The second wave of Covid-19 in India, in its extent and intensity has overwhelmed society, governments and local administrations.
So, India need to be fully prepared for the third wave of the pandemic.
What can be the mitigation steps?
First, the capacity for vaccine production must be ramped up at the earliest and more compliant units should manufacture it.
The government should seek agreements for others rather than going through the compulsory licensing route.
Second, the vaccination policy must change, and all vaccines must be procured by the centre at a reasonable price.
Under the current policy, states and private hospitals are engaged in unhealthy competition leading to inequity as the manufacturers will prefer to sell to highest bidder.
So, an expert group of epidemiologists and virologists should provide a vaccination plan, based on expected availability over the next six months.
They would identify targets, find ways to prevent spread of the virus, increase the vaccination sites and decentralise them.
Third, a massive communication campaign is required for inspiring Covid-appropriate behaviour.
Private advertising concerns can be roped in for this and these messages should be in local languages.
Fourth, a special group must examine how testing capacity can be expanded, and quickly.
This requires additional manufacturing and availability of consumables and other ancillary requirements.
Also, there is a need to augment staff in the testing laboratory infrastructure in district hospitals.
Mobile units can be created for testing in rural and densely populated areas where infection clusters could be developing.
Fifth, disease surveillance at the national level must be monitored by the NCDC so that government take necessary action on a scientific basis.
How to address the oxygen supply requirements?
Oxygen supplies has to be increased and rationalised and all district hospitals must get oxygen plants, with piped supply funded by PM Cares.
The private sector should be encouraged to set up plants wherever they can and a transportation and linkage plan must be made to supply from large producers to large consumers.
Decentralised centres should be opened where people can refill/exchange empty oxygen cylinders, with supply from the concerned local administration.
The demand for cylinders needs to be assessed in all districts and arrangement for supply made as per requirement.
NGOs can be encouraged to provide oxygen concentrators on rent to avoid a mad rush for purchase.
How to address the drugs requirements?
Medical care and treatment protocols must be standardised quickly by an expert group and be well publicised.
This will tackle the problem of often contradictory and confusing recommendations.
There is a rush to get certain drugs which might lead to their injudicious over use.
Also there are instances of black marketing and overcharging are being reported in the media.
A rapid assessment should be made of the requirements of all necessary drugs, what is being done to produce them and ensuring their easy availability in the market.
The Centre should fix prices for all these drugs and treatment protocols and each state could then procure and supply these to the government facilities and ensure availability at village levels.
It is imperative that a national tele-consultation centre be opened with sufficient capacity to cater to large number of requests.
What are the other measures which can contribute to the above steps?
Though a national lockdown is not desirable, but local lockdowns can continue depending upon evolving situations.
Sufficient beds has to be kept ready at all hospitals and each city, town or PHC area should have temporary oxygenated hospitals.
Healthcare manpower-doctors, nurses, other para medical staff- have to be augmented by providing attractive honoraria and other incentives.
Since all these actions are complex and have to be taken simultaneously, a small group with relevant experts should be formed, at both central and state levels.
They will plan, implement, monitor and will also serve as feeders to a larger monitoring group under the cabinet secretary at the Centre and under the chief secretary in states.
At the apex level, periodic consultations between the central and state government leadership to get feedback, fine tune the strategy, and take decisions will provide a push to all the efforts.
Finally, there is a dearth of information and data, hence it is imperative that all data be shared on real-time basis by the Centre, states and districts.
