By Kiran Mazumdar-Shaw
The second wave of Covid-19 descended on India like a tsunami. We were caught unawares and our response was one of panic and chaos. There was sub-optimal preparedness and rapid response planning. Hospitals were overwhelmed, medicines were in short supply and medical supplies of life-saving oxygen and ventilators were woefully low. From hubris and confidence at the start of 2021, we were reduced to hopeless despair by April. With ~400,000 cases a day and ~3500 daily deaths, we need to act fast, led by epidemiological wisdom.
LESSONS FROM THE FIRST WAVE
When Covid-19 struck us in March 2020, we responded with a nationwide lockdown and used the time to build up capacity in our healthcare infrastructure, diagnostic tests, medicines, medical equipment, PPEs, masks, pandemic software and human resources. The term ‘Atmanirbhar’ was coined to be self-reliant to battle the virus. Whilst a task force was set up at the centre, state governments set up war rooms to formulate strategies to contain the spread and rid themselves of the virus. Vaccine companies swung into action to develop vaccines either through international partnerships or indigenously. Various models that effectively dealt with the viral attack were recognised: ‘The Kerala Model’. ‘The Bhilwada Model’, ‘The Dharavi Model’ etc. Hotels were converted into Covidcare centres linked to hospitals. Indoor stadiums were also made into mega Covidcare centres. Various protocols were developed in terms of Covid appropriate behaviour, contact tracing, sero-surveillance etc. The one big learning was the huge economic devastation caused by the mass exodus of migrant labour from cities to villages. Food rations, shelter and community services were a positive response to this calamity.
One year later, we seem to have forgotten all these lessons. There was a visible lack of preparedness planning as our response was slow and inadequate. In fact, there was a strong opposition against any lockdown. A month into the second wave, lockdowns are being enforced much like bolting the stable door after the colt has bolted! Hospitals are collapsing with lack of oxygen, ventilators, hospital beds, and human resources. Doctors are battling to treat patients because of medicine shortages. Medical fatigue will set in and we will have a huge paucity of doctors and nurses. At 400,000 positive cases per day, at least 5% or 20,000 ICU beds are required per day. This indicates that we need 10X ICU beds. We simply do not have the nurses and doctors to manage this number of ICU patients. We need 200,000 nurses and 150,000 doctors to manage this pandemic.
MISTAKES MADE
Our hypothesis of being protected from the virus because of our innate immunity, BCG vaccination, young demographics and our hot weather has proven to be wrong. The virus has devastated us like it has across the world. So it is clear that Covid-19 does not distinguish between race, ethnicity, age and affluence. The only thing that works is extensive vaccination coupled with testing, tracing, quarantining and Covid appropriate behaviour. Lockdowns are also integral to a rapid response strategy. A combination of Lockdowns and Vaccination is the only sure shot way of overcoming this viral onslaught.
THE WAY FORWARD
- Impose total Lockdowns in the most impacted cities: Delhi, Bengaluru, Mumbai, Lucknow, Surat etc.
- Impose total lockdowns at district level with Test Positivity Rates of >10%
- Impose partial lockdowns in areas with <10% TPR until vaccination is completed.
- Vaccination at speed and scale: From May 1st, our entire adult population above 18 years are eligible.
- Eligibility of vaccination must exclude any persons who tested positive for Covid over the past 3 months.
- Vaccinating all districts that have a Test Positivity Rate of <10% on priority will safeguard any approaching wave of infection.
- Ramp up vaccine capacity both through indigenous production as well as imports.
- Our current vaccine capacity is 75 million which is expected to ramp up to a little over 100 million by the end of June. This will allow us to vaccinate 100 million per month over a 10month period to cover 75% of our population or 1 billion people. We will need to import 50 million doses as a contingency plan.
- We must utilise every dose available to us and both private and public vaccination centres must be deployed.
- The government has suggested a vaccine sharing model of 50% for the centre and 50% for Private hospitals, Companies and State Governments. If the Centre gets 50 million doses per month, it should be assumed that this will be distributed across all states for the poor. The balance 50 million doses need to be split 25% for the private sector and 25% for the State Government. Only when such allocation is agreed can it avoid confusion.
- All graduating nurses and MBBS doctors who are preparing for the PG exam ought to be deployed for Covid service with credits that can be added to their current scores for future qualifying examinations.
- All state governments and Central agencies must create safety stocks of essential medicines and essential medical supplies in preparedness for another wave.
- A surveillance effort that combines genomic tracking of mutants as well as sero-testing at community level must be actioned.
- PANDEMIC PREPAREDNESS must include surveillance testing, partial and total lockdowns depending on TPR and vaccination at speed and scale.
The article first appeared in The Economic Times on May 3, 2021.