Maharashtra has led by example in reining in the Corona pandemic even as the Opposition ramped up efforts to pull the Maha Vikas Aghadi Government down

As the city of Mumbai and the rest of Maharashtra re-opens cautiously but optimistically in a phased manner, it is important to mention how the Maha Vikas Aghadi (MVA) Government continues to face relentless attack from the main Opposition party, the BJP, ever since the three parties — the Shiv Sena, the Nationalist Congress Party (NCP) and the Congress — formed a coalition Government and took charge of the State in November last year. Barely had the MVA Government presented its first budget and started building a roadmap for the revival of the State’s economy, the Coronavirus pandemic brought fresh challenges for it.

The Maharashtra Government, namely the Chief Minster and the Health Minister, started providing daily updates on COVID-19 after the first case was registered on March 9. Most cases were related to travellers returning from abroad, who were not in the Centre’s scanner list initially. Since then, the State has seen a spurt in the number of Corona cases. With a total of 1,69,883 cases, the death toll stands at 7,429. There are 73,298 active cases while 88,960 patients have recovered so far.

Of course, this has prompted the Opposition to question the State Government’s strategy in handling the pandemic. It even predicted doomsday scenarios with hashtags such as #MaharashtraBachao trending on social media platforms. However, as it is said, the devil is always in the details. Truth makes the State’s BJP unit uncomfortable and, hence, it is unable to confront actual figures. The death rate in Maharashtra did climb up to 7.5 per cent eight weeks ago but it has dropped steadily since then and now stands at 4.65 per cent. Recovery rate has seen a marked improvement and now stands at 52.26 per cent, up from 26.25 per cent on May 20. Mumbai’s COVID-19 doubling rate is 25 days while the national average is 19 days. The daily death figures reported by Maharashtra so far, too, have declined in the fortnight. In the State capital and the nation’s financial capital city, Mumbai, where the average doubling rate of cases stood at 41 days, Dharavi, which was labelled as a ticking time bomb, is now recording cases in single digit. Further, Mumbai saw its coronavirus count rise with 1,297 new cases being reported in the last 24 hours, taking the city’s tally to 72,175. With 44 new deaths reported this week, Mumbai’s death toll stands at 4,179. The number of active cases here are 28,244 and 39,744 patients have recovered so far. This is way below the estimates provided by a five-member inter-ministerial central team that had projected that the number of cases would spiral to approximately 6.5 lakh by mid-May.

When the State Government announced a phased lifting of the lockdown, it remained focussed on augmenting bed capacity to be able to handle a rise in the number of cases. Since then, the State Government increased bed capacity in hospitals from 400 to 2.5 lakh, of which 25,000 beds had oxygen facilities. The number of ICU beds, too, was increased from 250 to around 8,500. Hospitals for treating infections with isolation facilities, too, were increased from just three to 2,576.

Moreover, the number of COVID-19 testing laboratories was raised from three to 100, the highest in the country. The State Government has also taken charge of 80 per cent of the beds in private hospitals and capped the treatment cost to ensure patients aren’t used to profiteer in the times of a pandemic. The State has neither shied away from testing nor from sharing data on the same. Trace, test and treat have been the guiding principle.

It was ironic that the media and certain influencers woke up to the transparency once Delhi raced past Mumbai in the number of cases reported,  forcing the Central Government to intervene to help augment their capacities. The State Government is now entirely focussed on bringing down the mortality rate.

It is depressing that the State has continued to witness political slugfest ever since the Corona pandemic began when it had to grapple with a high mortality rate. It continues to fight this battle even as leaders in the Opposition are busy holding press conferences and protests to give teeth to their political agenda. They even made frequent visits to the Raj Bhavan to create political instability in the State.

While the country was battling the migrant crisis, Maharashtra, which is home to the largest migrant population, created over 18,000 relief camps for them. However, the migrants spilled out on the roads in large numbers outside the Bandra station after the end of the first phase of the lockdown as a political slugfest over the Shramik Special trains for migrants workers erupted.

When the unfortunate deaths happened at Palghar, the BJP left no stone unturned to communalise the incident. The war of words intensified when the Railway Minister took offence to Chief Minister Uddhav Thackeray’s statement that the State had the capacity to handle more Shramik trains than were allotted to the State. This escalation happened at a time when the Railways were already facing flak for the conditions of the trains, over 80 deaths and approximately 40 trains that lost their destination and reached a different State altogether.

Despite provocations, the State Government has studiously kept itself out of politics and focussed itself in containing the pandemic by working in close cooperation with the Centre. The State Government was also left battling a second challenge in carrying out relief work that followed before and after cyclone Nisarga struck its coast.

There could be weaknesses in the State’s health infrastructure, which is being faced by other States as well, but what is important is that we should not lose sight of being able to handle this medical and humanitarian crisis with empathy and commitment to the people. So, while the Opposition continues with its political agenda, the people of the State continue to solidly back the Chief Minister and the MVA Government to help the State get out of the biggest humanitarian and medical crisis faced by the world.

(Writer: Priyanka Chaturvedi; Courtesy: The Pioneer)

Human trials to start this month, results in October. This is reason enough to prioritise Govt funding to R&D

When the going gets tough, the tough get going. And this is exactly what India’s innovators, scientists and researchers have shown in the face of the Coronavirus pandemic, most of them as self-starters. A potential COVID-19 vaccine, the first to be developed in India, has been given the Drug Controller General of India’s (DCGI) approval for Phase I and II human clinical trials that are scheduled to start across the country this month. Results are expected to be out by October, following which larger clinical trials will be conducted. The vaccine has been developed by Hyderabad-based Bharat Biotech, which has delivered more than four billion doses of vaccines worldwide and also created vaccines for H1N1 and rotavirus in the past. COVAXIN, developed by Bharat Biotech in collaboration with the National Institute of Virology and the Indian Council for Medical Research (ICMR), is an inactivated vaccine, created from a strain of the infectious SARS-CoV-2 virus that has shown promise in pre-clinical studies, demonstrating extensive safety and effective immune responses. The good news is that apart from COVAXIN, four or five other home-grown vaccines are in early stages of development, too. Zydus Cadilla is working on two vaccines while Biological E, Indian Immunologicals and Mynvax are developing one each. The rapid strides that are being made is proof that not for nothing is the country among the largest manufacturers of generic drugs and vaccines in the world. It is home to half a dozen major vaccine makers and a host of smaller ones, making doses against stubborn diseases like polio, meningitis, pneumonia rotavirus, BCG, measles, mumps and rubella.

When we began our fight against the pandemic, there was an atmosphere of fear and gloom in the country over the fact that our healthcare facilities were inadequate. We did not have enough PPEs, testing kits or ventilators and the general consensus was that with the West and China having massive resources at their disposal to pump into research, they would be the first ones to come out with the drugs and vaccines to treat Coronavirus. A vast majority of Indians were resigned to the fact that even if the vaccine did come out, it would reach us after a considerable time lapse as the rich and developed nations would get it first because of their money power and clout. If anything, the pandemic has unleashed our determination to find our own solutions since the world is starved of resources. It has also made it imperative for us to invest in research and development, so far neglected and supported by corporates. After testing kits, ventilators and even making our own PPE kits — we are now exporting the last — we have been innovating at a rapid pace. We have also developed robots powered by Artificial Intelligence to clean Covid wards and look after patients in isolation wards. The biggest news in the fight against the virus came on June 21 when the DCGI granted permission to Glenmark Pharmaceuticals to manufacture and sell Favipiravir and also gave Cipla and Hetero emergency marketing approval for Remdesivir for treating severe COVID-19 patients. We may have not been the first off the block where the vaccine is concerned as the ones developed by Moderna Inc, China’s Sinovac Biotech and UK’s Oxford-AstraZeneca are set to enter late-stage trials, but the fact remains that we will be independent and not look to the West or the dragon to tackle our emergency. Our researchers and scientists have shown that not for nothing are they considered the best minds in the business.

(Courtesy: The Pioneer)

The resourcefulness and resilience of our workmen should not be underestimated. This is especially true for services and goods for which there is a non-discretionary demand

The handwritten sign on the shuttered paan shop in my neighbourhood had just a phone number on it. I had, on a whim, gone to the market to see if there was any possibility of getting some cigarettes. With nothing to lose, I tried the number. A man named Tiwari answered the phone and when I asked him about the possibility of getting cigarettes, he said he could deliver them the next morning. Not just that, Tiwari also asked me if I wanted the “imported” or “Indian” variety of that particular brand. The price was finalised at a 50 per cent mark-up to the maximum retail price (MRP) and promptly at 10 am the next morning, Tiwari was there on his Scooty.

Surprised, I asked him how he had managed to reach me during a complete lockdown in our neighbourhood where the policemen were not just stopping people but actively demonstrating their penchant for using force.

Apparently, Tiwari was helped by serendipity. Several months ago, to make an extra buck, Tiwari had started selling bread and eggs from his paan shop. Now, he was allowed to open his shop as part of essential services and that is how he was managing to move around freely. Of course, there were few people buying eggs and bread from him, since these were easily available, but cigarettes and paan masala were another matter altogether.

Though the pandemic-induced lockdown wreaked havoc on the livelihoods of millions of hawkers, the street vendors were the worst-hit since they were surviving from day-to-day even before the shutdown began. But there are other small shopkeepers, mechanics and service personnel, who are still suffering immense hardships due to the lockdown, even though much of the economy has been opened up in a graded manner now by the Government in a bid to start up the growth engine.

However, the resourcefulness and resilience of our workmen should not be underestimated. This is especially true for services and goods for which there is a non-discretionary demand.

A few days into the lockdown, I noticed that suddenly the number of vegetable vendors who peddle their wares on carts in our neighbourhood had increased significantly. This seemed odd and so I hypothesised that these were people who ordinarily work other trades but were now forced to do this to earn a livelihood. This nebulous hypothesis was confirmed and the details fleshed out by Krishna, whom I accosted while he was on his rounds selling vegetables near my house.

It turned out that Krishna was otherwise a daily wage labourer — the kind that throng “labour chowks” in any city in the morning in the hope of being picked up by a contractor to work on a building site. With the construction business being shut and being a resourceful man, he struck a deal with his neighbour, Ahmad. Ahmad is a kabadiwala (scrap collector) who has a rickshaw which he uses. But kabadiwalas are not allowed to ply their trade now. So Krishna offered to rent Ahmad’s rickshaw at Rs 50 a day. Now Krishna goes at 3 am to the wholesale vegetable market and gets vegetables to hawk through the day. The iron law of markets makes both of them better off during the lockdown.

The resourcefulness of people slightly up the social ladder is also quite in evidence these days. Some at the top of the pecking order have used their “contacts” in the administration to get Covid-19 passes on their cars, which allow them to travel in the city way past the curfew hours and also cross State borders that till now remain firmly shut for the common man.

The not so fortunate ones have found other ways to manage the police roadblocks. For instance, I noticed that there is a sudden increase in the number of people who are socially-inclined and are thus providing relief to stranded migrants and daily wagers. Their cars have got home printed signs that read “Covid-19, Relief Material” and always seem to be filled with bags and cartons. Except somehow, I never see them going out to distribute this material to the needy.

Wikipedia lists at least 12 languages with the phrase “Necessity is the mother of invention.” This is certainly the case nowadays. A friend shared a picture of how he has carefully marked his cigarettes so that he can smoke them over time — one third in the morning, one third after tea and so on. The paan shops in his area haven’t opened up as yet and he obviously hasn’t heard of his neighbourhood “Tiwari.”

People who never tasted any other alcohol except for Scotch whisky are making do with whatever they can lay their hands on — in a friend’s case, a bottle of cheap vodka.

My own case was a bit more prosaic. Of all things, the strap of my chappals broke early on in the lockdown. Since one was home-bound, this item of footwear was the one used most of the time. Clearly something had to be done. So I went to the neighbourhood kirana (grocery) store, got some adhesive and used it liberally on the strap to fix it. Thankfully it is holding up and hopefully will last me till the “non-essential” shoe shops open.

Social distancing, a phrase which has entered common parlance, thanks to its constant use in the media, has been internalised by most people who can afford to distance themselves. Except that the distancing is mostly from the hoi polloi and that, too, only when it can be done without any discomfort.

In my neighbourhood, initially no maids or gardeners were being allowed. The residents, inspired by videos of celebrities on social media doing jhaadoo-pochaa (sweeping and mopping), decided that they, too, could do it. Alas, this lasted only for a few days and soon the maids were called back. However, now quite a few of the maids, having lost their livelihood, had gone back to their villages. Thus, the few who remained were cajoled and implored to take on work at extra houses.

The one thing which didn’t involve any social distancing was of course buying fruits and vegetables. This is one activity in which every household in India excels. In the initial days of the lockdown, as soon as the fruit/vegetable hawker would call out, women from the colony would come out and crowd around him.

No masks of course were worn by any of them possibly taking the initial World Health Organisation (WHO) recommendations of masks not being needed seriously. More importantly, every single apple, mango, tomato, potato and okra was hand-picked from a pile and then the usual haggling over price happened.

Now, of course, with the pandemic spreading like wildfire and the WHO recommending masks and gloves as a means of escaping infection,   the ladies of the colony and even the fruit/vegetable vendors are sporting masks. That they hang loose most of the time is another matter.

Yet another thing which happened during the forced lockdown was an increased interest in sports. This, in effect, meant playing the one game which is easiest to play on the road, in your garden, driveway or even  your terrace — badminton. It was vaguely touching to see couples, who last possibly picked up a racket 20 years ago, suddenly bonding over a game of badminton on their terrace. Board games also became all the rage for families forced to stay indoors and, of course, their prices skyrocketed thanks to the opportunism displayed by online toy vendors.

The children continued riding their bicycles as well as playing other games, blissfully unaware of the need for social distancing. While ordinarily they would play inside the house since the roads had traffic, the lockdown meant that the roads were almost empty and so they could play in the streets.

Incidentally, it also meant that the roads were taken over by dogs, birds, stray cattle and in our case, several horses — I am not sure where they came from — maybe because no weddings were taking place, the ghodi walas (wedding mare providers) had let them loose to feed on whatever they could find.

Now with the Unlock 1.0 in force and our leader telling us to unlock, unlock, unlock, things are changing. For instance, since there is a gradual increase in construction activity as well as street hawking, the number of fruit/vegetable sellers has decreased to almost pre-lockdown levels.

Tiwari now opens his paan shop as usual but what is curious, continues to sell his wares at a mark-up. When I asked him why he is doing this now, he conspiratorially whispers — “Sir, banned hai na.”

(Writer: Shobhit Mahajan; Courtesy: The Pioneer)

Showmanship is for politics, not science, warn researchers on the ICMR’s rush to launch Covaxin by August 15

Science cannot be rushed”, is a common refrain across our scientific community as the nation’s topmost medical research body, the Indian Council of Medical Research (ICMR), said it was attempting to launch the nation’s first COVID-19 vaccine, Covaxin, on August 15. The Ministry of Science had to curb such ambition with a statement saying it would not be ready before 2021. In effect, the ICMR is saying that while all the other countries, who are way ahead of us in terms of their research and trials on the vaccine and still would not be able to release it by the year-end, India by some miracle, would be able to do so in less than two months of it being approved for trial. This is a timeline unheard of anywhere in the world and even the Oxford COVID-19 vaccine, which is miles ahead of us, is expected to hit the Indian market at the end of this year at the earliest. ICMR may defend itself, saying it is cutting through red tape but vaccine development does take time. Under normal circumstances, clinical trials on volunteers who are innoculated take over 10 years. However, given the pandemic and its effects on the world economy and health, this timeline has been compressed by most scientists around the world. The trials will now combine Phase 1 and Phase 2 to speed up the process. Phase 1, usually small, is used to determine a vaccine’s safety profile while Phase 2 employs a bigger sample size and looks at the immune responses. However, a vaccine is deemed safe to be commercially available only after Phase 3, which is a much larger efficacy trial involving thousands of participants. But even with a telescoped timeline, experts don’t expect to see a vaccine before 12-18 months. This makes the ICMR’s plans scientifically implausible.

Worryingly, for Indians, who will be the final recipient of the shots, the trial document for Covaxin does not mention Phase 3. Even for Phase 1 and Phase 2, there appears to be some confusion over the sequence to be followed. Seven of the 12 participating institutes are yet to receive a green signal from independent ethics committees, a prerequisite for conducting clinical trials. And in one month, it is only possible to determine immediate safety, tolerability and immunogenicity of a candidate vaccine. It is not enough to find out if it is effective in preventing infections. Earlier, Bharat Biotech (BBIL), the Hyderabad-based firm which is developing the vaccine jointly with the ICMR, had itself indicated its availability for mass use by early 2021. Now, it seems to be toeing the Government line. As the country’s top research body, ICMR should have the gumption to resist political pressure and explain to its political bosses that human health and lives cannot be put at risk for the sake of showmanship or electoral gains.

(Courtesy: The Pioneer)

Not being able to establish the source of a disease is not surprising, especially in a country where people are divided by gender norms and socio-economic classes

The recent revelation made through a research paper published by William Joe in the Journal of Global Health Science raises alerts about the deficiencies of tracing Coronavirus victims in a divided society. The paper states that as of May, COVID-19 cases in men were at 66 per cent in India as compared to 34 per cent in women. However, the COVID-19 Case Fatality Rate (CFR) is 2.9 per cent for men and 3.9 per cent for women in the country. Interestingly, this is completely different from the worldwide scenario. According to UK Research and Innovation, a quasi-autonomous NGO, data from 18 countries evince that both men and women have an equal share of COVID-19 cases, except for Pakistan. Furthermore, men diagnosed with COVID-19 are more likely to die than women. These comparisons raise questions whether we are tracing and testing all social groups adequately. Women generally have a stronger immune system than men. However, there could be different social factors which impact women both favourably and adversely. Since, in a patriarchal social system women don’t venture out of the home as much as men, they are also less likely to get infected. This may be the reason why in India and Pakistan more men are found to be infected than women. On the other hand, as patriarchal norms consider the male as the primary agent for productive activity, women are often ignored at home and society at large. This deprivation may reduce their access to healthcare as compared to men. They would not be given medical care unless seriously ill. This could increase their fatality rate as compared to men in India. Nevertheless, there could be another reason for the higher CFR in women. Maybe the actual number of women infected is much higher than what is being reported. If the number of infected women would have been higher, then the death rate of women due to COVID-19 would have decreased because they would have been treated. There is  a major possibility that identification of infected women may not be happening due to inefficient functioning of the contact tracing mechanism.

Contact tracing is the process in public health through which the people who may have come into contact with an infected person are identified. Through the contact tracing process, the first set of people that the patient came into contact with are identified as the primary contact. Similarly, the first set of people that the primary contacts come into contact with are identified as secondary contacts. Through tracing of the primary and secondary contacts of suspected and confirmed cases, it is possible to track the spread and source of infection. According to the US-based Centers for Disease Control and Prevention (CDC), the symptoms of Coronavirus infection may be as simple as fatigue, diarrhoea and nausea. It is important to start contact tracing without waiting for the test results.

Researchers at Johns Hopkins found that the chances of getting false negative results are higher in the early stages of the infection. Hence, a negative test does not guarantee that the person is not infected. And they are still able to spread the virus. Improper contact tracing may be the reason that in India there were many cases where it was not possible to find the source of the infection.

The Health Ministry is emphasising on the need for aggressive contact testing. According to the Indian Council of Medical Research (ICMR), there is a wide variation among the States with regard to the number of contacts traced. It ranges from less than 25 to more than 75 per infected COVID-19 case. The infected patients are in general reluctant to reveal their contacts or the authorities are not nudging them enough to provide their contacts. Even a State like Karnataka, which has been canvassed as a successful State for contact tracing, is increasingly finding infections from unknown sources. This is increasing the spread of the infection due to delayed detection.

To be honest, not being able to establish the source of a disease is not surprising, especially in a country where people are divided by gender norms and socio-economic classes. These deficiencies are akin to the problems of the respondent-driven sampling (RDS) method of data collection. RDS is applied when the population is “hidden.” A hidden population may include people at the risk of contracting HIV or a group of injected drug users. The population may remain hidden due to privacy concerns and is rarely found among the general population. This is very similar to suspected Coronavirus infected persons. People may not be willing to get identified in public due to privacy concerns and the fear of adverse social repercussions. The number of COVID-19 infected until now is minuscule as compared to the population of the country. RDS assumes that the best way to access the hidden population is through their own peers. The initial sample individual is asked about the contact of their peers and thus contact tracing leads to revelation of the hidden population.

Three major deficiencies in this method of sampling are pertinent in the context of detection of Coronavirus infected persons. They are the problems of non-cooperative referrals, masking and inbreeding. The infected individual may not get the exact contacts of the people they have interacted with. The infected individual may attempt to mask the contacts as there are privacy concerns. They may avoid mentioning their close relative or loved ones with whom they have come in close contact. Furthermore, in a society divided by gender norms and socio-economic classes, people may select contacts primarily from the same gender and socio-economic class. A street vendor or bus conductor, if infected, may not be able to provide contacts of customers as they would refuse to share their contacts. A security guard would not be able to provide contacts of the people s/he interacted with. Moreover, all of them would be extremely uncomfortable in sharing contacts of people they are dependent on for their livelihood. They may only share contacts of people belonging to a similar socio-economic class as theirs and that, too, of the same gender. The men would hesitate to share the contacts of female family members or co-workers and vice versa.

In the RDS system of data collection the problem of masking is resolved though providing incentives to divulge the contacts of peers. In the fight against the Coronavirus, offering incentives to unmask the hidden population may be financially challenging. There could be two mechanisms through which it can be tackled. People should be made aware of the benefits of disclosing their contacts through public campaigns. As a result, those infected would be comfortable in revealing their contacts and the contacted individuals themselves would not be upset over being identified. It would rather come out as an incentive for those infected to get their near and dear ones examined and also an incentive for the contacts to get tested on time. Thus, the problem of non-cooperation of the referrals may also be resolved to a large extent.  Maintaining the contact details of people  in close contact may be made mandatory by local authorities in shopping complexes and other public spaces. Contact verification may become necessary if individuals provide wrong information. Deliberate sharing of wrong contacts may be penalised as well.

The problem of inbreeding may be resolved though conducting the contact tracing exercise over several rounds. For example, if an infected woman provides the  contact of one man along with five women contacts, then to overcome the inbreeding problem, the man’s contacts may be traced further assiduously. This is very similar to tracing the secondary and tertiary contacts but with an emphasis on tracing the odd ones in the whole contact list. Similarly, tracing people from a different socio-economic background as compared to the majority of the contact list should be given adequate attention. At present, the disaggregated data on primary and secondary contact tracing is not available in most of the States. Douglas Heckathorn, a social scientist from Cornell University who perfected the RDS methodology, suggested three to five waves of contact tracing to get rid of the problem of inbreeding.

Contact tracing is a more efficient methodology than random testing given the rarity of the infection in the population till date. Contact tracing, on the one hand, economises testing facilities and on the other hand, identifies the hidden population infected with the virus. The more the delay in reaching suspected individuals, the higher is the future burden of economic and social cost. Hence, non-cooperation of referrals should be dealt with through public campaigns. The danger of the contact tracing mechanism is that if masking and inbreeding are not dealt with adequately, then we would end up tracing and testing only one kind of a population. The initial sample would determine the prospective samples, unless infected ones are sensitised about the importance of unmasking the contacts and contact tracing is done for few rounds down the line of contact trail.

Only increasing the number of contacts traced per infected or suspected individual is not the solution. It must be done over a few waves and must adequately cover all categories of people. If not done properly, the outbreak of the disease would be lurking in some other corner of society, only to take us by surprise later.

(Writer: Indranil De; Courtesy: The Pioneer)

<!-- wp:image {"align":"center","id":23731,"sizeSlug":"large"} -->

<!-- /wp:paragraph --><!-- wp:paragraph -->

India has undoubtedly woken up to the spirit of humanity as evidenced by an entire civil army of Corona warriors, who are helping the medical fraternity and administration rein in the spiral. What is unprecedented, though, is the extent of participation of women around the country in the fight against the virus. First at the frontline are nurses and care givers, who are separated from their families while handling the epidemic, contracting the infection and yet discharging their duties. Then there are three women constables from Delhi’s Greater Kailash Police station, who are working tirelessly with a sewing machine to stitch cloth masks for the poor who are unable to afford them. Not only are they stitching them, they are sanitising the finished products by soaking them in a solution of water and sodium hypochlorite, before ironing them and distributing the masks to labourers and those living in slum clusters. Together, the trio of (s)heroes in uniform has made and distributed around 200 masks. Some women volunteers in distant towns are donning protective suits to help the police enforce the lockdown and social distancing protocols. Everyone knows about Minal Bhosale, a virologist from Pune, who created the first Indian testing kit for the virus and gave birth to a daughter the day after she finished it. Internationally, too, the contribution of women in this fight against the virus is noteworthy. There are teams of women scientists who are working round-the-clock in the race for a vaccine. Rebecca Sirull was the first human to sign up for a vaccine trial. Turning oneself into a guinea pig needs some courage, more so if one has dependents. But Rebecca took that risk, ignoring side effects. In China’s Wuhan district, female medics shaved their heads so that they could perform better and in an efficient manner, preventing the spread of the virus which thrives in hair. These are just a few examples of courage and dedication.

<!-- /wp:paragraph --><!-- wp:paragraph -->

The lockdown has created a tougher situation for women working professionals. With the call for social distancing, families are now holed up together 24x7 and must attempt to carry on with their professional lives while assuming household duties as well. Women now have to work from home as well as work for their homes. With an inherent sexism still latent in many households, most women aren’t lucky enough to have progressive and supportive partners who would readily extend a helping hand and share the workload. In the medical community, too, women have turned out to be more resilient to the impact of the virus and research is showing that more men succumb to it than women because of their inherent immunity and strength. Time the world recognises that there is nothing called gendered roles anymore.

<!-- /wp:paragraph --><!-- wp:paragraph -->

(Courtesy: The Pioneer)

<!-- /wp:paragraph -->

As we move to the critical stage where some activities have been allowed in Green and Orange Zones, there is a need for a strategy that helps us learn to live with the virus

The right communication strategy and leveraging technology is an important policy to deal with the COVID-19 pandemic. As we move ahead to the critical stage wherein certain activities have been allowed in Green and Orange Zones, there is a need for a communication strategy that helps drive behavioural change and ushers in an era whereby we can learn to live with the virus. This requires effective two-way communication between the citizens and the Government, which has been the core strength of MyGov till now. It has been the endeavour of MyGov to act as a bridge between citizens and the Government and ensure citizen participation and information dissemination on platforms that most people use.

When the pandemic began, it was realised that words and phrases like “quarantine”, “social distancing” and “lockdown” needed to be communicated well as most people didn’t know what these terms meant. Social distancing was an alien concept. Hence, epidemiologists and health experts came up with Dos and Don’ts for preventing the spread of the Coronavirus. Fake news and myth busters posed another challenge that MyGov had to deal with. We had all kinds of conspiracy theories being bandied about, ranging from a Wuhan laboratory experiment gone wrong to use of hot water and garlic to kill the virus. There was a need to bust these myths and focus on making interventions like the use of masks and washing hands properly for 20 seconds the norm. This was done with explanatory infographics and videos that helped explain all these in simple language.

Towards this objective, MyGov India, the citizen engagement platform of the Government  launched several initiatives on its MyGov.in platform as also its dedicated COVID-19 page, corona.mygov.in to support the communication efforts of the Ministry of Health and Family Welfare. MyGov has a presence on almost all social media platforms that include not only the conventional ones like Facebook, Instagram, Twitter, YouTube, LinkedIn but for the COVID-19 campaign, MyGov is also using unconventional platforms like Telegram, TikTok, Helo, VMate and Likee, with an objective to reach out to all sections of people by leveraging all channels and platforms. 

Content was created in multiple languages and also sign language to ensure that everyone became part of the communication process. Videos from reputed doctors were made to ensure clear and correct messaging. MyGov also launched its MyGov Saathi Chatbot that is available on WhatsApp & FB Messenger and is also available on https://mygov.in and https://self4society.mygov.in. MyGov Saathi is a mobile-enabled platform and uses a menu-driven approach, allowing users to select available options such as “Latest update on Coronavirus in India”, “State-level status”, “Useful alerts” and “Where to get help” to access information. It provides ready access to Covid-19 related resources such as latest updates, helplines, advisories from various Central and State Government departments as well as access to Self4Society initiatives, including donation and volunteering opportunities.

Another key feature of the campaign is the ability to ensure adherence to lockdown regulations which are among the strictest in the world and have contributed greatly in limiting the spread of the pandemic till now. This was made possible by the Prime Minister’s call for the “Janata (people’s) curfew”, cheering and clapping for healthcare professionals, the 9PM-9Minute lamp-lighting initiative, showering of petals on hospitals and so on. Some may not find any merit or value in these initiatives but when we did the sentiment analysis of the social media posts, it was found that a vast majority of people supported these measures.

We also launched the pledges around these campaigns — Janata Curfew Pledge, Stay Home, Stay Safe Pledge and Fight Against Corona — which saw the participation of lakhs of people. The Citizens’ Ideas and Suggestions page saw more than 1,00,000 suggestions coming from citizens. The Innovation Challenge for technological solutions launched on MyGov led to brilliant ideas and solutions — including those on contact tracing, which has now evolved into the Aarogya Setu app. The quiz on COVID-19 has seen almost 1,00,000 entries.

These initiatives help the people get involved and once they are engaged, they feel part of the overall solution to the pandemic. It has been a very important part of our communications strategy.

The launch of the Aarogya Setu app is an important part of the Coronavirus campaign. Given the questions raised by some with regard to privacy issues, it was essential to communicate clearly what the app does, why it is required and how privacy is built into the app by design. This was done by innovative use of graphics and videos. Even celebrities like Ajay Devgn helped in creating the #SetuMeraBodyguard campaign which was also endorsed by similar videos by regional language superstars like Nirahua in Bhojpuri and Anuj Sharma in Chhattisgarhi.

Top cricketers helped in the #TeamMaskForce campaign that promoted use of masks. Campaigns around these hashtags were launched on social media platforms that helped in getting user-generated content even in regional languages that contributed to carrying the message far and wide.

The lockdown instructions were a major challenge for us. The feedback was that many people were finding it difficult to interpret the directions and there was a lot of confusion on what to do. Immediately, MyGov demystified the directions and instructions by coming up with simple, easy to read and understand infographics which became very popular. These were also translated in various languages with the help and support of a volunteer group who did it pro bono.

With the lockdown, came the challenge of catering to the migrant labourers and there were a lot of issues regarding shelter homes and feeding centres for the poor and urban homeless. MyGov collaborated with Google Maps and Map My India and put details of shelters and feeding homes of around 750 cities on Maps so that they were easy to find and locate. Google also launched a messaging service for MyGov on Google Maps which has been integrated with the Saathi Chatbot to answer queries instantly.

When the Myth Busters infographic was released, it became viral and millions of people shared it. A suggestion was received to make it available in audio format. Accordingly, these, as also COVID-19 updates, were converted into audio podcasts as part of MyGov Samvaad. These podcasts were also shared with more than 200 Community Radio Stations who translated the content and helped expand the outreach of COVID-19 messaging. Further, it was felt that we also need to address anxiety and stress specially for people during the lockdown. So, an initiative called “Positive Harmonies” was launched in which prominent musicians from across the country created special numbers for MyGov along with their messages to help manage the crisis. This has become very popular. One key feature of all these endeavours has been that all of this was managed by our teams while working from home. Team members collaborated across cities and came up with brilliant innovations. We greatly benefitted from collaborations with top technology companies, media, volunteers and various Government departments. Innovation and collaboration seem to be our strength that has not only helped us in our communications but will ultimately help us tide over this crisis.

As India completes almost six weeks of the lockdown, one realises that some of the learnings from this crisis will help us in future, too. It is possible to work remotely and not everyone needs to commute daily for work. There are collaboration tools available that can help get output, that in some cases can be better than what is possible now. If employees save three hours of commute time, it will make them happier.

Other benefits will be lesser traffic and congestion, a smaller carbon footprint and we may be addressing issues of climate change, too. In the days to come, one expects that more and more companies will adopt this and it will greatly transform lives.

(Writer: Abhishek Singh; Courtesy: The Pioneer)

The Coronavirus has posed several challenges for expectant mothers and parents due to the closure of health clinics, OPDs and Anganwadi Centres providing vital healthcare services

Human health is a prerequisite for the economic health of a country. Unless the population is healthy, the economy of a nation cannot perform. This hypothesis has been validated by the outbreak of the Coronavirus which has led the world into an economic recession. In the light of this, the importance of mother and child health (MCH) cannot be overemphasised as pregnant women, infants and children are very susceptible to infections and diseases. The Coronavirus has posed several legitimate concerns and challenges for expectant mothers and parents due to the closure of doctors’ clinics, outpatient departments (OPDs) of hospitals and the Anganwadi Centres (AWCs) providing vital healthcare services.

So the question that arises is, how can beneficiaries access healthcare/welfare services during the pandemic? Pregnant and lactating mothers and children in both rural and urban areas have already begun to suffer. For instance, the Government order to the Anganwadi workers (AWWs), to home-deliver dry rations for children and mothers, has had problems in execution. The AWWs have complained about having to travel long distances on foot because of lack of personal/public vehicles and villagers threatening and in some cases even beating the women AWWs for violating the lockdown. Plus they have to bear an added financial burden as they have not been paid money to purchase rations for the last one year and have not been provided with protective gear to save themselves from the virus.

Another challenge that has emerged is the inability of the auxiliary nurse midwives (ANMs) and accredited social health activists (ASHA) to help pregnant mothers and infants get their vaccination as well as arrange transportation to the nearest health facility for delivery, while adhering to the service level benchmarking to combat the pandemic.

While we don’t know what the future will be once the lockdown ends, here are some solutions that the Government/States can consider to address MCH-related concerns during the times of Covid.

Harness the advantage of mobile phone and internet penetration to the remotest areas of the country for geo-tagging beneficiaries and for the provision of telemedicine, using location data, call data, and Health Management Information System (HMIS) database. In this situation, the health practitioner will only advise high-risk pregnancy cases like ante-partum hemorrhage (APH), gestational hypertension (PIH/GH), eclampsia and severe anaemia. To distinguish between severe and normal cases, the programme can be administered by machine learning and Artificial Intelligence.

 With all the recent beneficiaries of the Janani Suraksha Yojana (JSY) and the Pradhan Mantri Matru Vandana Yojana (PMMVY) having been assigned Unique IDs, these should be used for direct benefit transfers (DBT) and nutritional assessment, screening of COVID-19 cases, triage referrals and referral to secondary-care hospitals.

As an emergency measure, pregnant women (especially migrant workers) travelling or in transit in the next few months and seeking institutional delivery can be imparted with the benefits of the Pradhan Mantri Jan Aarogya Yojana (PM-JAY) or Ayushman Bharat (AB) with the participation of the private sector.

Create a MCH dashboard in line with the Ayushman Bharat and PMMVY dashboard, to synchronise data, harness HMIS and Integrated Child Development Services (ICDS) database to show the facility closest to the pregnant mother for rapid welfare delivery and integration of immunisation services for home-based new-born care, so that all the essential immunisation vaccines can be given to the children below two years of age without any delay.

 The dashboard can also track the whereabouts of pregnant women (of the region in focus) and put reminders on their cell phones and on that of their family members, which would provide regular information on the precautions they need to maintain and the ways to respond if they develop Coronavirus-like symptoms and so on. These can be integrated with the existing applications of the Government and must be triaged after primary screening.

 Most women have monthly to weekly interactions with  doctors/health practitioners during pregnancy for prenatal check-ups. But in the times of the pandemic this may go missing, so it is imperative to keep them informed via digital medium. For instance, the Kilkari application of the Haryana Government can be scaled up to include video messages for women that are specific to their stage of pregnancy. Frequent live conversations with doctors/health practitioners need to be arranged to reduce anxieties and negative psychological impacts due to the spread of COVID-19 and the lockdown in effect.

 WhatsApp accounts must be set up where pregnant and lactating women are able to share their concerns and through audio and video messages. Volunteers can be roped in with the support of civil society and community networks.

Coordinators of Self-Help Groups (SHGs) in the villages must be identified to assist ASHA workers and ANMs in-home delivery of required medicines. While this would help in reducing the burden on the latter two, it would also help expand community cohesion. For this, the SHGs can be awarded certificates of appreciation that would strengthen their credit scores for availing any further loans from banks.

The Government has identified both private and public hospitals to take in Coronavirus patients in each district. The contact numbers of these hospitals should be publicised through every available medium so that the people use these when they develop COVID-19 symptoms.

 Pregnant women, who become infected, should be treated with World Health Organisation-recommended supportive therapies in consultation with their obstetrician/gynaecologist. Pregnant women and health practitioners must be informed  about these therapies without any delay.

 It is also important to record all new cases of pregnancies due to the COVID-19 lockdown, so that Government prepares for an impending “Coronial generation” after nine months and also has a ready benchmark for future shutdowns based on the lessons learnt. The existing HMIS and ICDS data, though not very reliable, can still be low hanging fruits in this regard to utilise the Digital India architecture.

 In the lockdown scenario, the Government must ensure that the duties of AWWs are notified as essential services if it does not want the health and nutrition security of women and children to be compromised. All pending payments due to the AWWs must be transferred to the relevant bank accounts without any further delays. It must be noted that the Budget 2020-21 has allocated Rs 28,600 crore for programmes that were specific to women. It is indeed a matter of concern that the reimbursement for the purchases made for preparing Mid-Day Meals for children at AWCs has not been released for over seven months in States like Jharkhand.  With the present Budget outlay, there should be no financial excuse to withhold the payments due to the AWWs, and in fact, they must be paid a three-month advance honorarium to facilitate their work and ensure their safety.

 Expanding health insurance coverage to women and children will increase their access to necessary health services more than other groups. Along with the maternal and child health programmes, this must be added with the existing public health and community services such as prenatal care, well-child care and enabling services such as case management, transportation and home visits.

 The maternal healthcare services must include mental healthcare, contraceptive services and supplies; diagnosis and treatment of sexually transmitted diseases; prenatal, intrapartum, and postpartum care; regular breast and pelvic exams (including Pap tests), in accordance with well-recognised periodicity schedules; risk assessment; adequate education and counselling to support these interventions.

For infants and children up to five years, emphasis must be on preventive services, such as immunisation and the monitoring of physical and psychosocial growth and development, with attention to critical periods in which appropriate care is essential for sound development and progress.

 A separate, more comprehensive midwifery training programme with service level benchmarking in India must be introduced on an urgent basis. Having well-trained and capable midwives would provide a better birthing experience for the mother and would reduce the burden on obstetricians.

  Women’s SHGs should be roped in for better outcomes in ensuring the provision of take home rations. There should also be certain modifications and expansion in the type of food provided, varying regionally, to meet nutritional requirements. Planning of resources is a must to avoid misallocation and panic.

With the Coronavirus crisis expected to continue and peak in the next few months, it is imperative to urgently design and implement alternate solutions which ensure institutional deliveries, facilitate treatment to the pregnant mothers and their new-borns and address MCH needs in a timely and structured manner, simultaneously adhering to social distancing and isolation norms of the Government.

(Writer: simi mehta Ritika gupta Anshula mehta ; Courtesy: The Pioneer)

All industrial units do not have the requisite capacity to meet the new standards for resuming production yet

India followed its own definitive path to tackle the menace of COVID-19, ordering the strictest 21-day nationwide lockdown first and then extending it further. In its first phase, the Government chose to save people’s lives over the economy. Yet, when it became distinctly clearer that the fight against the virus would be long-drawn, it became impossible for it to ignore livelihood issues and look for ways to get the economy started. So it allowed industrial units to run in non-hotspot areas but with a new set of caveats that is now causing more confusion than clarity. While these are early days yet and the Government has to work out sectoral codes to ensure low risk, social distancing and safety parameters, the first set of compliances seems to have put more pressure on unit owners, who have to now factor in a new overhead like safety costs. In the absence of substantial working capital from the Government, some of them are wary about opening their units because of low consumer demand, labour shortage and a poor chain of logistics. Now they are further spooked by media reports of the stringent norms that call for punitive action, to the extent of registration of an FIR, against owners found non-compliant by the slightest degree or even if one staffer was diagnosed with COVID-19, something that even a routine health check-up would not reveal at the time of re-employment. Though the Government sought to allay fears by making it clear that the provisions would be applicable only for offences “with consent, cognisance or negligence” on the part of the employers, uncertainty looms large. This is why the standard operating procedures (SOPs) issued by the Home Ministry following the partial lifting of the lockdown in several areas have drawn flak from several quarters.

Major worries are over the broad norms prescribed under the National Disaster Management Act (NDMA) that have been invoked for the first time on account of a force majeure event. First, the implementation of the Act itself will be problematic because the onus now lies with respective States to ensure adherence. As expected, without any clarification, various States have offered different interpretations on whether they should risk people’s lives by opening up the factories or keep them shut longer. Even when some have agreed, unanticipated gaps during implementation mean there has to be another review. Further, given the varied capacities of each State, it is only fair to expect a less-than-equal response from all. Other guidelines, too, appear illogical and are hard to implement at the ground level. New rules demand that workers be accommodated in the factory premises or be lodged in nearby areas so that they can be transported with ease while strictly maintaining social distancing norms. Given the previous set-up of industries, it will be impossible for them to lodge even a small group of workers. Further, the guidelines call upon the respective units to get their workers, who have fled to their hometowns, back to work. With trust deficit everywhere and in the absence of a Central assurance, employees may choose to remain in their villages. Assuming they come back, the resumption of work is dependent largely on the behavioural shift of workers — all of whom need to get accustomed to all sanitary guidelines. One lapse by them and the owner would get harassed. This is why we will need far more long-term and sustainable solutions going forward. At the moment, smaller units cannot get rolling without Government support. Half-baked rush can only spoil the gains made till now.

(Courtesy: The Pioneer)

The number of confirmed COVID-19 cases in Nepal may be low but it is not due to precautions taken by the Govt but because of the low rate of testing

With the number of COVID-19 cases rising globally, India’s neighbour Nepal is also going through a critical phase in its fight against the pandemic. A country located next to China, the nation where the COVID-19 outbreak began, its immediate vulnerabilities lie in addressing the epidemic with an existing poor healthcare infrastructure and ensuring the safety of its people. The very first case of COVID-19 was reported on January 23 in Nepal. A student who had returned from Wuhan on January 9 was admitted to a hospital in Kathmandu. With no expertise and lab infrastructure to examine such cases then, the swab tests of the student were sent to Hong Kong and had confirmed the Nepal Government’s worst fears.

Loose end: Nepal’s first COVID-19 case had recovered in the second week of February. With no new cases reported until the third week of March, overzealous Government officials went on to declare Nepal a “COVID-19 free” country. While it was the time for the Government to deploy extra measures to prepare for the outbreak, declaring the country as “COVID-19 free” without any consultation with medical experts was indeed a short-sighted and irresponsible step. The Government was very clear that it did not wish to stop the arrival of tourists in Nepal because 2020 had been declared as a tourism year and the Government had spent a lot of time and money in making its ‘Visit Nepal 2020’ campaign a household initiative. However, in the end, with the appearance of the Coronavirus, Nepal had to suspend the campaign officially, even though till today it has a total of 16 confirmed cases and no reported deaths. In 2018, tourism had contributed more than seven per cent revenue to the Nepalese Gross Domestic Product (GDP), which was expected to double this year. With the suspension of tourism for this year, the economy will have to bear the brunt.

Logistic shortage: Compared to its neighbours India and China, which have reported a huge number of cases, Nepal has seen just 16 positive cases till now. The country has conducted a total of 6,299 tests, with a little over 80 people in isolation. Amid the ongoing lockdown, Nepal is facing an acute shortage of trained human resources, required healthcare infrastructure, including speciality hospitals, safety gear and testing kits. In several cases, healthcare staff have refused to attend to their duties due to lack of Personal Protective Equipment (PPE). In the present circumstances, testing is key to contain and control the spread of the epidemic. However, with just one specialised testing lab for COVID-19 cases in the capital city for a population of more than 29 million people, Nepal is wide open to any major surge in the pandemic. While nine more temporary testing labs have been established in the last 15 days, logistical support and their testing capacity are yet to be seen. Meanwhile, Nepal has requested several countries, including India, China, Singapore, South Korea and Israel to supply medical equipment and medicines needed to combat the disease.

Missing preparedness: Over the last two decades, the Government has not paid any heed to improving the quality and quantity of healthcare facilities in the country. Against this backdrop, Nepal has faced several emergencies such as the present outbreak. A decade-long civil war from 1996-2006 was followed by a major earthquake in 2015 which claimed over 20,000 lives and destroyed 1,500 health facilities, creating an immediate need for investing in the public healthcare system. Meanwhile, no lessons were learnt from these two important events and nothing was done to better the basic healthcare infrastructure. While conflict and natural calamities have both direct and indirect effects on people’s health and the overall health system in the immediate and post-shock phase, the missing healthcare infrastructure in Nepal is a matter of major concern, particularly in the present crisis.

India extends help: As Nepal awaits replies from other countries, India has begun to send new consignments of medical supplies, including the much-needed hydroxychloroquine sulphate. During an official conversation between Prime Minister Modi and his Nepalese counterpart on April 10, the two Prime Ministers agreed “to look after the welfare and medical care of the people of the two countries currently living in each other’s territory.”

The multi-dimensional friendly relations between India and Nepal are testimony to shared socio-cultural and people-to-people contacts that have stood the test of time and various disasters. The creation of the South Asian Association for Regional Cooperation (SAARC) COVID-19 Emergency Fund is a collective effort initiated by Prime Minister Narendra Modi to bring SAARC countries onboard to fight COVID-19. Nepal has actively participated in the initiative and the initiative shall work as an additional effective mechanism in Nepal’s fight against COVID-19.

China banks on the crisis: China, on the other hand, is banking on the ongoing crisis in Nepal. China’s online supply chain Alibaba along with the local administration of its Sichuan province have donated PPE and portable shelters to Nepal. However, a significant deal to a private Chinese company to procure equipment worth more than $10 million was cancelled amid criticism. The Government of Nepal faced criticism for defying the rules in granting the contract to a private company, which has been involved in supplying low-quality products in the past. Giving in to public pressure, the Ministry of Health and Population decided to annul the tender. At this critical juncture, it is the responsibility of the Government of Nepal to ensure that logistics are procured with caution, rather than appease China with multi-million-dollar deals. On April 10, the Tibet Autonomous Region also donated medical equipment to Nepal and China and Chinese officials conducted a “handing over ceremony.” With Nepal facing a critical shortage of supplies, Chinese assistance is not free from an attempt to win over public sentiments. Something that India needs to watch out for.

Poor governance: An acute shortage of medical equipment exhibits poor governance and the inability of the Government of Nepal to safeguard the interests of its citizens who have been a cardinal factor in sustaining the economy. Notably, one-fourth of Nepal’s GDP comes from the remittances sent home by the Nepalese workforce abroad. Following the initial fears of lockdowns in host countries, thousands of Nepalese migrant workers attempted to travel back to their home country. While the closure of international flights stopped millions of  workers  from returning to Nepal from the Middle-East, Malaysia and Australia, thousands of them are stuck at the Indo-Nepal border.

This is after they undertook long and arduous journeys through land routes to cross the border checkposts. With no quarantine wards and healthcare personnel deployed at the check-posts, these workers have been desperately waiting to get back to their homes.

By stopping the returnees at the border, Nepal might have chosen to contain the spread of the COVID-19 but it is a cruel, irresponsible and inadequate attitude towards its citizens. They have been left in the open without food, shelter and exposed to Coronavirus contamination due to lack of social distancing at several places. It was as late as April 10 that Nepalese Prime Minister KP Oli requested his Indian counterpart to look after the welfare and medical needs of those stuck at the Indo-Nepal border. As India does its bit to provide food and shelter to the suffering Nepalese workforce, the Government of Nepal should have had mechanisms in place in advance for its returning expatriates. It must have in all honesty anticipated the return of its people from the neighbouring nation given the long open border. That it chose not to do anything about it and let its people suffer knowingly is something that will always be remembered by the people of the little Himalayan nation.

 The number of confirmed COVID-19 cases in Nepal may be low but it is not due to precautions taken by the Government. It is less because of the low rate of tests being carried out per day. On April 11, Nepal recorded the highest number of COVID-19 tests and the same day, three new cases were reported. For all we know, it might be the next hotspot of the world. But that will only be revealed once more testing is done.

It is time for the Government of Nepal to provide proper healthcare to its people to contain the spread of COVID-19 in the country. The present Government won a large public mandate in the 2017 elections due to Oli’s promises of a stable Government and improved economic conditions. However, poor governance, flawed economic policies and imbalanced foreign relations have endangered the lives of citizens.

(Writer: Karan bhasin; Courtesy: The Pioneer)

As we run against time in our battle to fight the virus, we need to scale up domestic manufacture of medical devices

The Coronavirus spiral was inevitable but now that it is squeezing health infrastructure and medical care staff, we are battling a second front of the disease, when it attacks the preparedness. Doctors and care-givers from around the country have complained, even threatened to go on strike, because they do not have enough personal protective equipment (PPE), namely coveralls, gloves, goggles, masks and so on. There have been reports of frontline staff making use of raincoats and anything else that they can lay their hands on. The lockdown and the migration of labour have meant that even those manufacturing these essential gear are not being able to roll them out at breakneck speed. Though there is no dearth of Indian innovation — like the Pune virologist’s version of the test kits, IITs’ collective efforts to roll out apparatus or even car companies’ offer to make ventilators — the fact of the matter is these are all small-scale efforts. What is needed is a massive rollout, which, because of policy hurdles, delay in placing orders and over-dependence, like the West, on China for crucial components, has been halted badly. Even the contracts being handled by domestic companies are of a small to middling nature, with no capabilities to scale up output. It would be easy enough to attribute the scarcity to a global trend, arguing all countries battling the coronavirus are facing it as well. But we didn’t plan it as well with the Government ordering PPEs just before the lockdown. Safety wear would now need at least three weeks to be readied domestically, considering imports are not that reliable with most infected countries dependent on factory floors in China and Southeast Asia. China has just about emerged after the first wave of the virus and its manufacturing prowess is still not 100 per cent. The Government could also not have exported 90 tonnes of medical equipment and safety gear to Serbia at this time of a national emergency, confirmed by a tweet from the United Nations Development Programme (UNDP) though denied by the Health Ministry. Leave aside N95, even the triple layer surgical masks are not available for healthcare staff. There is also the issue of facilitating working capital for these units in the time of lockdown. As for chemicals and disinfectants, India has been dependent on China for critical intermediate goods and components. With so much dependence on China, particularly for raw materials, it is difficult to find easy replacements.

As we ride this unprecedented World War III, that literally came from nowhere and hit us before we could realise it, what should be the road looking ahead? Simply prioritise our health sector and go back to home-grown drug and health equipment manufacturing. They were there before but globalisation meant these units were sidelined and lost out on the cost advantage to cheaper imports. And now that the virus may spur the process of de-globalisation as it were, we need to begin with crucial sectors that impact national safety, health and well-being. Immediately after Wuhan, the Government drew up a list of 38 drug raw materials that it wants locally produced to end the country’s dependence on Chinese imports. Some of our key life-saving drugs, including those for cardio-vascular issues, use active pharmaceutical ingredients (APIs), which are solely sourced from China. Indian drugmakers import around 70 per cent of their total bulk drugs from China. Now there is no time for committees, policy or pondering. There is already a Make in India wishlist suggesting ways to make India one of the top five medical devices manufacturing hubs in the world. Most domestic manufacturers have in pre-crisis days shut their idling units and become importers and traders themselves. We have ignored an industry that could have helped us stave off this crisis. What else explains that though there are 1,000 domestic medical devices manufacturers, only 15 have a turnover of above Rs 200 crore and the rest are less than Rs 10 crore. If they are to scale up, then they need an enabling ecosystem, a level-playing field vis-a-vis imports and assured volumes. The last won’t be difficult given India’s huge market for healthcare, projected to be the fourth largest in Asia. Post-Corona, the demand is not expected to dip but rise. This way we can easily end our import dependence by 70-90 per cent. And be self-sufficient in the time of unforeseen crisis.

(Courtesy: The Pioneer)