Gujarat may soon overtake Maharashtra in COVID numbers

COVID numbers in Gujarat are rising dangerously, straining the State’s poor public health infrastructure. But the government is in denial.

Relatives of a COVID-19 victim mourn outside the mortuary of a hospital in Ahmedabad on April 15.

Gujarat seems to be grappling with a complete breakdown of public health infrastructure as it tries to cope with an exponential rise in COVID cases and deaths in the past few weeks. Sources who are witnessing the unfolding crisis say Gujarat is likely to see a sharp rise in the death rate and will probably overtake Maharashtra in terms of numbers.

On April 15, Gujarat recorded 7,410 fresh cases and 73 deaths; the figures are the highest since the pandemic began in March 2020. Official figures put the total number of active cases at 39,250 as of April 15 , and the total number of deaths at 4,992. In April 2020, Gujarat reported 82 positive cases and six deaths. A virus tracker in The Hindu says Gujarat has recorded a seven-day average of 46 deaths; this is a 141 per cent increase from the peak of the first wave. To put it in context, Maharashtra is reporting 314 as its seven-day average death rate.

According to the Gujarat government’s COVID dashboard, the main urban centres continue to witness the largest number of deaths. Ahmedabad has reported 2,514 deaths from the beginning of the pandemic, followed by Surat (1191), Vadodara (293) and Rajkot (256).

Sources in Ahmedabad and Surat, two of the hotspots in the State, say the actual numbers are at least five times higher than what the government is putting out. With laboratories taking up to five days to give reports on RT-PCR test results, infected patients often seek treatment too late, said a doctor at a government hospital. In fact, those who track the numbers say while the case fatality ratio (CFR) is 1.3 per cent (calculated as number of deaths per hundred), it is the adjusted case fatality ratio that gives the true picture—the deaths calculated on a particular day on the number of positive cases 14 days ago as COVID positive patients do not die immediately. On April 17, this is 3.4 per cent. In January 2021, the adjusted CFR was 0.3 per cent.

On April 14, Chief Minister Vijay Rupani hurriedly announced the creation of eight 500-bed COVID centres. The announcement follows alarming reports on Gujarat’s COVID situation in the national media and an intervention by the Gujarat High Court.

On April 9, C.R Patil, Member of Parliament and the Bharatiya Janata Party’s (BJP) State president, announced that he would distribute 5,000 doses of Remdesivir. The move backfired when journalists questioned him on how he got such a massive stock of the life-saving drug amid a shortage. It became a sensational story when a local newspaper splashed the Minister’s phone number on its front page saying: “Call the number for the drug.” When Rupani was questioned on why a BJP office was used to stock the drug, his answer was “Ask Patil”. Every person this correspondent spoke to in Gujarat narrated the Patil/Remdesivir controversy as a prime example of the State’s poor handling of the pandemic. Gujarat Congress chief Paresh Dhanani has filed a petition against C.R Patil for unauthorised procurement and illegal distribution of Remdesivir injections.

This correspondent spoke to several people in Gujarat on what fuelled the surge. The reasons given were lack of standard operating procedures (SOPs) in workplaces; poor monitoring of the practice of mask-wearing; absolutely no social distancing; opening of the Narendra Modi Stadium to the general public for cricket matches; permission for marriages and social functions; and poor public health infrastructure across the State.

Since mid March, when the COVID situation began to take a turn for the worse, Gujarat’s local media have been consistently reporting on it and claiming that the ruling BJP is “hiding” figures. Under pressure to provide answers on the mismatch in the number of deaths, Rupani told the media in early April that deaths caused by co-morbidities were not recorded as COVID deaths, and hence the discrepancy. He said the State followed guidelines by the Indian Council of Medical Research (ICMR) that required COVID-19 to be recorded as cause of death only when it was the primary cause. “A daft explanation and not accurate,” said an Ahmedabad doctor. “Even COVID co-morbidity related deaths need to be registered as COVID deaths. An increase in deaths should be reason enough to improve the infrastructure. The cause of death is irrelevant.”

On April 10, the Chief Justice of the Gujarat High Court, Vikram Nath, initiated a suo motu cognizance of the spike in COVID cases and the shortage in testing facilities, beds and medical infrastructure. He said in an oral order: “The newspapers, news channels are flooded with harrowing tales, unfortunate and unimaginable difficulties, unmanageable conditions of the infrastructure, the shortfall and the deficit of not only testing, availability of beds, ICU, but also supply of oxygen and basic medicines like Remdesivir, etc…had it been stray news here and there, I could have ignored it but the volume of reports in the leading newspapers having nation-wide circulation cannot be ignored. It is time the court must intervene.”

A journalist with a television news channel said scenes outside almost every hospital were unbelievably sad. He said: “You can hear sirens all day. There are serpentine lines of ambulances outside Ahmedabad’s Civil Hospital, which is one of Asia’s largest public hospitals. Relatives of patients told us it is taking up to 10 hours for patients to make it into a ward. People are lying on the floor in hospital corridors connected to oxygen tanks. Essentially, there are no beds and the pressure on the health-care system is intense What is worse is the number of hearse ambulances heading towards the crematoriums.” Corroborating the videos circulating in social media of people lighting pyres in the open, he said municipal crematoriums were burning up to 100 bodies a day. Even burial grounds say they are getting several bodies a day. “It is impossible that there were just 73 deaths [as claimed in the government portal] on April 14.”

Father Cedric Prakash, a human rights activist based in Ahmedabad, said: “It is a very worrying scenario here. During the past week, five people I know have passed away. The government is in complete denial of the extent of the spread. The spread took place because there was no control on marriages, social gatherings, no SOPs on businesses being allowed to operate to full capacity.” In a statement \put out on twitter, Jignesh Mevani, a member of the legislative assembly says: “Actual COVID cases in Gujarat are as worse as Maharashtra. Almost every second house has a COVID patient. Instead of making people aware of the actual situation, the government is busy suppressing the figures.”

Dakxin Chhara, a film-maker in Ahmedabad, said: “It is shocking the State administration did not learn from the two spikes we had last year. If 3,000 people were waiting in a line to buy the Remdesivir injection outside the Zydus hospital, that means each of them has at least one family member who has corona. The injection vial will not be given without a prescription.” Chhara, who has been documenting the impact of the pandemic says the government betrayed its callousness when it allowed crowds to watch the cricket match at the newly inaugurated Narendra Modi cricket stadium in Motera. “We believe those matches were singularly responsible for the spread in Ahmedabad. Besides, how can you can rebuild a one-lakh-seat stadium when we need one lakh beds during this crisis?” Anand Yagnik, a well-known rights lawyer, said: “Control the Prime Minister, and you will control the pandemic. What example are Prime Minister Narendra Modi and Home minister Amit Shah setting when they do not wear masks at public rallies? Why will anyone in Gujarat follow the rules? He holds a public rally in the morning and then discusses the grim situation in the evening with his ministers and bureaucrats. It is absurd. These are leaders from Gujarat, and we know how the State looks up to them.”

PILs on the pandemic

Yagnik’s office has filed two public interest litigation (PIL) petitions in the High Court challenging the management of the pandemic. Copies of both were given to Frontline . A Congress leader, Gyasuddin Shaikh, has moved a petition with multiple prayers for the benefit of corona patients and their relatives. Among other things, he has asked for an increase in hospital beds for COVID patients. Shaikh, who reportedly visited hospitals in the State, says this is the most important requirement. The petition says: “At least 50 per cent of private hospitals in Ahmedabad as well as in the State of Gujarat be reserved for the corona patients and notification in this regard be issued so that those who suffer from corona so that they may be admitted. So far, the State of Gujarat has issued certain directions reserving beds in the hospital but on payment. However, government hospitals are full and there are substantial number of people who cannot afford fee of private hospital and therefore even in the reserved government quota for corona treatment for corona patients in the private hospitals, 50 per cent should be made free of charge and State of Gujarat should undertake responsibility for payment to the private hospital for such patients from economically and/or socially weaker section of society irrespective of caste, creed and religion.”

According to Gujarat government figures, there are 71,021 beds in government and private hospitals. Doctors and health workers say this is not enough to handle the surge. Intensive care units (ICUs) are full, and oxygen tanks are in high demand. The television journalist said: “Unlike Maharashtra, where the government has taken a proactive stand and asked the armed forces to help with things like airfreighting oxygen, here they seem to have no plan. At least Maharashtra is acknowledging the problem.”

Champalal Bothra, president of the Federation of Surat Textile Traders Association, said things had come to such a pass because people thought they could beat the virus. “But the government should have been proactive. They are absolutely unprepared.” Unlike in Maharashtra, the government in Gujarat did not insist on workplaces functioning with reduced number of people.

The vaccine roll-out has been reasonably successful, say observers. According to official data, Gujarat has vaccinated 9.7 per cent of its approximately seven-crore population. The State has 5,500 vaccination centres, the highest number in the country. Observers say it is unlikely that the State will impose a full lockdown as people from the State belong mainly to the mercantile community, and nothing will come in the way of business. Not even a life-threatening virus.