COVID-19 Second Wave | How did India paint itself into this corner?

Migrant workers gather at a bus station to board buses to return to their villages after Delhi government ordered a six-day lockdown to limit the spread of COVID-19, in Ghaziabad on the outskirts of New Delhi. (Image: Reuters)

As I am writing this piece Delhi hospitals are on the brink of a catastrophe. Responsible officials from the Delhi government have said publicly that the oxygen supplies for all the major public and private hospitals will run out in a few hours’ time. The supplies which were supposed to come from Uttar Pradesh are yet to come and the Delhi government looks helpless, staring at a possible humanitarian disaster of epic proportions.

Twitter is full of requests for hospital beds and desperate pleas of people to get oxygen for their loved ones. There are news reports about endless lines of ambulances outside hospitals and crematoria in several cities in Gujrat. A report even suggest that multiple bodies of COVID-19 patients were burned on the same pyre, to save the costs. There is a widespread shortage of Remdesivir, which was initially touted as a very beneficial drug for COVID-19, though the reasons for such a shortage is debatable. Looking around, a lot of people may get a feel that we are living in a failed State in sub-Saharan Africa and not the country which takes pride in being known as the ‘Pharmacy to the World’.

The number of new COVID-19 patients per day had reached a peak of just less than 100,000 mark in September, before declining to 8,365 in February. By virtue of the nature of viral infections spread through respiratory route, all the public health experts had warned of a second wave.

The data from Western Europe and North America had also suggested that several waves of infections were possible. But when the number of cases started increasing in March, India was grossly under-prepared and its health system was totally overwhelmed. Around 2,023 people have died of COVID-19 in India in the past 24 hours, and some independent commentators take even this number with a pinch of salt.

Though the scale and intensity of the second wave has a role to play in this deteriorating situation across India, the primary question that remain is why we were so underprepared. India is almost on its knees and the public mood is turning sour. Now is the time to fix accountability and heal the system. But for that, we need to evaluate what went wrong and where.

India had managed to reduce the case fatality rates in the first wave of COVID-19 and this gave a false sense of reassurance to the people. There was also a certain level of ‘pandemic fatigue’ which had set in, making the public less likely to adopt the ‘social vaccines’ such as physical distancing, masks, sanitisers, etc. But equally culpable is the central and state governments’ apathy.

If we look at the number of COVID-19 tests done per day in India, it can be observed that the average number was around 1.1 million between September and December. That number has increased marginally to 1.3 million per day in April, when ideally it should have gone up many times.

The situation is more or less the same for oxygen production, the plan to set up oxygen plants in over 150 district hospitals across India has reached nowhere. During the brief lull between the waves, priorities such as increasing hospital bed capacity, improving the critical care facilities and even ensuring a robust supply chain for medicines were mostly forgotten or put in cold storage. The inherent inertia of the government systems rang the death knell for thousands of unfortunate people across India.

The lack of co-ordination between the central and state governments is also visible everywhere. The failings in distribution of oxygen and vaccines show a disconnect between the healthcare delivery apparatus in the states and the mandarins of the health ministry. We were unable to do a proper forecasting for vaccine demand — therefore, when the vaccination rates picked up over time, we are staring at a shortage.

The news that India had exported more than 60 million doses of COVID-19 vaccine, was also a result of poor supply side management by the governments. It is good that the government has finally opened up the vaccination space for new entrants, but the central government has transferred part of the fiscal responsibility of vaccine procurement to the already cash-strapped states. Failure to mount a well-coordinated response, with effective utilisation of resources, is a perfect recipe for disaster when we are fighting such a pandemic.

There is a hindsight bias (knew-it-all-along phenomenon) in most of the expert opinions floating around. No one could have anticipated such a rapid escalation of India’s COVID-19 landscape. But it is true that the successive governments systematically defaulted on its responsibility to increase the budgetary allocation for the health sector.

Our primary healthcare system is in a shambles and the referral system is dysfunctional in most of the districts. Patients who could have been managed at primary care level, ends up clogging the system at the level of district hospitals. This takes up valuable resources and denies more serious patients a chance of curative care. Carefully calibrated, strategic and sustainable investment in improving our health system is the only way by which we can fight future pandemics of this scale.