Maharashtra fights COVID-19

As Maharashtra renews efforts to fight COVID-19, hidden truths start emerging.

A near deserted street in Mumbai on April 29, during a lockdown imposed to contain the coronavirus infection.

The last weekend of April saw Maharashtra back in the ring, fighting the coronavirus with renewed supplies of vaccines and oxygen. The situation continues to remain worrisome, though. On April 28, the State saw 985 deaths, the highest one-day count since the start of the pandemic. April’s death tally of 12,000 was the highest monthly toll in the last six months, equalling that of September 2020. However, the daily cases in the State are down from 66,000 to 63,309. Health Minister Rajesh Tope said: “I pray to God that hopefully this may be the peak and the declining graph should start.”

On April 28, the total number of cases added in Maharashtra was 63,309, with 4,926 cases in Mumbai. The total caseload in the State is 44.7 lakh and the total number of deaths so far is 67,214. The number of people discharged since the pandemic began is 37.3 lakh.

After a period of intermittent availability of vaccines, the State vaccinated a record five lakh people by April 27. A statement issued by the government said the number is expected to rise further when the final figures come. “Till 6 p.m. on April 26, more than five lakh people had been administered vaccine doses,” the statement said. With this, the number of people vaccinated with both doses so far in the State stood at more than 1.48 crore. At a Cabinet meeting on April 28, the decision to vaccinate people in the 18-44 age group for free was taken. It will cost the State Rs.6,500 crore to inoculate the 57.1 million people in this age group in the State’s 13,000 vaccination centres. However, no date has been announced. The initial plan of starting this on May 1 has been axed because of inadequate supply of vaccines.

Maharashtra has also extended the 15-day period of restrictions. Instead of ending on April 30, it will go on until May 15. At an earlier briefing of reporters, Minister for Medical Education Amit Deshmukh commented on the drop in new cases and the rise in recoveries: “This is a satisfactory and comforting indication. I feel restrictions are working and the second wave numbers will soon come down if all of us adhere to COVID-19 norms.” He also said that in 15 out of 36 districts in the State, the number of people being discharged from hospitals is much higher than the number of admissions.

Minister for Relief and Rehabilitation Vijay Wadettiwar told the media that while Mumbai has seen a fall in numbers, other parts of Maharashtra have not. “After the increase in restrictions in the State, COVID cases reduced in Mumbai but are still on the rise in Vidarbha, Marathwada and other parts.” The Minister said the State had responded to the second wave by setting up new jumbo facilities, ramping up testing, and enforcing home isolation for mild cases.

Amit Deshmukh said: “The situation in Maharashtra is coming under control day by day, and that is why we are working on increasing the number of people getting vaccinated. Therefore, the MVA [Maharashtra Vikas Aghadi] government… is planning to purchase vaccines from the international market in huge numbers.”

Maharashtra has not found the Centre very cooperative in its hour of crisis. The shortage of oxygen was ascribed to indiscriminate use by Maharashtra’s medics. The Centre’s understanding of the problem was so poor that when in mid April Chief Minister Uddhav Thackeray called Prime Minister Narendra Modi to ask for oxygen supplies he was told that Modi was busy campaigning in West Bengal. On an earlier occasion, when the State was running short on vaccines, the Centre used the opportunity to attribute the shortage to wastage of vaccines. “Wastage is a relative term,” Dr Shashank Joshi, a member of Maharashtra’s COVID task force, toldFrontline . “Some amount does go unused. In any huge vaccination drive, some wastage is accepted.” In fact, Maharashtra’s wastage rate is so low that it does not even figure on the chart of States with high vaccine wastage.

The problem lay in vaccine distribution. Health Min ister Rajesh Tope said there was clear discrimination in the disbursing of vaccines to States. He said the Centre gave more doses of Covaxin and Covishield to States ruled by the Bharatiya Janata Party (BJP). “Gujarat has a population of six crore, they got one crore doses. We have a population of 12 crore, we got 1.04 crore doses,” he said. Soon after this on April 7, 17 lakh doses were sent to Maharashtra, but Tope said this fell far short of Maharashtra’s requirement of 40 lakh doses. “We are leading in vaccinations,” he said, “but other States get more stock.” He pointed out that Uttar Pradesh was sent 48 lakh doses, Madhya Pradesh got 40 lakh, Gujarat got 30 lakh and Haryana got 24 lakh doses a week. He said he spoke to Union Health Minister Harsh Vardhan about the discrimination in distribution but was told States were supplied with vaccines according to their requirements. “We have the highest number of cases, a huge population, and 57,000 deaths [as of April 8] and we get fewer vaccines,” said an outraged Tope.

Unfounded allegation

The latest allegation from the Centre was that Maharashtra failed to use money allocated from the Prime Minister’s Citizen Assistance and Relief in Emergency Situations Fund, better known as the PM CARES Fund. The fact is that no money was allocated directly to any State from this fund. In Maharashtra, Prasad Lad, BJP MLA and vice president of the party’s State unit, accused the MVA government of failing to use funds given from the PM Cares Fund. A furious Congress retaliated.

At a press conference, Maharashtra Congress spokesman Atul Londhe said: “The Central government had in January announced the setting up of Pressure Swing Absorption [or PSA technology] plants across the country. In the first phase of the project, 153 plants were to be set up across the country. The process of setting up 33 of these plants is under way and none of these plants have been commissioned till date…. No funds are going to the State government from the Central government through the PM Cares Fund for setting up an oxygen plant. These plants will be set up entirely through the Central Medical Supply Store under the Ministry of Health of the Central government. Under this scheme, 10 plants were to be set up in Maharashtra, but the Central Government has not yet implemented a simple tender process to start the construction of any of the plants [in Maharashtra].” He demanded that Lad apologise for spreading untruths and also said he should be booked under the Disaster Management Act, 2005, for “spreading rumours and fear”.

Atul Londhe blamed the “Central government’s greed” for the deaths of thousands of people across the country. He said: “During this severe crisis, the Central government has taken control of the procurement and distribution of oxygen, remedial injections, and medical equipment. Therefore, State governments cannot buy them in the open market and the Central government does not provide these materials.”

Reiterating that the State received no money from the Centre for the oxygen plants, Londhe asked: “How did corruption happen in a job for which no new money was received? If Prasad Lad thinks that there is corruption in this, then it is possible that the corruption has taken place at the level of the Central government.”

The responsibility for the delay in making arrangements for medical oxygen lies with the Centre. Tenders inviting applications for setting up oxygen plants using PSA technology were published only in October 2020, seven months into the pandemic. Moreover, the Centre and not the State is responsible for scrutinising the bids, awarding the contracts and seeing that the plants are built. The State’s only responsibility is to provide the land. It normally takes between four to six weeks to build an oxygen plant. After having delayed the initial process, the Centre awarded the contracts nearly 10 months into the pandemic; only 33 of the 162 proposed plants have been built all over the country. None is in Maharashtra and none has actually been commissioned. The Central government has issued letters to set up 10 plants in Maharashtra in Washim, Satara, Hingoli, Ahmednagar, Bhandara, Raigad, Ratnagiri, Buldhana, Osmanabad and Sindhudurg.

Londhe said: “Union Health Secretary Dr Nipun Vinayak has filed an affidavit in the Delhi High Court stating that only one of the nine oxygen plants to be set up in Delhi through the PM Cares Fund has been set up but is not operational. He could not answer the court when other plants would be set up. This is the situation across the country. The Central government has done nothing but announce the construction of the PSA plant. The role of the Central Medical Supply Store under the Union Ministry of Health in this time of crisis is questionable and thousands of people are dying every day due to lack of oxygen.” He demanded an investigation into the role of the Central Medical Supply Store and said those responsible for the situation should be charged with “culpable homicide”.

Where Maharashtra seems to have slipped up is that it relied entirely on the Centre’s promises. There is nothing to stop the State, or even a private sector entity, from building a plant. In mid April, the State-run Sassoon hospital in Pune did just this when it announced that it was setting up its own plant.

One success story that has been widely circulated was reported first in The Hindu BusinessLine in April. At the Banas Dairy in north Gujarat’s Banaskantha district, a team of engineers set up an oxygen plant in 72 hours to help the district medical college. It generates 680 kg of medical oxygen a day, which can sustain about 35 patients. The article says the oxygen generated is “equivalent to 70 jumbo oxygen cylinders”. It is, of course, a mini plant but it saved the situation and serves as an example of self-sufficiency that Maharashtra would do well to follow.

O ne example that is being held up with pride is that of the north Maharashtra district of Nandurbar, where the Collector, Dr. Rajendra Bharud, ensured adequate supply of oxygen at a time when the rest of the State and nation faced acute shortages. After the first wave, when everyone was dismantling their emergency health-care structures, Bharud, who holds an MBBS degree, maintained his. In an interview with the website The Better India he said, “As cases were going down in India, I saw America and Brazil face a massive surge. I wanted to be prepared in case we witnessed something similar. So, in September 2020, we installed the first oxygen plant in the district, which had a capacity to produce 600 litres a minute, even though our highest single-day spike was only 190 cases. In March, we installed another plant. As single-day cases touched 1,200 in April, we started preparing to instal the third one. Soon, we will have plants with a combined capacity of 3,000 litres a minute.”

Thanks to his foresight, Nandurbar has 150 vacant beds and patients from the neighbouring States of Gujarat and Madhya Pradesh have been admitting themselves in the district’s hospitals. The additional caseload does not seem to have been a problem. The district has cut its positivity rate to 30 per cent and the number of new cases daily dropped from 1,300 to 300.

One problem this Collector did face was access to extra medical personnel. So he gathered local doctors and trained them in vital life-saving procedures. The other innovation was to take vaccination to the people. Nandurbar is a tribal district and hamlets are remote in hilly regions. Sixteen vehicles travelled around vaccinating the people, with the result that of a population of three lakh above 45 years, one lakh have already been vaccinated.