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The Indian Railways is working on a war footing to modify as many as 20,000 train coaches into patient isolation wards to bolster the country’s limited healthcare infrastructure amid the rapid spread of covid-19.

These modified coaches will be able to accommodate up to 320,000 beds for isolation or quarantine needs, an official statement said on Tuesday.

Work on modifying an initial 5,000 coaches across 16 railway zones has begun. A single coach will be able to accommodate as many as 16 patients.

A senior government official told Mint that a large number of coaches, along with spare trains, can be used at a time when passenger trains have been suspended as part of a general lockdown. It will take around six-seven days to modify each coach, the official said.

According to an industry expert, converting train coaches is a good and cost-effective interim measure.

“Even if it takes around 2 lakh to transform a particular coach into an isolation ward, around 100 crore will be spent to re-model 5,000 coaches," said Jagannarayan Padmanabhan, director and practice lead of transport and logistics at Crisil Infrastructure Advisory. “These coaches can cater to the need of the semi-urban and rural areas, where medical facilities are limited. They can also be redeployed, if the railways get permission to run trains after the lockdown is lifted."

Only non-air conditioned sleeper coaches will be used for modification. Also, one Indian style toilet per coach will be converted into a bathing room with a bucket, mug and soap dispenser.

“The first cabin near the bathing room shall be provided with two hospital/plastic curtains transversely in the aisle so that the entry and exit to the entire eight berth cabins can be screened off. This cabin will be used as store/paramedics area," according to the Railways. Two oxygen cylinders will also be provided.

In India, the number of cases have witnessed a sharp and continual rise in the last few days. There are over 1,250 confirmed cases, with 32 deaths in the country. If the current trend persists, a spike in the number of covid-19, public health facilities will face tremendous pressure. Not only Indian railways, the government's policy think tank NITI Aayog has also stepped up efforts to support the country’s healthcare system, amid a crisis. NITI Aayog has called upon doctors to work as volunteers for handling the outbreak. “This overwhelming burden may not be met by the available doctors in the public health system. The central and state governments are augmenting and expediting the increase in healthcare services in every part of the country," NITI Aayog has said.

Bamboo mats will be pasted on the roof and each side of the coach--above and below windows--which will protect the patients from intense heat, as temperature begins to rise, with summers approaching.

It will take around six-seven days to transform these coaches, the official stated above said.

While experts said that the idea of converting train coaches to isolation ward is innovative, some said that implementation could face some hurdles. According to Col (Dr) Mohan Kubendra Director and Consultant, Family Medicine at Spandana Health Care, there could be an issue of disposal of waste--medical and general--which requires careful handling and chemical treatment before disposal. Besides, water supply as another issue, he said.

“If the ICUs are planned to be established the ventilation system needs to be serviced before induction and most importantly before the induction into the public service, which may require replacement of complete HVAC (heating, ventilation and air conditioning) system, a very costly exercise. So it is definitely not a very cheap alternative as perceived by many," Kubendra said.

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