Covid-19: The pros and cons of using train coaches as isolation wards

Indian Railways is exploring the feasibility of converting its coaches into isolation wards if the COVID-19 crisis deepens in the country, but there would challenges, according to Railways sources . That the trains are mobile, have a broad reach, have toilets, can be put along stations and can reach nook and corner of the country, make it an idea worth considering.

“Prototypes are under conversion,” Rajiv Chaudhry, Northern Railway General Manager told BusinessLine confirming that the idea is being tried out. "Several such ideas are currently being considered. Many will be tested and which one will be scaled up would depend on how the crisis unfolds," added another official. However, there are many challenges in keeping coaches as stationary isolation wards like maintaining hygiene, cleaning toilets, ensuring proper ventilation, water supply, among others. Moreover, the more significant challenge will be to make sure the availability of enough doctors, equipment, and paramedics, added another official.

“The country should consider several other facilities like the hotels that are empty, community halls, mandaps and dharamshalas, which should be exhausted for isolation and quarantines first. But if case-loads escalate, or for far-flung areas where these places are not available, then probably non-AC sleeper coaches can be readied” said one official.

Maintaining hygiene

He explained that AC coaches of trains typically require electricity which can probably be managed. “But, the AC vents are not very clean and can even cause infection for someone housed for 14 to 21 days or even a month. But the non-AC sleeper and second class coaches could be used. In these coaches, one cabin can be used to house one patient, enabling 8-10 patients in a coach,” added the source.

“There will also be issues of maintaining hygiene and cleaning the toilets if they are of open discharge type, (if the toilet empties onto tracks) and tracks have to be cleaned regularly, or some other arrangement will have to be made. If the toilets are bio-toilets, which do not empty onto tracks, then they can start stinking with frequent use” he cited among other challenges that would have to be taken care of, if coaches become isolation wards.

However, the biggest challenge such conversions will pose is not that of physical infrastructure but of human resources--- availability of doctors and paramedic staff.

Hospital on wheels

What may come handy if such a need arises is Indian Railways’ experience of running Lifeline Express, which is a hospital on wheels that visits different parts of the country, usually rural areas with inadequate health facilities or areas affected by natural disasters where it parks and offers medical services including surgical interventions. Indian Railways also has experience in designing hospital-like rakes for the army. These rakes, though few in numbers, have one operation theatre, beds, doctor's room and other medical facilities.

The Railways also have a hospital network of significant size. As of March 31, 2019, Indian Railways had 125 hospitals with 12,935 beds, with in-house doctors, who could be of help, if Coronavirus crisis takes a turn for the worse in India.

“For now, it is just about the preparedness, getting ready for any eventuality and assessing on a real-time basis how things are unfolding. If Italy with such a good health system is being forced to use open-fields for hospital beds, it doesn’t hurt for us to keep our train coaches ready wishing that the country doesn’t reach that stage” said an official.