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Virus in the system
Read more on - Polity | Economy | Schemes | S&T | Environment
- Back with a vengeance: The horrifying numbers in second Covid wave in India show more than 3 lakh infections and 3000 deaths daily. Almost all medical facilities, equipments and materials have fallen short across cities in India.
- Official logic: The government (scientists and bureaucrats) say that they knew a second wave would arrive, but they didn't know the virus would mutate so dangerously, and people would become so 'arrogant' about not following Covid behaviour. Media is focusing on Kumbh mela and political rallies. But actually, all this is a routine failure of India's centralised scientific and administrative bureaucracy.
- Comparing US with India: If one visits the website of US CDC (Centre for Disease Control), then one sees micro-level data of the Covid spread, hospital demand, median stay duration, mortality, etc. Nothing like that is done in India, no clinical facts compiled, etc.
- Maharashtra, March-April 21: Covid-19 care is organised as tier 1 (large hospitals and well-equipped hospitals in main cities), tier 2 (smaller hospitals public and private all over) and tier 3 (community or home care). Critical care is in tier 1 and 2. This is broadly the union structure also.
- Now link mortality with critical care bed availability for severe patients. Make a Quality of Care multiplier. Learning is one can expect 1 death per day from a 250-bed tier 1 critical care hospital, and 3 per day from a 250-bed tier 2 one. Tier 3 is not for serious Covid.
- To update the Quality-of-care multiplier is basic statistics. Alongwith the no. of beds in each tier, a city's preparedness is known. Maharashtra has been transparent about preparedness and also responsive to rising demand.
- Using the DDR (daily death rate), hospital use level and stress in a district can be found. Colour them white (0) if all get tier 1 care, grey (1) if some are into tier 2 with more mortality, and black (2) if it drops into tier 3 (denial of service). DDR is taken as 7-day average.
- It's seen that districts degraded from white (0) to grey (1) and then to black (2). Epidemic came so fast that Maharashtra could not increase capacity enough in tier 1 and tier 2
- Mumbai and Pune saw many deaths, despite being better off; rural areas like Parbhani had poor provisioning and some patients migrated to white (0) or grey (1) districts, or into home care only
- Tier 1 gets exhausted and Tier 2 is left then (poor quality supplies leading to hoarding of supplies and drugs). The chain continues.
- Planned approach: The above is a way to check key parameters and plan ahead to check the geography of the pandemic. But, India's scientific agencies have not done anything quantitative like this, gave no guidance to states, and forgot all about bed allocations and ambulance dispatch.
- Oxygen: A critical care patient takes in 15 kg per day, so the daily 4000MT all India demand means 260000 patients are in critical care. Assume tier 2 care, so we get 3000 deaths per day from these hospitals. That's 2 deaths per million per day (seen across the world). A peak rate of 5 deaths per million per day should have been the planning goal in NDMP (national disaster management plan). Why? So that 7000MT was inadequate would be revealed.
- No plan: There's no National Plan really. In August 2020 (major first wave), the SC gently accepted what the Solicitor General (SG) told it that "no special plan was needed!" It's in April 2021 that the SC asked the GoI for oxygen and vaccination plans, and states for an affidavit on health infra. Will they be granular enough?
- Poor design: So the scientific and empirical systems are badly designed due to centralisation. Execution is pathetic. Sarkari scientists and bureaucrats (permanent, with no hire and fire) cannot care less!
- Lack of research: Micro questions are not asked and researched - do micro-containment zones really work? How Kerala keeps death rates so low? Are railway coaches safer today? Classrooms? Indian scientists (and their students) are neither asking these questions, nor going to field to find answers.
- Summary: So while politicians and people are to blame, our scientific and administrative system are equally culpable for the deaths we now see.
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