Introduction
A makeshift COVID-19 hospital in India’s capital city of New Delhi was created within seven days to meet the demand for beds during the devastating second wave of the COVID-19 pandemic. Their experience shows how a resource-constrained health care facility can deliver quality care and save lives in a densely populated country. Despite receiving patients who came to the hospital with low oxygen levels, the Burari Sant Nirankari COVID-19 Center managed to provide timely treatment to everyone, with a record of zero deaths, during the peak of the country’s pandemic in May and June 2021. The facility treated on average 500 patients daily through an effective triage system, which helped ease pressure from the larger hospitals with severe shortages of beds due to the rising number of cases.
India recorded over 200,000 COVID-19 cases daily and Delhi alone recorded on average 20,000 cases daily in April 20211 when a shortage of beds remained a critical issue in the capital.2 Senior doctors from the private hospital Ujala Cygnus, Delhi government, and a few nonprofit organizations such as Rotary Club acted quickly to set up this COVID-19 center.
Burari Hospital decided to become an isolation center that treated mild patients with few symptoms who needed to be isolated from their family members to curb the infection spread, and moderate patients whose oxygen saturation levels dropped below 90 percent. The goal in setting up this center was to relieve the pressure on large hospitals in Delhi that were dedicated to treating severely ill COVID-19 patients. The private hospital Ujala Cygnus volunteered to run the facility, which included managing medical services, administration, and triaging patients to ensure that those most in need of care were prioritized.
"It was a truly dark time, the worst time of our lives. But all our medical team knew that they had no option of stepping back.” —Dr. Shuchin Bajaj, CEO, Ujala Cygnus Hospital
How can you replicate or adapt this promising practice?Collaborate with the governmentThe deep involvement of the Delhi state government from inception to implementation shows the importance of state intervention in delivering effective public health. Because the Delhi state government played an active role in finding a physical location for the COVID-19 center, accelerating permissions within a few days, and using diplomatic connections to import medical equipment such as oxygen cylinders and concentrators, the center was up and running within seven days. Leverage a network of health care professionalsThe Ujala Cygnus team leveraged its network of health care professionals, which enabled it to recruit the best medical staff from across the country to work at the center. Even in densely populated cities like Delhi, there was a shortage of medical professionals during the peak of the pandemic due to doctors becoming sick with COVID-19 and remaining off-duty. While setting up the emergency field hospital, young medical professionals were incentivized to work for the center through a pooling system and an active recruitment drive. In the case of Burari, the government’s offer to pay high salaries to attract talent also helped alleviate the shortage of medical staff. Utilize the power of youthReaching out to the young medical professionals and medical students proved to be key to this project’s success. Young medical professionals are eager to help, idealistic, and hungry for experience. The Burari COVID-19 center’s experience shows that reaching out to medical students and young professionals who can hit the ground running with minimal assistance is critical to filling immediate shortages of medical staff. |
What are the lessons learned from this bright spot?
The biggest lesson from Burari’s experience was the direct involvement of the Delhi government, which enabled the construction of a fully functional hospital with capacity for 1,000 beds within a week. Before the pandemic, setting up a hospital in New Delhi typically required at least 67 clearances across all government departments to become functional. With the direct involvement of the Delhi government, however, this process was drastically accelerated. Within three days, all necessary government permissions had been received.
With an investment of 400 million Indian rupees (approximately US$5 million) from the Delhi government, the entire hospital was established. Because it was a direct procurement, negotiations took place directly with companies through diplomatic channels without a public tender.
“It is ultimately a government's will, if they want to do something they can do anything.” —Dr. Shuchin Bajaj, CEO, Ujala Cygnus Hospital
Dr. Bajaj added that for anyone who wants to set up an initiative of this scale it is extremely important to work with governments, which provide guidance and operational ease that is required to execute such projects. Finally, he says, “The biggest learning in running the center during a pandemic is that at the end of the day there is inherent goodness in people. All they need is a structure to come forward and help.”
The Burari COVID-19 center was created as a sub-unit within the main Burari Hospital—a multispecialty government hospital—which also reduced paperwork. The land for setting up the facility was donated by Sant Nirankari Mission, a spiritual organization.
How was this promising practice implemented?
Identify and hire staff
Once the equipment had been delivered, the next big hurdle was identifying medical staff to run the center. The Delhi government repeatedly advertised for medical staff and offered to pay higher salaries to those who agreed to work in the facility.
“This was one of our biggest challenge, finding a trained staff to run the center as in the initial days of COVID-19 even medical professionals were scared to come to duty.” —Dr. Prasun Kumar, Operational Head, Burari COVID-19 Center
The center’s management team reached out to medical professional networks across the country through various associations and medical schools to recruit clinical staff. The Ujala Cygnus Hospital also assigned its own hospital staff to work at the center since there were fewer non-COVID-19 treatments taking place at that time.
More than 50 medical students from India and abroad who had completed internships and were looking for jobs were called to join the center. In total, 60 trained doctors, 80 nursing staff, and 300 support staff came on board to work for the makeshift hospital. The management team also reached out to the British Association of Physicians of Indian Origin who helped establish the clinical protocol for critical patients (refer to the primary documentation attached). Nonprofit organizations such as the Rotary Club and corporate social responsibility teams from private companies pitched in to deliver essential supplies, such as food and health supplies, to patients who were in isolation.
Establish an effective triaging system
The operations team at Burari Center built a triage system through which they decided how to admit patients. This triage approach was necessary—as COVID-19 cases increased in Delhi, patients and their family members rushed in a panic to hospitals in search of treatment, as explained Dr. Prasun Kumar. Patients with mild infections occupied hospital beds in fear that their situation might worsen and that they would not be able to get treatment if they needed it. In addition, patients in severe condition were unable to find beds as hospitals ran out of space to admit new patients. Delhi needed an urgent solution to the critical shortage of hospital beds. According to Dr. Bajaj, the aim of the protocol was to ensure that the patients most in need were prioritized. The triage system also minimized the burden on other government hospitals who could only treat the most critical patients. The management team began to triage as soon as a suspected patient stepped into the center.
The center was divided into two sections—a waiting area and an isolation center with oxygen beds. To ensure the safety of those staffing the reception desk, physical barriers made of glass or plastic screens were installed to ensure social distancing of at least one meter. This served to limit close contact between registration desk personnel and potentially infectious patients.
The reception team was trained to record several clinical parameters of a suspected COVID-19 patient to determine their eligibility for admission. In addition to travel history, comorbidities, oxygen level, and chest CT severity score (which indicates the severity of infection), the clinical team also asked patients to list other relevant symptoms. All patients with oxygen saturation levels above 85 percent were eligible for admission to the isolation center. Patients with a CT score lower than 12 and oxygen saturation above 85 percent, or with a CT score lower than 15 and oxygen saturation above 90 percent, were also eligible for admission. Critical patients—those who had comorbidities such as chronic lung disease, renal disease, heart disease, chronic liver disease, diabetes, hypertension, and other immunocompromised conditions—were considered high risk and were referred to other large hospitals for admission and care.
Procure medical equipment and technology
Medical equipment such as oxygen concentrators and cylinders, and equipment for heating, ventilation and air conditioning were airlifted from countries such as China and Malaysia on special flights through diplomatic negotiations by the Delhi government. Some of the equipment was purchased at a premium to ensure faster delivery.
A teleconsultation network, which included partners such as the British Association of Physicians of Indian Origin and StepOne, also monitored the health of patients who were not admitted but who had called in to report their health conditions. This system ensured that patients with mild symptoms who had the required facilities to isolate at home could still receive remote care.
“This was the first field hospital we had set up and we had to find a way to compress the work of six to eight months (the usual time it takes for a hospital to get fully operational) in seven days.” —Dr. Shuchin Bajaj, CEO, Ujala Cygnus Hospital
Despite the huge caseload, not a single death occurred in the center. Within four months from the launch of the center, which began with about 100 regular beds, the center had 300 ICU beds and became one of the largest field-based centers in India.
“The Burari Center helped all those patients, irrespective of the socioeconomic background, who were not getting beds anywhere in Delhi or in the neighboring National Capital Region. And we were able to save lives by providing treatment to patients at the right time.” —Dr. Prasun Kumar, Operational Head, Burari COVID-19 Center
A doctor from Rajasthan in northern India, 28-year-old Yusuf, was one of the earliest recruits to work in the center. What was most important for him, aside from handling clinical care, was ensuring the mental well-being of patients in the center. To keep the spirits of the patients high, the center organized small entertainment activities that helped staff and the patients cope with the grim situation of the pandemic.
“We had patients who were admitted for over a month and we had to ensure that they remained mentally strong to cope with the illness.” —Yusuf, Physician, Burari COVID-19 Center
Prepare for a third wave
The management team at Burari Hospital are preparing for a third wave of COVID-19 cases in the country. In anticipation of this third wave, they have created an additional 300 ICU beds in case of a surge. They have also set aside 100 beds for pediatric patients. Although the number of new COVID-19 cases in Delhi has dropped significantly, the Ujala Cynus Hospital and Delhi government are keeping this facility operational. They have reduced the number of staff but feel confident that the hospital can function for at least the next three years. The Delhi government continues to financially support maintenance of the facility and is equipped to handle pediatric cases during a potential third wave. There is a running oxygen line, in addition to beds and other equipment, that remains functional and can also be used to treat non-COVID-19 patients as needed.
“If such a facility would have come last year we could have avoided the grim situation of second wave. But now if a similar wave strikes at least we will be prepared.” — Dr. Prasun Kumar, Operational Head, Burari COVID-19 Center
Supplementary material
Burari COVID-19 Center - Created Within a Week to Deliver Quality Care in a Low-Cost Setting.pdf
Burari patient information form.pdf
Covid Burari TRIAGE Policy.pdf
Covid_Centre_Buradi_(Tutorial).pdf
Sources
- COVID-19 India. Delhi. Updated November 1, 2021. Accessed December 10, 2021. https://www.covid19india.org/state/DL
- Jadhav R, Kalra A. India’s capital Delhi faces hospital beds shortage as coronavirus cases surge. April 16, 2021. Accessed December 10, 2021. https://www.reuters.com/world/india/india-reports-another-record-daily-rise-covid-19-infections-2021-04-17/
