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COMMENTARY
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 94-95  

The armed forces medical services response to COVID-19


Director, General Armed Forces Medical Services, New Delhi, India

Date of Submission13-May-2020
Date of Decision14-May-2020
Date of Acceptance15-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Anup Banerji
Director General Armed Forces Medical Services, ‘M’ Block, Ministry of Defence, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_516_20

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   Abstract 


The Indian Armed Forces have always responded to the Nation's call and the COVID-19 pandemic response has been no different. On instructions from the Government of India, the Armed Forces Medical Services (AFMS) pitched in right from the initial stages of the epidemic in India as part of a coordinated national response. Be it the execution of medical quarantine for Indian citizens evacuated from China and other COVID affected countries or establishing dedicated and mixed COVID hospitals for its own clientele as well as civilian patients, the AFMS worked in tandem with the national policies. The Armed Forces ensured force preservation and protection of its own troops and families by timely implementation of public health measures, even as it played its designated role in the national strategy. With vision, understanding and clarity, the AFMS continue to lend shoulder to India's response to this global public health challenge.

Keywords: Armed Forces, COVID-19 response, quarantine


How to cite this article:
Banerji A. The armed forces medical services response to COVID-19. Indian J Public Health 2020;64, Suppl S2:94-5

How to cite this URL:
Banerji A. The armed forces medical services response to COVID-19. Indian J Public Health [serial online] 2020 [cited 2020 Sep 26];64, Suppl S2:94-5. Available from: http://www.ijph.in/text.asp?2020/64/6/94/285628



”By failing to prepare, you are preparing to fail”

Benjamin Franklin


   Introduction Top


The World Health Organization (WHO) declared a pandemic on March 11, 2020, of a novel disease, COVID-19, caused by a severe acute respiratory syndrome coronavirus-2.[1] The onset of this pandemic can be traced to early December 2019, when some hospitals of Wuhan city in China reported cases of pneumonia of unknown cause. On December 31, 2019, China informed the WHO regarding a cluster of cases of pneumonia in Wuhan city in Hubei Province; this outbreak subsequently spread to other provinces of China and countries across the globe.[2] This article describes the response of the Armed Forces Medical Services (AFMS) in India to COVID-19 for its preparedness for the Indian Armed Forces and for its role as a part of the National Response Strategy to COVID-19.

The Indian AFMS has a large public health workforce and has always been ahead in disease prevention, control, and mitigation. Accordingly, the initial COVID-19 advisories for its troops and families were issued in January 2020.


   Response of the Afms Top


As the outbreak in China started to spread with increasing number of cases and deaths, countries across the globe began evacuating their citizens from China. The Government of India (GOI) issued instructions to the Armed Forces and the Director General AFMS for establishing a quarantine facility for about 300 student evacuees being planned to be brought back from Wuhan, China, by a special flight. Medical quarantine of healthy individuals traveling from an epidemic affected country/area and suspected of carrying the infection has been stipulated under Article 32, read in conjunction with Articles 23 and 31 of the International Health Regulations.[3] Although there is no established universal guidance regarding the infrastructure for a quarantine facility, such a space should be expected not to further enhance potential transmission of the disease under question.[4] Nevertheless, the exercise of organizing a quarantine was not something new for the Armed Forces. The AFMS with guidance and inputs from the Ministry of Health and Family Welfare developed protocols and guidelines for establishing a quarantine camp in an existing army facility at Manesar, Gurgaon. A treatment facility for COVID-19 cases was established in an armed forces medical facility in Delhi. The teams of AFMS underwent training in the National Centre for Disease Control on various aspects of COVID-19.

A team comprising of public health specialists and clinicians of the AFMS successfully quarantined four batches of evacuee's ex China, Italy, and Japan at this facility. The Armed Forces created additional quarantine facilities at multiple places in Rajasthan, Uttar Pradesh, West Bengal, Tamil Nadu, Maharashtra, Telangana, and Madhya Pradesh. The evacuees who were quarantined were tested for COVID-19, and a few of them tested positive.


   Armed Forces Preparedness Top


The Armed Forces had to ensure force preservation and protection of its own troops and families even as it played its designated role in the national strategy. Breaking the chain of transmission and prevention of transmission in hospitals from cases to health-care workers (HCWs), HCWs to non-COVID-19 patients, attendants, etc., was the priority. In the backdrop of this, the AFMS developed various standard operating procedures and treatment guidelines aligned to the GOI policies and the emerging evidence. The Armed Forces has earmarked certain AFMS hospitals as “dedicated COVID hospitals” and some of its hospitals as mixed COVID hospitals to cater for not only armed forces clientele but also to civilians. The mixed COVID hospitals have clearly demarcated separate COVID and non-COVID outpatient and inpatient departments with earmarked separate teams of HCWs. The AFMS established testing facilities for COVID-19 at ten laboratories in AFMS hospitals, and five more laboratories are being operationalized. More than 9000 beds in these hospitals have facilities for isolation and treatment including availability of high dependency units and intensive care units. The availability of medical equipment in these hospitals was scaled up through procurement of additional ventilators, oxygen concentrators, multipara monitors, etc.

Shortfall of personal protective equipment (PPE), hand sanitizers, disinfectants, and ventilators were a concern when the COVID-19 pandemic struck the country. This was anticipated much in advance; accordingly, the procurement processes were initiated and expedited, ensuring that the armed forces hospitals do not face a shortfall. The supply chain management for all essential medicines, PPE, and medical equipment was maintained through service transport including aircraft from the Indian Air Force.

Public health measures have been implemented as key control measures to reduce transmission of the explosively spreading pandemic. These include information, education, and communication coupled with behavior change communication; disinfection of offices, barracks, residential areas, and public places; and screening and meticulous contact tracing and testing. People returning from leave and training activities are being quarantined and tested as per policy.

The paramedical workforce of the AFMS was augmented by volunteers, who were general duty soldiers, already trained to give first aid. They underwent a short capsule in screening for COVID-19 and implementation of preventive measures among the armed forces personnel and their families.

As a part of the GOI policy of collaborative response to COVID-19 in South East Asia Region (SEAR) and friendly foreign countries (FFC), the AFMS sent teams of experts to Maldives and Kuwait to provide assistance and technical knowhow regarding COVID-19. The teams had experts from respiratory medicine, public health specialists, intensivists, microbiologists, and hospital administrators. Some of the FFCs requested the GOI for help in procurement of medicines and medical equipment. Some of these requests were tasked to the AFMS, and the needful actions for the same were initiated. Armed Forces help was sought in aid to civil authorities for the Narela camp at New Delhi, created for evacuees related to the cluster of cases from Nizamuddin, New Delhi. The AFMS rapid response medical teams were deployed for screening, isolation, and management of persons at the camp.


   Conclusion Top


The health-care systems in many countries have been overwhelmed by the volatile, uncertain, complex, and ambiguous (VUCA) environment created by the COVID-19 pandemic. The present situation is unprecedented, and there is no blueprint of readymade solutions. As the situation continues to evolve, we need to be prepared, adapt, and respond swiftly. AFMS has always been in the forefront in dealing with disease outbreaks either natural or postdisaster, and the transcendent knowledge and extensive experience gained over the years in dealing with trying situations has not let AFMS sway in the VUCA environment of COVID-19. We hope to overcome the pandemic with vision, understanding, clarity, and agility, “Sarve Santu Niramaya.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
WHO. Novel Coronavirus (2019-nCoV); Situation Report-51. WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-repor ts/20200311-sitrep-51-covid-19.pdf. [Last accessed on 2020 May 10].  Back to cited text no. 1
    
2.
WHO. Novel Coronavirus (2019-nCoV); Situation Report-1. WHO; 2020. Available from:https://www.who.int/docs/default-source/coronaviruse/situation-rep orts/202 001 21-sitrep-1-2019-ncov.pdf. [Last accessed on 2020 May 10].  Back to cited text no. 2
    
3.
International Health Regulations. Available from: http://www.who.int'csr'ihr'WHA58-en. [Last accessed on 2020 May 06].  Back to cited text no. 3
    
4.
Key Considerations for Repatriation and Quarantine of Travellers in Relation to the Outbreak of Novel Coronavirus 2019-nCoV. World Health Organization; 2020. Available from: https://www.who.int/ith/Repatriation_Qua rantine_nCoV-key-considerations. [Last accessed on 2020 May 11].  Back to cited text no. 4
    




 

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    Abstract
   Introduction
   Response of the Afms
    Armed Forces Pre...
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