Decoding Indian Railways' COVID War Strategy

Indian Railways has provided valuable services to residents throughout the country, including passenger transportation and a hospital on wheels. The company's latest offering comes in the form of COVID isolation wards for patients. The question is, will mobile wards help or hinder the situation?

"The railway system, therefore, will become in India, truly the forerunner of modern industry," scrawled Karl Marx, in a piece titled The Future Results of British Rule in India, published in 1853. That was the year Indian Railways began operations.

Railways seriously influenced the industrial development of the nation, while providing an affordable way for India's poorer citizens to travel to work and nearby cities. The railways, in a very literal sense, freed many citizens from their dependence on traditional agricultural lifestyles; But can they free the country from a virus?

The Great Indian Railways

The good news is that even during a pandemic, the national transporter hasn't become redundant. There was a lot of positive feedback from citizens when the government had initially assigned 215 railway stations for the deployment of remodelled railway coaches as level 1 COVID Care Centres.

The index of 23 states where these coaches could be allocated and appropriated for COVID care covered Andhra Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Goa, Gujarat, Haryana, Jammu and Kashmir, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Odisha, Punjab, Rajasthan, Tamil Nadu, Telangana, Tripura, Uttar Pradesh, Uttarakhand and West Bengal.

Augmenting Capacity is Key

"Our crumbling healthcare system cannot support a huge load of patients. Upgrading railway coaches is part of the government's plan to enhance the healthcare infrastructure," says Dr Arun Shah, who works in Muzaffarpur, Bihar. He adds that the worse is yet to come as far as India's COVID cases. "Currently, in states like Bihar, there are many mild cases and a few severe patients. We are expecting a surge in July/August. We will need more isolation wards, with specialised care during that time. But with high infection rates among healthcare workers, it will be tough to find healthcare workers to man these train isolation wards/hospitals."

Originally there was a three-pronged approach to COVID treatment. The first part of the process was to segregate people who tested positive for the virus but were asymptomatic. The second priority was to fill hospitals with oxygen facilities. Third, hospitals were more adequately equipped with ventilators and intensive care units (ICUs) for critical patients. Currently, in Mumbai, only critical patients are admitted to hospital, while those with more manageable symptoms are supposed to isolate at home.

Lifeline of the Nation

According to an initial official document released by the Ministry of Health, COVID isolation trains will be assigned at their stations and delivered over to the District Collector/ District Magistrate or their approved staff. The state government is required to schedule at least one COVID hospital for every train so that patients can be moved to the hospital easily during an emergency. The State\UT administration is then responsible for making suitable ambulance arrangements at the train's home station, preferably providing a life support ambulance with oxygen and Ambu bag.

Further, the Ministry of Health stated that the Railway Protection Force should ensure suitable security to the coaches, patients and staff working there. Should the necessity arise for coach temperature control, arrangements for rooftop masking of the coach or any other suitable provision shall be made through local methods.

The National Institution for Transforming India has also recommended that some of these isolation wards might be turned to hospitals with oxygen, ICU and ventilator.

Jugaad or a Made-in-India solution?

According to The India Express, 5,150 train coaches have been converted into Level-1 isolation centres but not used. In late May, Indian Railways decided to use 60% of those isolation coaches to run Shramik Special trains for migrant workers.

"How clean are our railway stations and trains?" asks Dr Yudhyavir Singh, Assistant Professor of Anaesthesiology, Critical Care and Pain Medicine at AIIMS, New Delhi. "Most Indian railway stations are filled with rats and mosquitos. Sanitisation will be a big hurdle for healthcare workers. Besides, it will be tough to stay inside these coaches in hot weather. It would also have an impact on the mental well-being of patients due to its design-resemblance to a jail barrack," he emphasises. "It is better to use seminar halls, auditoriums, schools, private medical colleges, or even indoor stadiums to create makeshift facilities."

Officials said that modifying each coach into an isolation ward has cost Railways around 2 lakh while reconverting them into regular non-air-conditioned coaches would cost the national transporter 1 lakh for each coach.

India, however, is not a country that prides itself on punctuality and organisation.

So, after almost two months since the COVID-19 pandemic gripped the nation, Indian Railways has deployed the first COVID-19 care centre consisting of 10 modified coaches with 160 beds in the national capital. These railway isolation coaches have been stationed at the maintenance depot of the Shakur Basti railway station in the Northern Railways (NR) zone in Delhi.

Even Trinamool Congress demanded answers about why the COVID isolation coaches have not been in use until now. For instance, South Western Railway (SWR) changed 312 railway coaches into isolation wards and ICUs for the treatment of COVID-19 patients, but according to some reports, there are no patients in these trains.

"It is indeed great to see the Indian Railways, Ministry of Health and states working together during the pandemic. The idea to have a mobile rail carecentre for facility-based isolation which can move to high-risk areas is indeed interesting. When intensive care facilities in Paris were overwhelmed, the high-speed Trains à Grande Vitesse was used to transport patients to other smaller cities where caseload was poor. India's approach is not reactive, thus making it more meaningful from a systems perspective. However, it is challenging. Would people want to go to mobile units in railways for this? Smooth governance during a pandemic, is challenging, and railway stations will still be needed for rapid movement of logistics. A key challenge might be moving patients to intensive care facilities if rapid escalation of symptoms happen— time is critical for such cases. There is a strong need to invest in government primary care centres and government hospitals and add capacity. COVID-19 is here for the long run, and we need a new economy, which invests in basic healthcare services (like the railway's care centres) rather than fancy technological innovations which have not been tested," says Soumyadeep Bhaumik, a public health specialist at The George Institute for Global Health.

Is there any point investing money and supplies in the project? Authorities are working out some of the flaws of the COVID coach plan. For instance, the non-air conditioned COVID care isolation coaches may soon get a solar-reflective cover, which would bring down the heat inside by 5-6 degrees Celsius if experiments on other coaches have positive results.

Indian Railways has overcome many challenges over the course of its 167-year-old journey. That's why Edward Arnot wrote in 1865, "Railways might do for India what dynasties have never done—what the genius of Akbar the Magnificent could not effect by government, nor the cruelty of Tipu Sahib by violence; they may make India a nation."