Saving megacities

by June 13, 2020 0 comments

Will setting up a professionalised task force for India’s hotspot metros be effective in arresting the COVID-19 slide?

Going by the crumbling medical infrastructure in India’s megacities battling the furious onslaught of COVID-19, it would take more than the Supreme Court’s censure to respect the dignity of human lives. Horror stories keep flooding the morning news of patients not being tested since the laboratories cannot guarantee results in the required turnaround time, they being consequently turned away by hospitals, Government hospitals going vacant because of pitiable conditions there, delayed treatment leading to deaths and unaccounted bodies being cremated without informing family members. All reflect a general sense of helplessness in the local administrations of these cities, clearly without the depth of either experience or resources to wall off the swamp. As of now, four cities account for almost 70 per cent of new cases and over 80 per cent of deaths from Covid-19, namely Delhi, Mumbai, Ahmedabad and Chennai. Pune and Kolkata are also fast catching up. And given their population hyperdensity, no matter how specialist their hospitals, both public and private, they are currently defenceless against a virus that is coursing through their matrix with an unmatched rapidity. Just for comparison, some of the cities with the most advanced healthcare infrastructure in the world, like New York, too, could not keep pace with the massive spiral. All our cities have two major problems. One, the lack of testing, without which no planning can be done, and second insufficient capacity of critical care to flatten the mortality curve. According to data analysis, even if the private sector infrastructure were to be included, India would still need 80 to 100 times the available number of ventilators if one considered a “worst case scenario.” Should there be a Central megacity task force then to intensively focus on containment and mitigation strategies in our big metros? Cut through differing procedural protocols and evolve a unified war room response for seamless logistic management? For example, there are still no takers for Government hospitals where beds are empty because of the dismal disparity in conditions. Would a task force ensure that the disease burden is spread evenly and the treatment protocol standardised? A task force would also cut through the red tape, like the one which has tied up Indian pharmaceutical companies which are to roll out Remdesivir despite clearances and which we are now importing from Bangladesh as a desperate measure. Besides, there is going to be a massive crunch of doctors and nurses and maintaining a frontline COVID-19 medical army would indeed be a tough challenge. Could a task force rationalise the resource allocation and marshall additional staff from elsewhere for primary care at least? Could it also devise a fast relief protocol for waiting patients, who are seriously ill, with immediate oxygen support so that we do not lose them simply because they are being turned away? Of course, all this would mean stepping on federalism, considering most of the metros are in Opposition-ruled States and healthcare is a State subject. May be a dedicated task force should remain depoliticised and entrusted to experts and epidemiologists and emerge as a new example of cooperative federalism where both the States and Centre decide the best case scenarios possible. For when human lives are at stake, nothing else matters and ordinary people are by and large disgusted with every kind of political leadership and competitive egos at the moment. What they need is healing and dignity.

There are enough templates of city management for reference. For example, Singapore completely assigned the disease management leadership to professionals, did not let positive patients back into the community, tested liberally and built an effective communication strategy at the micro-community level. The last was so effective that people internalised disciplines voluntarily, which minimised the risk. Best of all, numbers were not fudged and there was absolute transparency that led to trust-building. South Korea, which is battling a second wave of the virus despite its aggressive testing, digital interventions and contact-tracing, has now let scientists and medical professionals do the talking at national briefings. Politicians have stepped back simply because people trust doctors. In fact, both Paris and New York, while equally driven to restart economic activity, kept social venues like theatres, bars and restaurants shut during the peak spiral, reopening them only when numbers seemed controllable enough. Unlike New York, policy makers, medical professionals and employers in San Francisco acted sooner and unitedly to slow the spread. City and State Governments communicated a lot better in California than in New York. One doesn’t need a copy paste formula but surely a common city management plan is required to prevent India’s throbbing metropolises from faltering and failing. Urban planning and resource management will have to be rewritten for the future but in the short-term, a task force could yet weather the tide.

(Courtesy: The Pioneer)

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