As a doctor, I have seen life and death from very close quarters. In fact, all doctors do — both in and once out of medical school. But never have I witnessed death at this scale, so much so that every morning, I am now scared of logging in to my social media handles, terrified of discovering who it might be next to succumb to the pandemic.
The Covid-19 pandemic has gripped nations across the world and dominated headlines in all formats of news. The second wave of the pandemic has hit India with a fury more lethal than before. As our nation grapples to contain it, the situation in places like Delhi and Maharashtra is almost spinning out of control.
There is little or no clue as to what went wrong after March 2021. Has there been a letting down of guards en masse? Was the administration caught off guard? Was it complacency? Or was it a case of lack of scientific knowledge? In my opinion, it is a combination of all of these. The jury is still out. The political blame game will continue for some time but we have an emergency at hand. The country must rise above all of it and come together to contain the side-effects of the pandemic. With patients falling like ninepins, we have no other option but to plug a few holes in the system on a priority basis.
Assam has been the torchbearer in Covid-19 management. The state had the lowest death rate (0.28 per cent) and highest recovery rate (98.02 per cent) in India around the end of 2020. The government of the day, riding on prompt and coordinated action by politicians, bureaucrats, doctors and other caregivers, could keep things under control and was also able to keep the morale of the people of the state high.
The tireless efforts of Health Minister Himanta Biswa Sarma in criss-crossing the entire state and putting its health infrastructure on a war footing is a matter probably unseen in the whole country of 1.35 billion people. The seven medical colleges, 27 civil hospitals, innumerable primary healthcare centres (PHCs), and Covid care centres saw a massive capacity building exercise worth acknowledging. By the time the first case of Covid-19 in Assam was detected in Silchar Medical College and Hospital on 31 March 2020, major work was already underway in the state. When the peak was reached in September 2020, Assam had things in control to a reasonable degree.
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Challenges of the second wave
Riding on the experience of the first wave in Assam, we have hit the ground running during the second wave. But things are different this time around. The positivity rate, which was not more than 7 per cent during the peak of the first wave, is already almost 9 per cent. The daily cases have risen to almost 5,000 per day. The day-wise curve of positive cases has drastically increased since 26 April 2021. Though the current recovery rate of 88 per cent is better than most other states in the country, it has to go up further. On 1 May 2021, the total number of Covid-related deaths in Assam was 23, which jumped to 55 within five days, with Kamrup Metropolitan district leading the list. The mortality ratio and case fatality ratio are seemingly higher than what was witnessed during the first wave. Therein lies our problem. The new mutation has changed how the virus behaves and the dangerous ‘AP variant’ and the triple mutant variant is also suspected. So, we have a problem at hand.
The dependence on remdesivir, steroids, antibiotics and plasma therapy has taken a different turn. This time around, oxygen requirements have hit an all-time high. Consequently, the priority has been oxygen production and ensuring its timely provision to the needy. While all the states were planning for this, we had already set up 11 oxygen generation units in Assam; and now, more will follow. Currently, the total oxygen production capacity in the state is 65.77 MT per day, while work continues to increase it by another 80 MT. But despite all efforts, there is a possibility that oxygen requirements will sky-rocket in the coming weeks. It has already gone up threefold in all the medical colleges of Assam in just over a week. We need to act before it is too late. The availability of hospital beds and ventilators also need to be adequate and the health minister and other officials are at it.
The healthcare system in Assam is a mix of both public and private enterprises working in tandem. But the private players operate mostly in places like Guwahati, Silchar, Dibrugarh, and a handful of other areas. The rest of Assam is largely dependent on state facilities. For the last six decades, our spending on healthcare has been minuscule and the capacity building in this sector for its population of over 3 crore has not been as desired. Now is the time to think, plan and act.
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What needs to be prioritised
Today, as we witness the ascendency of the second wave of the pandemic, I presume we have to prioritise saving lives by providing adequate hospital beds, sufficient oxygen and trained workforce. The next priority is to keep the economy moving. Keeping all these factors in mind and charting a path is a real challenge for the state government.
Today, almost 30 teams consisting of 200 doctors are working round-the-clock in the medical colleges of Assam. As we do not know how long the pandemic will continue, we need to protect our workforce — both physically and mentally. We have a limited number of Covid-19 specialists and it is our moral responsibility to prevent them from getting fatigued. It must be remembered that they have been on the job since January 2020, without a break. If the fight against the virus continues for a longer period than expected, we need to proliferate our workforce and train them. From my understanding, the Assam government is already on the job. Based on experiences of other states, we can very well say that the total number of cases in the state might go up to approximately 12,000 per day and a projection of 1,00,000 cases in 10 days at the peak of the curve is something we should brace ourselves for.
The developing situation in Dibrugarh and Barak Valley, along with Kamrup, is a matter of concern. We need to act before things go beyond our control. Knowing the social behaviour of people, they will happily continue to ignore the government directives of Covid-19 protocols. But the entire state, and the nation, will have to pay the price for this.
The newly elected government enjoys the goodwill of the people and strong action at this opportune moment will be highly appreciated. They say “difficult times call for difficult decisions” and this popular, new government is capable of doing so as it has shown in the past. I feel a lockdown in the state, for a substantial amount of time starting in May 2021, before all hell breaks loose, is the best foot forward for us. It gives us time to boost the health infrastructure and break the chain. Till then, proponents of ‘save the economy’ can take a back seat, because if there is no life, there is no economy.
The author is a Lok Sabha MP belonging to the BJP in Assam, and is a doctor by profession. Views are personal.