Since the beginning of April 2021, many states in India have experienced a rather virulent second surge and this has thrown up multiple challenges. India’s healthcare systems and personnel have been stretched, and the multiple cracks in our healthcare infrastructure was exposed. Many states in the country witnessed a shortage in hospital beds, critical care medicines and equipment, oxygen supply and so forth. Oxygen consumption, which is directly proportional to the number of cases, has shot up drastically. Prepandemic, India required medical oxygen of about 700 tons a day. The first wave saw demand rise to 3,000 tons a day, and now demand has gone up for as much as 8,000 tons a day. The second wave has also given rise to numerous make-shift hospitals across the country to cater to the growing need for hospital beds, oxygen beds and critical care equipment. Several states have responded to the crises with the installation of war rooms at the state and district level to monitor patient shifting, data collection and oxygen supply.
In response to the creation of the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) and with the objective of galvanizing Industry support, CII formed a Task Force on COVID-19 Vaccine to supplement the Government’s initiatives in the vaccination drive. The Task Force is chaired by Mr T V Narendran, President-Designate, CII and CEO & MD, Tata Steel Ltd, and co-chaired by Dr Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS) and Chairman, CII Public Health Council. The Task Force also comprises of Industry Members from across the healthcare continuum.
With the help of the Task Force and it’s pan-India network, CII has been sharing critical data and expertise with NEGVAC as well as engaging in communication and outreach on the vaccination programme. In the submissions, CII has consistently requested the Government to involve the Industry fully in the massive inoculation to ensure that the vaccines reach those who need it the most in an accessible and equitable manner. According to CII, this national mission should be approached with the joint support of private and public sectors.
The Task Force on COVID-19 Vaccine carried out multiple interactions with various departments of the Government over the last few months and several key recommendations have been submitted. Some of them are as follows:
In order to reduce the burden on healthcare infrastructure and prevent further mutations & waves from occurring, our primary concern now is to vaccinate the adult population of India. To vaccinate adult population (18 years and above), particularly in states experiencing a spike, the Government of India allowed vaccination of all persons above the age of 18 to begin from 1 May.
Vaccination is the only way through which our battle against COVID-19 can be won over the medium term, while protecting both lives and livelihoods and allowing the country to return to usual economic activity at a fast pace. The Industry has taken several steps in order to improve our vaccination coverage across the nation. CII is in touch with the two vaccine manufacturers in the country, Serum Institute of India and Bharat Biotech International Ltd, to ascertain the possibility of purchase of vaccine doses as per the requirements mapped through the CII survey.
The Government has also permitted Industry members to undertake vaccination on their premises provided there are more than 100 beneficiaries and also placed the spending on this for nonemployee beneficiaries under the CSR rules. Taking advantage of this, CII has therefore requested Members who wish to expand their vaccination drive to external members of the community to advise their requirements which is being further added to the aggregate. Through this initiative, over 1000 companies, mainly small and medium companies, from 170 cities have so far come forward to identify their requirements. As on date, CII received demand from 1062 small, medium and large companies from across the country for approximately 40 lakh single vaccine doses. Of this, companies have identified demand of 36% for employees, 47% for family members of the employees, and 17% is for community outreach efforts.
The vaccination project, largely aimed at the economic agents of the country, who are common citizens, will help enterprises to revert to their usual scale of operations at the earliest so that lives and livelihoods are both preserved.
Even though the daily active cases have plateaued slightly over the last few days, this is not the time for India to be lax about the situation. India need to prepare for the third-wave and not repeat the mistakes. The country’s healthcare infrastructure needs to be built up in order to withstand future waves that may or may not occur.
The lives and livelihoods of every single citizen is the only priority that should matter, and in order to protect them, Industry and Government together need to actively take every measure to ensure that we guard our nation. We are in this situation together, and like multiple adversities India has faced in the past, we will together overcome this pandemic.
The second wave of Coronavirus currently sweeping across the country is causing large-scale hardship and economic disruption in the country, which has already been facing enormous challenges since the outbreak of Covid-19 in 2020.
As India’s leading industry association, CII and the CII Foundation, and affiliates played a key role in providing relief and rehabilitation to over 80 lakh people in 2020.
In 2021, as the second wave is spreading faster and deeper, including in rural India, CII and CII Foundation have re-doubled their efforts to alleviate the economic losses and the impact on people.
CII and CII Foundation, along with Young Indians, a CII initiative, and affiliate associations, are working closely with the Central and State Governments and leveraging the vast industry connect to reach millions across the country. The relief and rehabilitation efforts are centred around:
Extensive awareness campaigns through various channels are also being undertaken simultaneously to promote safe practices as well as vaccination. The CII Foundation Woman Exemplars, a network of grassroots-level women who have emerged as community leaders after battling the odds, are creating awareness, especially amongst marginalised communities, in various states.
Procurement and Deployment of Medical Equipment: More than 22,000 oxygen cylinders, 2000 PPEs and 1600 pulse oximeters have been distributed. These are helping bridge the gap between the supply and demand for medical equipment, which is essential to combat Covid-19. A lot of this medical equipment is being distributed in Tier II and Tier III towns to bolster the healthcare supplies available there.
Strengthening healthcare Infrastructure: The second wave of Covid-19 has stretched to the limit the healthcare infrastructure, and as an increasing number of people require healthcare assistance, especially oxygen support and hospitalisation, there is a pressing need to set up Covid-care facilities and ramp up existing facilities. Eleven Covid-care Centres have been set up. A 200-bed Covid-care Centre has been set up in Gurugram with excellent medical equipment and facilities such as oxygen concentrators. These services are free of cost. In Kochi, Kerala, CII has converted a Convention Centre into a 500-bedded Covid-care facility.
Distribution of Relief Material: One of the biggest challenges people face in a pandemic is the lack of regular and easy access to essentials such as food and medicines. This lack of access could be due to many reasons, but its impact can be detrimental to the physical and mental wellbeing of a person. CII and CII Foundation have, therefore, focussed on distributing relief material across the country. More than 7,000 ration kits (approximately 10 kg a kit), 92,000 medical accessories such as face masks, 14,000 PPE kits and more than 2,000 litres of santisers have been distributed.
The outbreak of Coronavirus is unprecedented in scale and impact. As economies across the globe struggle to combat its ill effects, sustained and focussed effort is needed at the community level to reduce the social impact. Job losses, uncertainty, health challenges and a host of other issues are testing the social fabric of every country, and collective action is the need of the hour.
CII is grateful for the support it is receiving from Government and industry as it undertakes extensive relief and rehabilitation efforts across the country in this battle against COVID-19. The challenges can be tackled best with collective action.
“Patients are dying in ICU because there are no nurses and doctors” is going to be the headline news after we address the oxygen shortage. Based on data from the first Covid wave, positivity rate should remain at 25-30 per cent for the next 3-4 months. Every day over 3 lakh people are testing positive. Statistically, for every positive patient, there will be at least five more patients who are positive but not tested.
That means at least 15 lakh people are getting infected every day. Assuming that 5 per cent of them may need ICU care, we will be adding about 75,000 ICU patients every day, who need to stay in the ICU for about ten days. Unfortunately, we only have 75,000-95,000 ICU beds, which were full even before the pandemic reached the peak. Today, our own intensivists aren’t sure whether they will get a bed in the same ICU where they’re working if they get infected.
Unlike the first wave, ICUs today are getting filled with younger patients. So, most of the patients who die are going to be young breadwinners of the family, with devastating social implications.
We need to add 5 lakh new ICU beds in a few days to prevent this calamity. Any bed with central oxygen in a government or private hospital can be converted to an ICU bed with a few accessories, which can be procured easily.
Unfortunately, beds do not treat patients. Doctors, nurses and paramedics do. Well before Covid, shortage of medical specialists in government hospitals was 76 per cent. Most of the government hospitals’ ICUs are suboptimal and Covid patients end up in short-staffed private hospitals. Frontline workers who did a phenomenal job during the first wave are tired and exhausted. We need a few lakh young, skilled and vaccinated nurses, paramedics and doctors to win the battle.
India is the only country in the world that can produce a few lakh young Covid frontline workers in a few days, just by changing the regulations. The greatest bottleneck in expanding ICUs is the shortage of nurses. There are about 2.2 lakh nursing students who finished GNM or BSc training, just waiting for the exam. The nursing and ICU serving paramedical students should be exempted from appearing for the exam to graduate and given preference for future government jobs, provided they work in a Covid ICU for one year. Most students would love to take up this offer.
The second greatest hurdle is the availability of specialist doctors. Over 25,000 young doctors are about to finish training in various medical and surgical specialties. NBE or NMC should exempt them and the ones who failed in past exams and offer a degree if they work in Covid ICU for one year.
There are a few thousand medical specialists with diplomas in critical specialties like intensive care cardiology or emergency medicine who aren’t recognised by the Medical Council. If the NMC recognises these diplomas, we should get thousands of motivated and skilled medical specialists to manage Covid ICUs across the country.
Over 1.3 lakh young doctors are sitting at home memorising multiple choice questions to secure a PG seat through NEET exam. Since there are only 35,000 PG seats in clinical subjects, there will be over a lakh doctors who will be unsuccessful in securing a PG seat. They can be offered grace marks for the next NEET exam, provided they work in a Covid ICU for one year.
In addition, there are at least 20,000 doctors who graduated from overseas universities and are unable to pass the Indian entrance exam. They can practise as doctors in other countries except their country of birth. These doctors can be given medical council registration in exchange for working in a Covid ICU.
All the doctors who I am suggesting to be exempted from the final exam are already qualified doctors with the ability to practise medicine. In the United States, postgraduate resident doctors do not need to even appear for a final exam. They are recognised as board eligible and allowed to practise.
A Covid ICU is the worst place to work with PPE. We rarely encounter a situation wherein we need to be thinking about our lives first before saving the patient’s life. No monetary incentive can make one work in the Covid ICU for months together.
We need to give young nurses and doctors a lifechanging gift to face the battle. Let’s be practical and accept that whatever we are doing currently inside the hospital to increase ICU beds is not working. That’s the reason why today private hospitals are not providing ICU beds even for millionaires.
We belong to an amazing country that can solve life-threatening challenges in remarkable fashion. We started the war against Covid with virtually no PPEs and very few ventilators. In a few weeks we produced enough PPEs and ventilators to become a net exporter.
Today the entire country is gasping for breath due to lack of oxygen. Thanks to the generosity of the industries and the government’s interventions, the oxygen shortage will get solved shortly. We have a tiny window of opportunity to address the manpower crisis and prevent one of the greatest human tragedies.
We have no doubt that our government under the able leadership of PM Modi can convert any catastrophe into an opportunity to save precious lives.
The article by Dr Devi Shetty, Member, CII Healthcare Council & Chairman and Founder, Narayana Health, appeared in the April 2021 issue of CII Economy Matters. Click here to read the issue.
The second wave of Covid-19 is now firmly upon us- triggered by new variants of the virus which appear to be spreading faster than anticipated. The magnitude of the spread is far more pervasive, and the surge is much more severe than that experienced last year. Not surprisingly, the second wave has taken a significant toll on lives, it is threatening recovery in business and economy, and is once again triggering livelihood and productivity concerns.
India is now experiencing a delayed, but strong second wave. The daily Covid-19 caseload is much higher than the previous peak evidenced in September 2020. The number of daily new cases started rising since February 2021 and has shot up from an average of 12,665 during the month to an average 35,788 in March 2021, thus registering a whopping 183 per cent rise.
The daily caseload continues unabated in April 2021, with nearly 3 lakh new COVID-19 cases registered as of April 20, 2021. Maharashtra has reported the highest daily new cases at 58,924. It is followed by Uttar Pradesh with 28,211 while Delhi reported 23,686 new cases.
The recent surge in COVID-19 infections has caused various state governments to impose restrictions on non-essential activities. For instance, Maharashtra has stopped most activities except those deemed essential. Considering that Maharashtra is the largest state in the country in terms of GSDP, this is bound to have repercussions on the economy. The other affected states have also brought in localized lockdowns and created containment zones within their precincts.
Yet during the last one year there have been medical and scientific advances and, importantly, vaccines have been made available in record time to check the spread of the pandemic.
In fact, since the onset of the vaccination drive against coronavirus on January 16, adults aged 45 and above, healthcare workers and frontline workers are being inoculated. India has administered the first dose of COVID-19 vaccine to 7.59 crore people till April 10th, 2021 and exported vaccines to other countries.
Despite this, India’s vaccination effort seems to be lagging other affected countries. So far, only 5.1 per cent of India’s population has been vaccinated with a single dose. The US has vaccinated 32 per cent of its population for the first dose; UK (47 per cent); Israel (59 per cent) and Serbia (66 per cent). Full vaccination (both doses) has been given to only 0.8 per cent of the Indian population.
What is more, the vaccine is in short supply and majority of the population is yet to be vaccinated. Unless inoculation reaches the requisite threshold, the pandemic would continue to pose risks.
The wastage of vaccine doses is also causing concern. This is being happening largely at the distribution end. Reports of wastage have emerged from Tamil Nadu (12.4 per cent), Haryana (10 per cent); Bihar (8.1 per cent), Punjab (8 per cent); Delhi (7 per cent); Andhra Pradesh (7.3 per cent); Assam (7.3 per cent) and Manipur (7.2 per cent). The national average is around 6.5 per cent.
Hence, it is important to ensure vaccine availability and reduce wastage so that the vaccination drive can be stepped up from the current rate of 90 million vaccinations/ month (i.e. 30 Lakhs/day) up to 200 million vaccinations / month (66 lakhs/day). The model of Kerala, Himachal Pradesh, Mizoram, etc. of zero wastage could be studied and emulated.
The response of the government to the crisis has been swift. It has taken steps to ramp up domestic production and fast-tracked emergency approvals of foreign Covid-19 vaccines which have successfully completed phase 3 trials elsewhere. About 60 lakh doses of Sputnik vaccine are likely to be imported in May by vaccine manufacturers. Production in India is expected to start in June, making Sputnik available for about 30 crore people between June 2021 and March 2022. Capacity of India made COVAXIN, which now has been proved to have a 79 per cent efficacy in the age group of 18-97 years and 100 per cent efficacy against severe COVID, is expected to be ramped up from 1 crore doses per month to 5-6 crore doses per month. Bharat Biotech’s nasal vaccine has also completed its first phase of human clinical trials.
Further, in a landmark initiative, the government has decided to open vaccination for everyone above 18 years from May 1, thereby minimizing the damage to lives and livelihoods. This has been followed up by sanctioning advance funds to vaccine manufacturers to further scale up production and augment capacity.
The government has agreed to partially remove price caps and allow remunerative market pricing of the vaccine for those below 45 years of age. This would provide an incentive to the private sector to produce, build scale and invest in technology. These are laudable measures to address vaccine deficiency and it is hoped that there would be speedy implementation of the measures.
CII has also stepped in to work alongside Government to counter the impact of the second wave of coronavirus. Apart from being engaged in setting up vaccination camps at many locations across the country, a task force has been working closely with NEGVAC (National Expert Group on Vaccination) to supplement and support the Government’s vaccine development and distribution.
Besides, to supplement the Government’s ongoing vaccination efforts, CII has undertaken an initiative on ‘Project Vaccine Nation’. The Project envisages mapping the vaccine requirements of CII Member companies for their employees and their families. Through a nationwide survey, CII requested Member companies to advise their requirements in terms of specific number of doses.
The Government has also permitted industry members to undertake vaccination on their premises provided there are more than 100 beneficiaries and has also placed the spending on this for non-employee beneficiaries under the CSR rules. CII has therefore requested Member companies which wish to expand their vaccination drive to external members of the community to advise their requirements which is being further added to the aggregate.
As on date, CII has received demand from 1062 small, medium and large companies from 170 plus cities across the country for approximately 36 lakhs of single vaccine doses. Of this, companies have identified demand of 36 per cent for employees, 47 per cent for family members of the employees, and 17 per cent is for community outreach efforts.
CII is in touch with the two vaccine manufacturers in the country, Serum Institute of India and Bharat Biotech International Limited, to ascertain the possibility of purchase of vaccine doses as per the requirements mapped through the survey, by healthcare providers in the 170 plus cities.
This vaccination project, largely aimed at the economic agents of the country, would help the enterprises to revert to their usual scale of operations at the earliest so that lives and livelihoods are both preserved.
Apart from vaccination, CII has been actively working with the Government to assist in the evolving situation on oxygen. More than 100 companies have been mobilised to provide augmented oxygen supply for medical use in different parts of the country. Industry has been willingly coming forward to divert the supply of oxygen from industry, for medical use, even at the cost of losing out on manufacturing.
Industry is also making the essential drugs like Remdesivir available wherever possible by connecting hospitals/ State governments to pharma producers.
CII members manufacturing Remdesivir are working towards exceeding the committed target of 78 lakh vials per month to reach a production of 1 crore vials per month. Indian manufacturers are also looking at a Remdesivir pill, which will reduce the need for hospitalisation.
CII has been consistently communicating with members ensuring strict observance of COVID protocols by the business community. Several editions of workplace protocols and guidelines for safety and protection of the workforce have been shared with Members.
In addition, it has also reached out to other stakeholders through multiple social media campaigns including in Hindi and local languages on the SMS and vaccination messages.
CII would continue to remain in constant dialogue with the Government on the action agenda to ensure a strong and adequate response based on scientific and medical advice which would help deal with the second surge of the pandemic.
While CII compliments the government for the host of measures for bringing immediate relief, CII would also recommend a seven-pronged approach on vaccine distribution plan for phase-III to ameliorate the situation.
One, the same methodology may be used in Phase-3 as in earlier phases of the program, via the Central Government distribution channels including for smaller towns and villages. This would make the program more inclusive. The same channels could be used to provide vaccines to non-state entities that are eligible for providing vaccination.
Two, the procurement price of vaccines for central and state governments may be fixed at the same amount. For non- government entities, there could be a differential price as deemed appropriate by the Government.
Three, a predictable and equitable supply for all districts may be prioritized as per a pre-determined formula which could be based on suggestions by experts.
Four, the Central Government’s involvement in distribution of the vaccines to all age groups would make the process equitable and inclusive for all adults as well. This would help States which may not have the fiscal capacity to vaccinate from their side and enable all States to progress on vaccination. The Government may also like to consider vaccination of this age group for weaker sections of society from its own side.
Five, as CoWIN app may not be available to all, walk-in registrations for all adults should be permitted.
Six, a direct approach by various entities to vaccine manufacturers may lead to concentration of supplies with a few vaccinating agencies. The mode of supplying doses through the administration would ensure that all healthcare providers are able to access the vaccines in all parts of the country. All entities, including private healthcare providers, could make their requirements known to the district authorities and collect the doses as allocated.
Seven, the Government may like to put a cap on the administrative fee that a healthcare provider can charge from the beneficiaries per shot of the vaccine. Apart from this, we need to take remedial measures, on an immediate basis, to address the problem of acute shortage of skilled health workers and their inequitable distribution. The priority should be to ramp up the supply of skilled medical personnel which, among others, would be required to treat the health emergency brought on by Covid.
In the medium term, we would need to build research capabilities and capacities to battle COVID as well as build our capacity in terms of hospitals, oxygen, ventilators, medicines, personnel, etc. so that we are not caught off guard next time.
The article first appeared in the April 2021 issue of the CII Economy Matters. Click here to read the issue.
- Chandrajit Banerjee
Director General, CII
Today, the country is faced with a crisis of epic proportions. With several new mutant variants and a resurgence of infections, the second wave of the COVID-19 pandemic continues to spread at a rapid pace, affecting lives, livelihoods and the economy.
With a national healthcare emergency of such magnitude, it is critical to take all possible measures at the earliest to arrest further spread of the crisis. A disaster response strategy with impactful measures in collaboration with all stakeholders can be developed, with a strong focus on saving lives and livelihoods.
The industry can be a powerful player in this strategy in multiple ways. The CII has provided inputs to the government on various dimensions of the response measures, including supply of critical care requirements, vaccinations and strengthening medical manpower resources.
To address the shortage of oxygen availability, we suggest direct vessels be used to import liquid oxygen and unloaded fast for the containers to reach key destinations. Support equipment needs to be imported including ISO containers, cylinders for liquid oxygen, personal oxygen concentrators for home treatment and PSA and VSA containers for hospitals.
Military oxygen generators, which are lightweight, modular and can be used for about 50 bedded hospitals, can also be imported. The industry is being encouraged to use their CSR funds in creating this pool.
For expanding domestic manufacturing, 20 leading manufacturers could be identified and provided support for importing some of the required components to reduce set-up time to about eight weeks. The CII has formed a task force to work with Central and state governments to raise oxygen supply through capacity enhancement and imports.
Tata group, Reliance Industries Ltd, JSW Group, Adani group, ITC Ltd, and Jindal Steel and Power Ltd, amongst others, are helping hospitals with emergency medical supplies. The industry is diverting its industrial oxygen production to manufacture medical oxygen.
The challenge is the lack of appropriate containers to transport the gas, which is a hazardous material. Making transport arrangements for oxygen supplies linking to nearby factories is critical using multi-modal transport.
The requirements of healthcare workers must be ramped up to address the magnitude of the crisis we are faced with. Medical manpower such as retired medical personnel, doctors and nurses may be requested to join in the effort.
Nursing and medical students who have finished GNM/BSC training and are awaiting exams can be roped in. Medical specialists, PG seat aspiring doctors and specialists can be included. NRIs working abroad as doctors and nurses can be encouraged to come back for a national cause for a brief period and also be available for digital consultations.
Vaccination and testing are yet another top priority for the country. The CII recommends the distribution of vaccination supplies to states according to well-defined criteria. As per experts, population size, exposure and vulnerability can be mapped to supply specific required quantities to the states.
There is a need to scale up RT-PCR testing to double the current daily numbers both in urban and rural India. The requirements for testing kits can be met through imports or ramping up domestic manufacturing, including Rapid Antigen Self Testing Kits for use at home.
Also, vacant educational institution premises or other unused areas can be used for creating community testing facilities at scale.
On the logistics and infrastructure front, the CII has suggested the deployment of the Armed Forces and central security personnel for temporary medical facilities, logistics, infrastructure and personnel. The government has now given emergency powers to the Armed Forces for setting up such facilities.
It is important that the healthcare and frontline workers, who have gone beyond the call of duty at great personal risk to take the crisis head on, feel protected. There is a need to strengthen security at hospitals for medical personnel and protect people and property, which can be done by deploying military and paramilitary forces.
A central asset mapping control team should be created for monitoring supply of various essential critical care items as well as predicting possible occurrences of shortages and pre-emptively enhancing states’ capacities. Shortages may be made known to the industry for helping reach resources to the needy geographies as the wave moves across the country.
There is a need to strengthen logistics to reach supplies to the affected districts. Transportation must also be put in place for supplying the required medical drugs and oxygen on a continuous basis to districts where requirements are high, including Railways and road corridors, with minimal state border delays. With all of us working together on a war footing, India is certain to win over the second COVID wave.
The article first appeared in The New Indian Express on 06 May 2021.