an eyelid even if the nurse quotes Rs 50,000 in certain cases for a day.
Time has been the most critical issue – be it timely setting up of a Covid facility or getting oxygen. “To avoid further crises, we must act in time,” says Gupta of Fortis. “When it happened in Maharashtra we had 15 days’ notice-–we didn’t use that notice. Most of the working population was not vaccinated and we were caught off guard.”
Oxygen scarcity has been another big issue. Redistribution of oxygen and greater availability of concentrators is required. As doctors say, if we were to make concentrators available, many would not have been hospitalised. Due to panic, several patients have been looking for admission when they actually don’t need it.
Finally, a pandemic of this order can only be fought when all hands join. Collective efforts reap results. And it calls for proper planning. As Benjamin Franklin said “By failing to prepare, you are preparing to fail.”
Table: Typical cost of infrastructure for a basic Covid unit in a housing society
Five hospital beds with mattresses
Oxygen cylinder (3 nos)
|Refundable Security 40,000; Refill charges 400-2,000
|Oxygen concentrator (2 nos)
|8,000-15,000 a day
|Miscellaneous items such as PPE kits, oxygen cans, face shields, pulse oximeters, thermometer, sanitisers, gloves
Medicines (generic set of common drugs)
|Cleaning and maintenance cost
|2,000 per day
|100-300 per person per meal
Source: RWAs in Delhi NCR