There is a resemblance between Maharashtra and Italy, not just in the extent of damage the virus has done to both the regions but also in its political repercussions.
Like Italy, where leaders do not complete terms and rarely get re-elected, in Maharashtra too, chief ministers do not last long and rarely complete their five-year terms. Except Devendra Fadnavis, no chief minister in Maharashtra has been able to complete the full term in the last 47 years. This political instability has been instrumental in creating the current crisis and has made Maharashtra one of the worst-hit states with coronavirus disease.
The current government’s inexperience and indecisiveness and the fear of taking bold initiatives aggravated the situation. If the state government had announced a lockdown and social isolation measures before the prime minister announced it, the situation would have been much better.
Urban areas—Most hit
Unlike other states and cities where the government had to face gatherings like Tablighi Jamaat; in Maharashtra, it is the urban areas which have been the most hit and cities are where most of the cases are still concentrated. Although an early lockdown could not have prevented problems arising from poor hygiene and sanitation in rural areas, it could at least have helped control the spread of disease in urban areas. With relaxed norms and bustling shops and markets, the number of cases increased in such a way that the state health minister Rajesh Tope lamented at one point that despite all the measures being taken, the number of cases in the state are not declining.
He said if people don’t listen and continue to use transport unnecessarily, we may have to rethink the containment strategy during Phase-3 of the disease. He also said that crowds of working class people at railway stations, heading back to their home states, was a cause of worry. To resolve this, he suggested an increase in the number of outstation trains for those who wanted to go back to their native places.
However, nothing has helped slow down the spread. The government, meanwhile, has announced more and more measures to curb the spread. Among these was medical insurance cover of up to Rs 1.5 lakh under Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY). The MJPJAY is a state-run insurance scheme that covers 2.25 crore families and provides medical cover of Rs 1.5 lakh. Tope said about 25 lakh more families are now included under the insurance scheme in addition to 2.25 crore. In addition, Tata Trusts announced the upgradation of two government hospitals into treatment centres for the disease. The state has also set up an 18-member task force to plan and suggest treatment of asymptomatic and mildly symptomatic patients through Ayush drugs and concoctions.
Ramping up facilities
Among the initiatives taken by the state post the announcement of the lockdown, the department of public health ordered the closure of all educational institutions, cinema halls, hostels etc. and all exams were deferred. The state government constituted a high-level committee to formulate guidelines for mitigating the spread of COVID-19 in the state.
The responsibilities of the committee included taking a daily review of the status of COVID-19 in the state and implementing the guidelines issued by the WHO and the ministry of health. Screening for people affected by the disease in hospitals has also been implemented. A state-wide lockdown was enforced from March 23, involving the closure of state borders, suspension of public transport services and banning the congregation of more than five people at any public place. Only the supply of essential goods and services were permitted.
What has worked in favour of Maharashtra till date is the lower death rate and good recovery seen in cities like Pune.
On the current status of the state’s healthcare infrastructure, Dr Shivkumar Utture, President, Maharashtra Medical Council said: “The two months of lockdown has allowed us to ramp up healthcare facilities and healthcare forces in Maharashtra, especially Mumbai. From not having a single dedicated facility for corona patients, today, we have more than 40,000 beds dedicated to patients afflicted by corona in Mumbai alone. A similar build-up of facilities is taking place all over Maharashtra. Unfortunately, the numbers are increasing day by day and the whole healthcare sector is overwhelmed by the sheer weight of COVID-19 patients. It is becoming a Herculean task to keep up with the demands of the health sector in spite of the fast-paced ramping up of facilities. We are also facing problems on the testing facility front. In spite of increasing the number of tests from zero to almost more than 1 lakh tests per day in India and increasing the testing laboratories to more than 70 in the state of Maharashtra, we seem to be still lagging behind in the number of tests required to be done in comparison to the population figures. We are forced to do only focussed testing due to lack of testing kits and facilities and this seems to hinder our fighting capacity. The gold standard is testing, contact tracing and isolation if we expect to fight this menace, given that we are nowhere in our search for a scientifically proven treatment protocol or a vaccine.”
With no cure or vaccine, the only light at the end of the tunnel was plasma therapy. However, a clinical trial of Maharashtra’s first novel coronavirus patient resulted in death, unlike improvements seen in patients of other states. In spite of this, ICMR has approved 5 hospitals in the state to carry on with the trials.
A war-weary frontline
Commenting on the challenges faced by frontline workers, Dr Utture — who was the executive commissioner of Maharashtra Medical Council from 2012 to 2017 and has been the president of IMA Mumbai Branch — said “There is fatigue setting in among our frontline workers after having been continuously on duty for the past two months. The whole brunt till date has been borne by government facilities and now we require to rope in the private sector health staff and infrastructure to augment our resources. Day by day, the number of health workers being infected is on the rise due to improper protection (PPE), overwork and deteriorating nutritional supplements due to the lockdown. The loss of this working force is increasing the load on the already overstretched healthcare force, thus depleting the numbers on the frontline. Their numbers require to be urgently augmented and proper protocols for work environment and facilities require to be diligently followed to save these frontline warriors as this is going to be a long-drawn battle. The number of cases increasing was an anticipated phenomenon epidemiologically. These numbers are increasing mainly in urban areas like Mumbai, Pune, Nagpur etc. The reason behind this is overcrowding, slum pockets and unhealthy sanitation facilities. It is practically impossible in overcrowded slums to maintain social distancing and home quarantine due to lack of space and infrastructure.”
Rural migration—A ticking time bomb
Dr Utture, who is a member of National Medical Commission, also warned that citizens are not following the advice given by the government with regard to staying indoors. “We find a lot of crowding and movement, especially in market areas. This situation is going to worsen due to the partial lifting of the lockdown and [because] a huge number of people are moving out of the cities to their native place and hometowns, both towards the interior of Maharashtra and across state borders. This may potentially act like a ticking time bomb as this mass of bodies moving out of the cities will probably shift the epicentre from the cities to small towns and villages where unfortunately we do not have the health infrastructure to manage this menace. We may be looking at an exponential rise in the number of cases in the near future,” he added.
Despite all the measures, the number of cases is seeing a continuous increase in the state. If the lockdown is relaxed and people are allowed to resume their services, there will be even more cases and deaths. Unlike earlier, testing facilities in the state have improved, but with the relaxation of norms — such as giving permission to liquor shops to open — the state may have to face a far worse condition than what it has faced till date.
Giving advice on the post lockdown strategy, Dr Utture, M S. FICS(USA) who is also an Honorary Surgeon at Fortis (Raheja) and Shushrusha Hospital, Retd. Surgeon at St. Georges Hospital and Retd Professor of Surgery at Grant Medical College J.J. Hospital, said: “Changes in lifestyle is the mantra for our future battle. We are going to see a sea of change in our daily routine and work ethos as we shift from the Pre-Corona era to the Post-Corona era. Continuation of avoidance of crowded places and the maintenance of social distancing, regular washing of hands with soap and water and an increase in the usage of sanitisers, the compulsory wearing of masks in public places etc is needed.”
He further said the government spending on healthcare should increase to put in place a robust public healthcare system which can overcome such a public healthcare catastrophe in the future.
“An Increase in facilities — so that patients can be tested, isolated and treated in a seamless manner, the implementation of staggered timings for workplaces to avoid routine rush hour crowd seen in urban areas, implementation of the concept of work from home in those sectors where it can be implemented, protection of vulnerable sections like our elderly, children and those with comorbid conditions — who are most susceptible to be infected, instilling the concept of natural food, increase in outdoor activities and daily exercise routines and the maintenance of proper public sanitation and a clean environment to increase our immunity can help combat the disease,” he adds.