There are lessons in COVID-19 fight but will the govt follow them?

The fight against COVID-19 is more difficult than the mythological war of Mahabharata, an editorial in Sena mouthpiece ‘Saamana’ said, adding that the battle against the pandemic will continue till 2021 as the vaccine won’t be available before that. The war of Mahabharata lasted for 18 days. Prime Minister Narendra Modi had exuded confidence (in March) that we will win this battle against COVID-19 in 21 days. But it has been over 100 days and the Coronavirus still persists and those fighting it have become tired, the Shiv Sena mouthpiece said.

India is now the third worst-hit country, after the US and Brazil. Mumbai, Delhi, Chennai and Ahmedabad have a substantial number of positive cases. The virus is also rapidly spreading into rural areas where health care is even less accessible. The rapid spike in COVID-19 cases in rural areas was triggered by the chaotic return of nearly 10 million migrant workers to their home villages. India went for an early lockdown on March 25, when the total number of cases were less than 500. As Coronavirus cases are exploding in recent weeks, the Modi government is overseeing the phase-out of virtually all lockdown measures and has assured that no second such shutdown will occur. Like its counterparts around the world, India has embraced a policy of “herd immunity” that threatens to cost many lives.

Mumbai, India’s financial capital, is the worst hit city with about 20% of India’s COVID-19 cases. Mumbai, one of the world’s most densely populated cities, is struggling to suppress the Coronavirus pandemic as its hospitals have been pushed to the brink. In a first in the country, the Brihanmumbai Municipal Corporation (BMC) will now outsource critical ICU services to private bidders as the number of Coronavirus cases continues to rise in the city. Amid staff crunch, the civic body has allowed private entities to take over ICU beds at its jumbo facilities at Bandra-Kurla Complex, Dahisar, NESCO compound in Goregaon and Mulund CIDCO where the private bidders will have to provide their own doctors and staff members while BMC will provide the health care infrastructure including beds, medication, oxygen supply and ventilators.

In Mumbai, India’s smallest district by area, 365 people live on every sq km of land, according to the 2011 Census. An estimated 42% of the households live in the city’s slums. A lockdown, especially in a densely-populated city such as Mumbai, does not mean COVID-19 cases will not spread. Testing, tracing and treating are the key. Maharashtra had tested only 2.3 contacts per positive case between January 30 and April 30, much lower than India's average of six. As of June 23, India had performed 5.17 tests per thousand people, among the lowest testing ratios of any country with large-scale COVID-19 outbreak.

The situation in Delhi is no different. The Hindustan Times has recently reported on the appalling situation at Lok Nayak Hospital, Delhi's biggest COVID-19 hospital with 2,000 beds. Relatives are forced to wait for up to three days to receive information about their loved ones in intensive care. A doctor at the hospital said, “Demands for updates from the relatives of patients are overwhelming.” Authorities in Delhi expect the case count to reach a staggering 5,50,000 by the end of July. In Gurgaon, an industrial city about 30 kilometers southwest of the capital, where large numbers of workers toil in manufacturing plants, infections are projected to reach 1,50,000 by the end of next month. Tamil Nadu is the second worst hit state in India, after Maharashtra. Chennai city accounts for nearly 63% of the total cases in the state.

The Indian state has starved the public health system of resources, spending somewhere in the order of 1 to 1.5 percent of GDP on health care annually. India had just 0.5 hospital beds for every 1,000 people—a long way behind Italy, with 3.2 beds per 1,000, and China, with 4.3. Despite warnings from health experts that India is especially vulnerable to the pandemic because of its high-population density, endemic poverty and ramshackle health care system, the Modi government has not poured in sufficient resources into fighting COVID-19.

Mumbai city needs to learn a lesson or two from the New York city's valiant fight against the Coronavirus. “New Yorkers did the impossible—we went from the worst infection rate in the United States to the best infection rate in the United States,” NY governor Andrew Cuomo said recently. New York is slowly re-opening in what governor Cuomo calls “New York smart ways". The New York Forward Reopening Advisory Board will help guide the state’s reopening strategy. The board includes over 100 business tycoons, community and civic leaders from across the state including Mastercard CEO Ajay Banga, chair of advisory firm Tandon Capital Associates, Chandrika Tandon, and president and CEO of Hotel Association of New York City, Vijay Dandapani. Mumbai also needs to constitute an Advisory Board consisting of eminent business tycoons, community and civic leaders, to find smart ways of dealing with pandemic.

The only effective way to control transmission is to break the chain. While the rest of India didn’t take stringent steps to limit virus movement for another two months, Kerala had ordered its four international airports to start screening passengers from January itself. Kerala state has also meticulously traced and treated the infected persons. Kerala's health-care system is ranked the best in India. On March 11, the WHO declared the COVID-19 outbreak a pandemic. The next day, India reported its first death. With 15 confirmed cases then across the state, Pinarayi Vijayan, the Chief Minister of Kerala, ordered a limited lockdown immediately, shutting schools, banning large gatherings and advising against visiting places of worship. He held daily media briefings, got internet service providers to boost capacity to meet the demands of those now working from home, stepped up production of hand sanitisers and face masks and set up a mental health help line. His actions assuaged the public’s fears and built trust. The worst-affected states in India need to follow the pro-active approach of Kerala state in containing the virus.

A Harvard University paper looks at the operational aspects. One critical lesson it talks about is for leaders to listen to experts, rather than rely on their gut feelings or inner circles. The other lessons are to learn from China and South Korea to take "multitude of actions" simultaneously, instead of being a one-trick pony; war-like mobilisation of human and economic resources that need to be deployed and sound coordination across different parts of the healthcare system, different entities in both public and private sectors and society at large. India's central government particularly needs to pay attention to these lessons.

(V Venkateswara Rao is a retired corporate professional and a freelance writer)